I used to work with a doc who would walk over to hypotensive patients and feel their pulse, then come back to me insisting that the BP reading wasn't correct, they had a strong pulse, and by feeling the pulse he know the systolic was over 100. I could get the same number automatically, and manually on both arms, and he'd still insist it was wrong...but would never take a BP himself.
Automatic. For patients in the ICU, many have art lines, so the two results are compared. Normally they match up very closely.
I do manual if there is no correlation, and my art line has a poor waveform. Also, it seems that the automatic cuffs do a poor job taking BPs on patients with abnormally low pressures, so manuals are done then, but overall it's pretty rare that we do manual blood pressures.
I trust my ear alot more than the machine. The machine is good if they are available, but my experience has been that the machine can give false readings, high or low. If in doubt I always recheck manually.
See I am the complete opposite I trust the machine more than my ear. My hearing is pretty bad.............Plus manually I can never get an exact number its always around 120/80 or around something or other......
Machines. I like doing it manually, partly because the machine can take forever! But the machine has a thermometer, probe cover, pulse ox, different sized cuffs, and it's on wheels... so it evens out. :)
At my clinical site, we do both. We have two dynamaps on the floor but of course in the morning the PCA's and us nursing students are fighting for them in the morning, so if I cannot get to one, I'll just do it manually. There is a sphygmomanometer at each bed side.
It's also important, as well as having the right size, to have any equipment wrapped as tightly arounf the arm as possible.
An MA had loosely wrapped a cuff loosely around my arm before my doctor saw me for a routine check-up, and insisted that I sit on the examining table while it was done, "so the equipment is at heart level". I had never heard of the heart level point, and shared that, along with my background as a R.N. with 40 years of experience taking blood pressures with the equipment that is to be read below, above, and across the room (a narrow one) from the patient.
I was comfortable identifying myself, wasn't hostile at all, just helping out. My reading was higher than it had ever been - 180/100!!!! (usually 130/80)
So, as the MA went to write that down, I suggested in my calm, fun teacher kind of voice, "Let's try it one more time with me sitting on a regular chair here, and the cuff a little more snug". Not condescending in any way.
Well, you might have thought I'd asked the impossible! She huffed and said "It's not going to be a correct reading.....". I asked that she indulge an old nurse. You guessed it - that second reading was 135/80.
Thinking about how dangerous it could be to have someone with 3 weeks of education and a massive chip on her shoulder performing BPs on already compromised patients, I shared my opinion of her skill with my PCP when she finally arrived (the wait was twice as long as usual - about 40 minutes).
The next time I came in, for a pap smear, I waited an hour in the reception area, and was placed in a dimly lit treatment room where the same MA insisted that I sit on the examining table, but I refused and she took the BP with me sitting in a chair, and the reading was WNL. I was instructed to get into the paper "gown" and disrobe, which I did, but when I looked at the examining table, the part that my perineum would have been in close contact with, was slimy! I couldn't find a light switch to turn up the light, but I took the paper off, found disinfectant under the sink and thoroughly cleansed and then dried the examining table. Suspecting that the 3rd longer than usual wait was intentional, my patience wasn't the best and this time I'd waited an hour before getting into a room, then 45 minutes more before my sweet, formerly understanding doctor came in raging about how late I'd been for my appointment. There was no convincing her that I'd been on time, and I told her how long I'd waited so far.
She actually said, "If I have to make a choice between a patient who's late, phobic of white coats and examining tables; and my MA, it will be the MA!"
Needless to say, that was the last time I saw her. I mentioned all this to emphasize that you can have the right equipment with which to take BPs, but in the end a correct reading will result if the atmosphere is calm, the worker well prepared and the patient's well being considered.
I did report the dirty table and the wrong attitude with less than optimal skills/education to the administrators of the clinic, but the same personnel are still there. It's like anything that's wrong. It may start with less than the best equipment and fewer checks of it than is necessary, but that can lead to the presence of more infractions. Thorough monitoring is essential to the smooth running of any health care setting.
canoehead, BSN, RN
6,909 Posts
I used to work with a doc who would walk over to hypotensive patients and feel their pulse, then come back to me insisting that the BP reading wasn't correct, they had a strong pulse, and by feeling the pulse he know the systolic was over 100. I could get the same number automatically, and manually on both arms, and he'd still insist it was wrong...but would never take a BP himself.