Forearm bloodpressure

[Awesomepossum]

So this week I had a patient who I needed to do a forearm blood pressure on and I just couldn't hear a thing with the manual cuff. I've practiced and practiced on other people and I just can't get the hang of it. Upper arm (normal blood pressure) I'm much more confidant with. I know not being able to just do it perfectly makes me look like a bumbling fool so any tips or tricks? I've asked my lab professor and he said it's a very hard skill and he couldn't tutor me on "It's more than just listening hon" So...any tips and tricks? I'm practicing on whoever I can get my paws on but I need something to boost my game as it were as right now I'm stuck.

[MunoRN, RN]

It can be difficult to get the diaphragm of a stethoscope to contact the forearm/wrist area correctly. You can try the bell of your stethoscope or a pediatric stethoscope if there's one available.

Remember to document the site since a forearm BP tends to run higher than an upper arm.

[Awesomepossum]

It can be difficult to get the diaphragm of a stethoscope to contact the forearm/wrist area correctly. You can try the bell of your stethoscope or a pediatric stethoscope if there's one available.

Remember to document the site since a forearm BP tends to run higher than an upper arm.

I did have a very hard time trying to get the stethoscope to lie flat. Where i could feel her pulse was right there on the edge by the thumb. Does it work better to listen a little further up on the arm where it's flatter?

[That Guy, BSN, RN, EMT-B]

This is where a good stethoscope comes in handy. The proper seal in your ears and a quiet environment are very beneficial. I had to do a few this past day on a pt and everyone kept trying to talk to me and the sounds are very feint to begin with. I can listen on the wrist, closer to the radial more than not as I can get the best sounds from there.

[MunoRN, RN]

I did have a very hard time trying to get the stethoscope to lie flat. Where i could feel her pulse was right there on the edge by the thumb. Does it work better to listen a little further up on the arm where it's flatter?

The Radial artery is deeper further up the arm so it's harder to hear. There is sometimes an area that is proximal enough to the wrist enough to get the diaphragm to lie flat, yet still close enough to the wrist to hear. The bell of the stethoscope is acceptable to use and has been shown to be just as accurate as the diaphragm; some resources even say the bell is preferable for listening to Korotkoff sounds since they are a lower frequency tone.

[GHGoonette, BSN, RN]

Do they insist that you have to listen? Back in the days before Dynamaps, if I found it was difficult to hear the pulse, I used to palpate it instead, and I found I could get a fairly accurate reading.

[MunoRN, RN]

Do they insist that you have to listen? Back in the days before Dynamaps, if I found it was difficult to hear the pulse, I used to palpate it instead, and I found I could get a fairly accurate reading.

How did you get the diastolic?

[GHGoonette, BSN, RN]

Same principle applies as when you listen-you should feel the pulse strongly at first, then it gradually returns to normal. When you feel it fading, you take your diastolic reading.

It might be argued that it's not as accurate, but when you want to get an idea of the range, and there's no other way....

Try it when you next do a BP, and double check your reading with the stethoscope.

[That Guy, BSN, RN, EMT-B]

We never chart the diastolic when doing a palpation method. It is always recorded as blank over palp so that you know how it was read