Auto blood pressures?

Nurses General Nursing

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Are they really accurate? I had a pt. on a lower dose of minoxidil for hypertension. Lower dose is d/t renal failure...blood pressures monitored closely and meds held if systolic BP under 130. CNA couldnt get reading from blood pressure machine but did a manual and got 132 something...we were told to use pediatric BP (very tiny elderly lady)...i went in to double check, i tried auto as well, with pediatric BP which did NOT!!!! at all fit, way too small. She was tiny, but not that tiny. I took manual BP and got 133, about the same. i gave the meds. I was just curious as to why auto wasnt working...i tried a regular sized cuff right after, and it worked. the regular size cuff read "122" as systolic.

How accurate are those?? i mean it was a little big for her, but she is in the range of a regular size...but like i said, even though doc says to use pediatric BP cuff, it just does not fit!!!

Also, im a first year nurse...i nearly crapped my pants when i saw that BP was 122, because thas less than 130!...i KNOW i got 133, but i questioned my self because of what auto says.

she has been hypotensive the past several days.....so as a new nurse i am second guessing myself, and just worried!!!!!!!

Comments??? Anyone know really the accuracy of these things?? was i wrong to go against doctors orders and use regular size if it does not fit?? was i wrong to still give the med?? (even though Manual, was 130 but order was to check BP with auto bp pediatric cuff)???

LIke i said, i am a new nurse....i get nervous asking more experienced nurses questions like that.

*Jade*

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I dont trust them! I always take a manual pressure when possible through experience I have seen that they dont work by taking them both ways and sometimes the difference is signifigant. When you are working it is on your own license when you feel the need do it the old fashioned way it takes a couple of seconds longer but you will feel more secure. Never use a cuff that is too small it makes the reading too high trust your instincts they seem good.

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Well in nursing school, every hospital iw ent to uses Auto...so i havent done manual aton, obviously i know how to do them...but after seeing that, i second guessed myself.....like im running through my head "Am i sure i heard the first beat?? did i read the numbers right??am i really sure it was 133? did i use the right size manual cuff??"

Do autos tend to read higher or lower?? it was a tiny bit big, because she is the size where she would be too big for a pediatric, but just barley fits into a medium....

ah!!! i dont want her to be all hypotensive again!!!!

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Thankyou!!! really,

i guess i tend to do EXACTLY what the doctors say...i am always like NO! my licesnse is at stake. i just got it, and i dont want to loose it. i also dont want to call the doctor with a stupid question like "Jane Does blood pressure cuff is too small. Are you ok if i use a bigger one?"

i mean come on (haha)....so i'm just in the phase where i get super nervous if i have to do something other than waht the doctor says. Obviously i know its wrong to use a BP cuff that doesnt fit...but i really need to ask, if he used the pediatric himself? or if he just guessed?

I've also never seen orders as to what size to use....usually its just whatever fits. that kind of threw me off.

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You do not need a dr's order to take a blood pressure it is within your scope of practice and part of nursing is using nursing judgement you know damn well the pediatric cuff is too small...it is like when you have a larger patient you get a large cuff...you can try the regular but in the end you know you need a bigger cuff so you get it. machines can read high or low depending on the machine. Practice taking blood pressures the only way to get great at it is to practice practice practice that is what we did in our program and look at the meter you will see the needle bounce back and you will know you have it. A slighly big cuff is more accurate than a small one especially if you are trying to keep from putting someones pressure too low.

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Specializes in Critical Care.

Actual studies support NIBP's higher accuracy than manual in most cases.

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when I say damn well I mean it in a good way lol your judgement is good trust it!

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Machines are considered more accurate only because not all people can hear the tones and not subject to human error.well I know a nurse who always gets super high bp's on her patients but the reality is she just cant hear the lower level tones lol. In that sense yes statistically a machine is more accurate but compared with someone who is really good at taking pressures and can hear soft tones well and is at the proper level with the gauge then the person is more reliable.

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Specializes in Med/Surg, LTAC, Critical Care.

Sometimes they're more accurate and sometimes they ain't. Depends largely on the machine. Cuff size and patient behavior matters too (tossing and turning etc).

When the machine gets a weird reading I always check a manual.

Just last weekend I had 2 pts that the machine just refused to give me a decent reading. One 1 guy the machine read too high, on the other lady, the machine read too low. Checking each manually, I was able to get much better readings (about 10-20 points better) on each. I also have really good ears too so.....

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Specializes in Addictions, Acute Psychiatry.
Actual studies support NIBP's higher accuracy than manual in most cases.

In the ICU, they were pretty close to the arterial lines (never spot on because of live reading and tissue) but they were pretty good.

Make sure you've got it on tight enough and it's way up the arm far as it goes. Get any elbow and it's flawed. I do the doctors orders and anything else I do under my own license. If a doc prescribes a sliding scale med, I need to get the reading. If it's a regular med and it comes with any precautions, I need to get the readings.

After a while you'll get the hang of it and become a pro so fast you'll say "Remember when..."

If the velcro fits, it's OK; if the velcro is all the way and it's loose, get the medium one if they've got one. be careful asking the doc too much (their time is crunched and they don't like "unimportant" practice questions. Ask a senior worker or preceptor or manager but don't use the doc's time if you don't have to. They'll love you for it!

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Specializes in Cardiac Telemetry, ED.
Actual studies support NIBP's higher accuracy than manual in most cases.

Except with A Fib. There is frequently a difference of as much as 10mmHg. This has something to do with the irregularity of the pulse and the way the auto cuff detects it....

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Specializes in EMS, ER, GI, PCU/Telemetry.

if i get a very high reading on the electronic BP, i always recheck it manually.

you'd be surprised of the difference in readings sometimes.

alot of times the machine will pick up background noise, esp if like the TV controller is near it or the patient's visitors are talking... and it makes the reading alot higher than it would be.

same thing for low readings, just a little difference in cuff positioning or cuff size can make a big difference!

always get out your ears when in doubt.

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