Is it customary where you work to recheck BPs manually?

Extra Pickles · Apr 27, 2017

I think my surprise in reading through this thread is the dependence that seems to be growing on the automated BP machines. If they are more accurate most of the time and most of the time are available, then that's a good thing. But I'm a little concerned about scenarios like someone described in which a senior nursing student only a few weeks from graduation doesn't know how to use a manual cuff. I thought that was a pretty basic skill check from first semester, and I thought everywhere? Maybe not, or maybe not anymore.

I'm not against technology, it just makes sense to me that if an automated reading looks strange to me for some reason I should get a manual reading. In fact, in school, it was drilled into our heads to NOT rely on the "nurse on wheels" and to always check the BP ourselves. They wanted us to use the machines only as a last resort, really. I see nothing wrong with using it initially now, but I'm glad I know how to take one manually if a machine isn't available.

I'm also now thinking of the number of times I've needed to do a manual check on someone and the machine just wasn't an option at all. Glad my school made sure I knew how to do it!

blackribbon · Apr 27, 2017

If we get an abnormal BP that isn't expected, the NA calls us and takes another one 30 minutes later (assuming we aren't talking about critical levels). If they are critically high, then I grab my personal manual cuff and go check myself. If I see that the wrong size cuff was used or suspect that the NA did it over clothing or in an odd place, I may use the electronic. Most times, I will just do a manual...the reason isn't that it is more accurate but rather that I want to do the recheck personally AND I want verification that electronic measurement was accurate (a similar reading verifies this). I started this habit because the first thing the doctors used to ask me was to take a manual reading to verify the electronic reading. Remember, the automatic cuffs can get very tight and painful and drive the BP higher r/t to pain - especially if it keeps refilling and trying over and over. I have been challenged because my manual cuff hasn't been calibrated by the hospital but I am not making a medical decision based on it alone but rather a combination of the electronic reading and my manual...my manual is the backup reading. We do have a rolling manual on the floor but it is always hard to find. If I need an "official" manual reading, I can hunt that one down but honestly, a manual cuff isn't that complicated and all external readings (electronic or manual) are more general estimates and not exact measurement. (Manual readings change as the hearing range of the nurses change...electronic ones change based on the location of the cuff to the artery being read)

BSN16 · Apr 27, 2017

I will switch arms but i almost never take a manual

Irish_Mist, BSN, RN · Apr 27, 2017

If you take a BP on a patient and it's out of normal range (either abnormally high or low, but usually high) on the machine, is it customary to recheck it manually? What if the high pressures are driving treatment and medication decisions?
I'm trying to figure out what the practice is elsewhere.

I always take a manual reading if I or a PCT gets a serious out of range one. I had a patient who could only get readings on her right leg. After the PCT told me her BP qas 190/100, I took a manual and it 130/80. Imagine if I had jumped the gun and given her Hydralazine ( a potent vasodilator) when I really didn't need to?

TeeDotNurse · Apr 27, 2017

I would imagine the student not knowing falls on the school. We had to learn and check off doing manual BP's. We had to use a very hard to hear dual stethoscope with the instructor and our reading had to be within 2 points of what the instructor had, we had to do it on 3 people to get checked off.

Us as well! We didnt get past first semester without this. We use manual for all our isolation pt's as well as if we cant get the reading with the automatic- usualy if it is too low. But for an abnormal reading I just wait a few mins, recheck on same arm, then on other arm.

TeeDotNurse · Apr 27, 2017

I should add that was 2 years ago so I guess it could change now? But hopefully not. Its a good skill to have. For community/home nursing also

NurseLife88, ADN, RN · Apr 27, 2017

^^ This.
I work with an older adult population who also use a lot of psychiatric medications and, in certain times, ECT (the after effects). If I'm not feeling right about an automatic reading I'll take it manually but for the most part, the machines are often on par with my manual reading.It did spook me with one recent student encounter. I asked a student to take a BP before med administration and received the comment, "all the machines are being used." I stated, "well, please take it manually then" and handed him the cuff and stethoscope. He wouldn't do it; finally, after his instructor observed the interaction and told him to do it he stated that he "never really learned because he didn't really have to."
He is graduating in 3 weeks.

I can't imagine having graduated nursing school and never learning to manually take a BP. We had to test out on this before we ever even entered the actual nursing portion of my program. We used a dual stethoscope and had to be within a five point range of the instructors reading. I dont think that this basic knowledge should be swept aside in favor of machinery. How nice it is to have automatic BP cuffs and machines but realistically these are not always available and certainly not an option all the time. I myself would not be comfortable if I could not even get my own set of VS manually.

mmc51264, BSN, MSN, RN · Apr 27, 2017

We have different machines that are not always accurate. I always take a manual BP before I call a doctor. That's the first thing they ask, What is scary are the nurses that don't seem to know how to take a manual pressure. There are also proper ways if you have to take in alternative sites

kevler · Apr 29, 2017

why not get another automatic machine? I'd be assessing the patient if they have any symptoms associated, and be looking their rhythm (I work in Cath lab procedure settings,). We usually follow artline blood pressure and confirm with cuff automatic. We usually have to intervene quickly the readings and how the patient looks. Ain't nobody got time for manual in that settings

Elfriede · Apr 29, 2017

The "ERR" of the machines is a good theme for a homework.

- Pulsresult vs. Parkinson vs. sclerosis

- Velcro: How old is too old

- Hygiene vs. warranty: How exakt are the produktinformations

PANYNP · Apr 29, 2017

Where I get my outpatient care, all pressures are manual. However, working in the hospital 7 years all pressures were with a machine or an arterial line. Maybe manual in a case of 'we can't get a cuff pressure.' Machines are very reliable and if we trust them in the ICU to make treatment decisions, then we should every where else. The more important thing, I think, is that for outpatient measures the patient's pressure is checked after a few minutes of rest with their arm in the proper position. In the hospital one blood pressure generally doesn't drive a lot of decisions, it is more what the pressures are over the day except in more abnormal circumstance, for example your patient's pressure is 190/100 and it is repeated twice with similar results and the physician decides to give a little hydralazine or labetalol. I truly believe machines are more reliable than people in most cases and we need to trust the tools we use to make decisions.

Machines are reliable as long as they are calibrated. Need to know how often biomed engineering comes around to check all devices on which we base patient management decisions, i.e. drips etc.

Penholder · Apr 29, 2017

All the time. I work in LTC. Our machines, at least as I have seen, are poorly calibrated. We have be up to 30 points off on a SBP. For meds, all are done manually.

And I'm only one year out of nursing school, but was a CNA for ages.