Help!!! I cannot take a manual blood pressure for the life of me...

[erin11408]

I know this sounds ridiculous, but in nursing school I was able to take manual blood pressures on the dummies at school. Now that I am working on the Cardiac floor...I have to take A LOT of manual blood pressures because a lot of my patients are Hyper and Hypo tensive and the machines will not pick the readings up. I feel like such an idiot but does anyone have any tips? After Im off orientation I dont want to have to go get other nurses to do a manual on my patients!!! My problem is I just cant hear anything at all really...

Thank You!!!

[twentytenRN]

Have you thought about changing your stethoscope? If you're working on a cardiac floor, some patients may have very weak/thready pulses and this will be difficult to hear with a cheap stethoscope. Other advice would be to see if you can palpate the brachial artery prior to taking the BP. Sometimes you need to hyperextend the arm a bit, some people's vessels are deep within their tissue and this helps to may the pulse more audible/palpable. Hyperextend the arm, place the head of your stethoscope at the interior lateral aspect of the arm just above the crease and that's usually the best place to hear it.

[NursMaddy]

This was something I had trouble with at first too. The automatic machines have an especially hard time with A. Fib (at least where I work) - so I got a lot of practice.

Go home & practice on family/friends. Get a good stethoscope. Use the right size cuff. Make sure you're lining up the cuff over the artery correctly.

I also noticed that not only could I hear it when I was taking blood pressure, but I could see the difference on the manometer gauge - slightly bumping up with each heartbeat. (I hope that makes sense)

[CloudySue]

I started hearing things better after I moved the bell a bit lower down the arm than what I was taught, like in the crook of the arm, or even a bit lower. And I press down hard on either side of the bell with two fingers. The ear pieces really have to make a good seal, too, and sometimes if I tilt my head back the rubber hits my ear canals just right and I can instantly hear better. Sort of hard to explain but you just have to experiment. I do agree with getting a quality stethoscope. I have a medium quality, but it's so much better than the Fisher Price pieces of tin they have at my SNF!

[RedhairedNurse, BSN, RN]

Get a new stethoscope.

[anticoagulationurse]

I had a doc show me once that I was pressing too hard with the bell of the steth when auscultating. He said to just gently lay the bell on the most medial part of the antecubital. He said that pressing too hard can change or obstruct the sounds.

Also, you may want to consider a cardiology stethoscope or even an artificially amplified one!

[MeganS]

All the advice you received is excellent. I had some difficulty hearing hert sounds. I finally researched amplified stethoscopes. Littmann has an electronic stethoscope that has ambient noise reduction. Not only is it light weight but you can increase or decrease the volume. It works great but it is expensive. They did have a free d loaner stethoscope program to enable buyers to play with the unit and determine if it is a good fit. I don't know if the program is still available.

[Do_Good]

One other thing is I've seen many nurses putting the ear pieces in their ears the wrong direction. The earpieces should be pointing forward.

Check out this link at 3M Littman - Use of sthethoscopes.

http://solutions.3m.com/wps/portal/3M/en_US/Littmann/stethoscope/products/stethoscope/

[ghillbert, MSN, NP]

You can do a palpable systolic pressure by holding the brachial or radial artery and noticing when the pulse comes back. Then you know where to listen for it. Really it's just practice though. Get a cuff and manometer and stethoscope and torment your family until you get it. BP is one of those things I remember being scared of not hearing in school.. but after a while you wonder how you thought it was difficult.

[brownbook]

All good advice. Also all stethoscopes come with long tubing. No reason for it, obviously the shorter the tubing the easier to hear. But too short and you might as well put your ear on the patient. Cut the tubing, around 12 inches is a good length. Don't cut the fancy expensive stethoscopes, they may have something odd within their tubing, but if you buy regular or even cheap stethoscopes, shorten the tubing. (And when you lose it, and you will, you won't be so annoyed that you lost a $150.00 stethoscope!)

[Shirt]

I never place the bell off to the side of the ante cubital (toward the midline) I never have an issue

Check out a good littman stethoscope.