How to take blood pressure

Compassion_x · Nov 16, 2013

You wrap the cuff around the patients upper arm above the elbow with the artery line about over the brachial artery. You place the diaphragm of your stethoscope on the artery, which is general where the elbow bends. Turn the dial on the bulb all the way right, then inflate the cuff. When it is inflated to around 160-180, turn the knob left slowly to let the air out slowly. When you begin to hear the heart sound, that is the systolic, then keep going and the last sound is diastolic.

guest123 · Nov 16, 2013

in addition to ^^^, you need to be accustomed to counting backwards accurately/quickly, also, each little "tick mark" is 2.

so, 0 2 4 6 8 10.... etc. etc. etc.

so your readings for a manual b/p reading will always be an even number, if you report a manual b/p with an odd number.... people are going to look-- and laugh.. your instructor may scold you. (for the electric v/s machines, any number, even or odd, may be in the results)

BTW- ONLY USE SOUNDS YOU HEAR TO MEASURE B/P, DO N O T WATCH THE NEEDLE FOR BOUNCING TO MEASURE B/P! its not accurate, don't let anybody tell you otherwise. the needle can bounce due to small movements.

in adults, the normal ranges are as such (but ranges may differ from school-school/facility-facility ask your instructor/supervisor):

(systolic "top" number- first heart sound you hear) 100-140

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(diastolic "bottom" number- very last sound you hear) 60-90

an optimal b/p reading for an adult would be 120/80

if you are having difficulty obtaining readings because (even though you heard the sounds) you were trying to find where you heard the heart sound (if that makes ANY sense.. LOL)

just go slow. count backwards in your head by 2's.

not too slow that your patients/classmates arm feels like its going to fall off, just slow enough to count in your head backwards in time with where the needle is dropping

EXAMPLE- 200 198 196 194 192 190..

(my instructor has us inflate the cuff to 200 for an adult)

THIS MAKES TAKING B/P A BREEZE!

(I used to dread it, but now I am very confident and accurate)

A good tool to use is what's called a "training stethoscope". ask your instructor if your school owns one.

Good luck hon!

-Valerie Elise Rapp, SVN

(6mos in, 6mos to go!)

wirehead · Nov 16, 2013

Compassion got it right for the most part, however, I would inflate the cuff to 200 before I deflate, and do not use your thumb on the stethoscope while listening for the sounds, there is a pulse in your thumb and can cause an incorrect reading.

akulahawkRN, ADN, RN, EMT-P · Nov 16, 2013

If I'm taking a manual pulse, I would add a step in there... which is to actually locate the brachial artery by palpation, and then follow it toward the AC fossa. Just after it crosses the crease in the elbow, that's where you're going to want to center the stethoscope diaphragm.

I'm very practiced at doing manual BP's, and I can be as fast, or usually much faster than any NIBP autocuff I've ever seen. Autocuffs do have an advantage in that they can take a pulse as it measures the BP... they "feel" the pulses and counts them while measuring the BP, where I would have to do separate tasks of measuring BP and pulse separately if doing vitals manually.

Honestly, the hardest part about taking a manual BP is learning what those Korotkoff sounds actually sound like so that you can pick it up in less than ideal conditions.

I use a slightly different method to take manual BP's that helps me be fast and accurate, but you really just have to concentrate on learning the sounds and matching them up to what you see on the gauge face. Don't worry about being fast... just be accurate. Work on proficiency and the speed will come naturally.

Compassion_x · Nov 16, 2013

Inflating pressure really depends on the patient. If they're hypertensive and can handle 200, absolutely. If they run systolics around 120 usually, I won't. If they're little old people on anticoagulants, 200 is a bad idea. Don't squeeze their arm off and leave petechia.

So I don't disagree, it's really a nursing judgement call based on the patient.

wirehead · Nov 16, 2013

Agreed, it is a judgement call, and as an RN, we can assess the overall picture of the patient. Medical assistants and even LPN's (who often technically assess) but can't actually assess, are better off inflating at the very least to 180mmHg. Often those patients on blood thinners are hypertensive patients to begin with, and this is where the overall picture matters the most. If you hear sounds at 180 right away chances are the the pressure is higher, and you need to take that into consideration. It's also a good idea to ask the patient what their usual blood pressure is and than you can pump 20mmHg beyond that. Most patients can tolerate being pumped up to 200mmHg in my experience. I also read a study that inferior quality stethoscopes can actually be off by 20 points or more, which is why I can't stress enough to get the best stethoscope you can afford, there is a difference!!

rubato, ASN, RN · Nov 16, 2013

My systolic is usually 80-90, so going up to 200 on me would be a bad idea. I don't think I'd go up that high on someone unless I knew that they ran high usually.

allnurses Guide · Nov 16, 2013

Beware the ausculatory gap.

And I would never trust what someone's "normal" is or what another nurse measured the shift before.

wirehead · Nov 16, 2013

Beware the ausculatory gap.
And I would never trust what someone's "normal" is or what another nurse measured the shift before.

I am aware of your points. I think patients in this day and age know what their normal blood pressure reading is, and it's important to ask them. If they don't, as an RN that's an important teaching moment especially if they have a heart condition or are diabetic.

For most people, I still think inflating from 180-200 will be the correct number, and in addressing the ausculatory gap, we should be palpating the radial pulse as well, but how many times do you see that done? I think the original post wanted general guidelines on how to take a BP reading, as they practice and the pieces fall together throughout their training in LPN school, they will better understand the bigger picture behind the importance of measuring the BP correctly and accurately.

All in all, what a good discussion, everyone has made excellent contributions.

akulahawkRN, ADN, RN, EMT-P · Nov 17, 2013

I don't take manual BP's the way we're taught in school. One of the things I do differently is that I actually palpate the brachial pulse near the AC fossa, not the radial pulse, during inflation. I do this for 2 reasons: one is to determine how high to inflate the cuff for each individual patient, and the other is to allow me to locate the brachial artery so I know exactly where it is so I precisely place the stethoscope head instead of guessing where to put it.

If your SBP tops out at, say, 124, I'm going to feel that change pretty quickly and end up only inflating the cuff to about 140. If your SBP happens to be 224, I'm going to note that and stop inflating at around 234-240 and start listening... and I'll only have to do this once. A machine or person that inflates to a single set amount will have to perhaps do it again and again until an accurate reading is accomplished. I figure that if I'm going to make someone uncomfortable (because some people do find BP measurement very much so), I might as well only do it once!

vgny914 · Dec 2, 2013

Thank you all for the great advice. I'd like to practice taking blood pressure outside the classroom. Does anyone know a good brand for stethoscopes? I know Littmanns are good but they are a little outside my price range.