Is it customary where you work to recheck BPs manually?

offlabel · Apr 25, 2017

I don't know if it's policy anywhere, but it is common sense to recheck it on the same arm, different arm, etc. I don't see a manual cuff being any more accurate than an automatic one as they're probably far more accurate over time.

If the idea was to confirm measurement with a manual cuff, why bother with automatic at all? Normal readings could be in error as easily as abnormal ones.

klone, MSN, RN · Apr 25, 2017

I guess because a normal reading isn't going to result in a potentially serious intervention.

Here.I.Stand, BSN, RN · Apr 25, 2017

We don't have manual cuffs on my unit; disposable cuffs are hooked up to our cardiac monitors. I'm guessing biomed is diligent about calibrating them, because in the ICU setting we make critical decisions based on BP parameters.

Like the first poster, if we have reason to believe it's inaccurate (e.g. 70/20 after days of 130s/80s with no other indication of hypotension), we ensure proper placement of the cuff, recheck, try another site etc

Extra Pickles · Apr 25, 2017

I have always rechecked a Dynamap (or whatever brand) with a manual cuff if I think the reading is off-kilter. I simply don't trust the machine to be accurate 100%of the time when medication decisions are hanging on that reading. If the reading is as expected I let it go, all good. If the reading is not what I expect for whatever reading, I grab a manual cuff.

Most of the time, nearly all the time, the reading on the machine is correct, or close enough to make it recordable. Rare occasions it's not and then I was glad to do it myself.

Heaven help us the day they stop teaching students how to get a manual BP reading because "we have machines for that now"!

AceOfHearts<3 · Apr 25, 2017

If the patient is in an irregular rhythm, such as afib, and the electronic BP seems way off then I will check a manual. Otherwise I use just the electronic BP.

~Mi Vida Loca~RN, ASN, RN · Apr 26, 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.

My practice is to recheck on the same arm and then if still really high (for me really high is probably a lot more extreme than some others definition) I will check on the other arm. If still really high I will go off that. If I am not getting any kind of consistency I will find a manual cuff to check.

If patient is complaining of back pain and one arm is high and that isn't normal for them, I will automatically check other arm too.

Emergent, RN · Apr 26, 2017

Unfortunately, many nurses don't do this. It obviously wasn't the custom in my ER amongst many of my colleagues because the manual BP cuffs were becoming difficult to find. I let our new manager know about the situation and he made sure that we have a Manuel BP set up in each room.

I think it's very important that nurses know that the manual BP should be checked in the case of an abnormal blood pressure.

~Mi Vida Loca~RN, ASN, RN · Apr 26, 2017

Unfortunately, many nurses don't do this. It obviously wasn't the custom in my ER amongst many of my colleagues because the manual BP cuffs were becoming difficult to find. I let our new manager know about the situation and he made sure that we have a Manuel BP set up in each room.
I think it's very important that nurses know that the manual BP should be checked in the case of an abnormal blood pressure.

They were always hard to find in my ER's too, always in the Trauma Bays though but we had problems with them getting put back. That said, I have often found the monitor ones to be accurate and consistent with the manual readings when I have compared.

pixierose, BSN, RN · Apr 26, 2017

I have always rechecked a Dynamap (or whatever brand) with a manual cuff if I think the reading is off-kilter. I simply don't trust the machine to be accurate 100%of the time when medication decisions are hanging on that reading. If the reading is as expected I let it go, all good. If the reading is not what I expect for whatever reading, I grab a manual cuff.
Most of the time, nearly all the time, the reading on the machine is correct, or close enough to make it recordable. Rare occasions it's not and then I was glad to do it myself.
Heaven help us the day they stop teaching students how to get a manual BP reading because "we have machines for that now"!

^^ 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.

~Mi Vida Loca~RN, ASN, RN · Apr 26, 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.

sallyrnrrt, ADN, RN · Apr 26, 2017

I awkward fi manual, as slog as correct cuff size and calibration... Ki

Never have a problem with my assessments. But I'm old scguul