Is it customary where you work to recheck BPs manually?

[klone]

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.

[klone, MSN, RN]

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

Um...Huh?

[MunoRN, RN]

This is a nursing practice that has always perplexed me, we typically on recheck on a BP we don't like, and keep rechecking until the BP is what we want it to be. Either automatic BP's aren't reliable, which means they are just as inaccurate when they say 120/80 as they are when they say 70/30 and should be rechecking both normal and abnormal BP's with a manual, or they are reliable, which is the position we tend to take when they give us a number that doesn't require any response on our part.

[~Mi Vida Loca~RN, ASN, RN]

Um...Huh?

I often do manual as long as correct cuff size and calibration. I've never had a problem with my assessments, but I'm old school.

Are you impressed with me??? HAHAHA

[~Mi Vida Loca~RN, ASN, RN]

This is a nursing practice that has always perplexed me, we typically on recheck on a BP we don't like, and keep rechecking until the BP is what we want it to be. Either automatic BP's aren't reliable, which means they are just as inaccurate when they say 120/80 as they are when they say 70/30 and should be rechecking both normal and abnormal BP's with a manual, or they are reliable, which is the position we tend to take when they give us a number that doesn't require any response on our part.

How do you recheck until you get the BP you like. Are you talking about just rechecking with a manual?

I don't find it bad practice to recheck an abnormal BP (again my definition of abnormal is on a broader scale because I work ER) I will recheck any highly abnormal VS before doing any interventions. Just like I will check the cuff size and placement.

Just trying to clarifying what it is exactly that perplexes you. If it's the fact of rechecking or the fact of rechecking with a manual.

[ChryssyD]

Actually, yes--because I tend to trust my eyes and ears more than a machine. Sorry. If the reading seems incongruent with what I'm looking at--280/140 or 50/20 and the patient is pink and happy and absolutely tip-top, well, I check it manually because I'm just curious. And machines are not infallible; movement artifact, tremors, positioning--and, of course, incorrect cuff size--are common causes of funky numbers.

[Scottishtape]

In LTC, it was customary to recheck with a manual. All we had were those rolling ones (Rosie), that were never calibrated. I refused to even use them to begin with.

In the hospital setting, we don't have manuals on our unit. So, if we get a crazy reading, we'll change out the cuff or try a different linb. That usually solves the problem.

[umbdude, MSN, APRN]

When a tech gives me an unusually high BP, I use a machine to recheck the patient and make sure it's done properly (eg, on bare skin, right cuff size, no crossing legs or moving arm around). If it's still high, I recheck with a manual and ask for symptoms. It's not a policy but that's how I was taught in nursing school and the hospitalist always asks for a manual BP.

[LovingLife123]

I guess then why are you only rechecking abnormal ones, why not recheck all? A 120/80 reading could be just as off, if you don't trust the machine.

If I get a BP reading that seems out of range, meaning what their baseline has been for me all day, I check the cuff, placement, all that jazz. In ICU, I'm looking at BP anywhere from every 15 minutes to every hour. If it's way off from a previous reading, I will try a radial, but I will call and will treat.

My patients lives depend on those BP parameters I am given and we honestly have to have some trust in those monitors to do their job. Now, if they have been normotensive all day and now I'm getting a 50/30 with no outward symptoms, I will recycle and check the cuff placement first. But I'm not searching the hospital for a manual cuff. If I still get a 50/30 I'm reporting it and treating it.

[ruby_jane, BSN, RN]

^^ This.

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.

Flinching a little bit.

As a nursing student (long ago and far away) I got to participate in a health fair for men. We were told to bring our cuffs and scopes "but we'll have portable machines." None of the machines worked. Best experience ever (and first time I'd seen a 230/120 BP). Now I always have a cuff and a scope in my bag. Just in case. And yes, I recheck something that seems too high or too low, or doesn't correlate with how the patient's acting.

[Scottishtape]

I guess then why are you only rechecking abnormal ones, why not recheck all? A 120/80 reading could be just as off, if you don't trust the machine.

If I get a BP reading that seems out of range, meaning what their baseline has been for me all day, I check the cuff, placement, all that jazz. In ICU, I'm looking at BP anywhere from every 15 minutes to every hour. If it's way off from a previous reading, I will try a radial, but I will call and will treat.

My patients lives depend on those BP parameters I am given and we honestly have to have some trust in those monitors to do their job. Now, if they have been normotensive all day and now I'm getting a 50/30 with no outward symptoms, I will recycle and check the cuff placement first. But I'm not searching the hospital for a manual cuff. If I still get a 50/30 I'm reporting it and treating it.

I definitely see where you're coming from.

I liken the rechecking of abnormal B/Ps to the rechecking of anything abnormal.

If my patient appears to be breathing just fine, I'm not going to stop and do another focused assessment, because everything appears fine.

Same thing with the B/P. If his/her pressure is where I expect it to be, then there's no reason to delve further.

At the point where his/her breathing appears to become abnormal, I'm going to then delve into what could be causing it, starting with the simplest thing and moving onward. Same with B/Ps, and the simplest thing that could cause an off reading is a machine/cuff malfunction or bad positioning.

Thats just my rational for it :)

[Chisca, RN]

Auto BP machines don't measure BP the same way as human ears. They take the strongest impulse and calculate a systolic and diastolic number. Ears hear Korotkoff sounds that the heart valves make opening and closing. The quality of the NIBP machine degrades over time and in my unit false BP measurements are common.

[foggnm]

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.