Is it customary where you work to recheck BPs manually?

Nurses General Nursing

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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 recheck. In the acute care setting, when calling a doctor to report an abnormal BP and looking for intervention, the first response I would get was "recheck it manually"...um, that is the manual one or I would not have paged you yet.

I worked at an ALF one time that only supplied an automatic cuff. Better yet, never checked for calibration and it was one from the drug store and don't even get me started on finding batteries for the darn thing when it was in need of new ones. I bought my own manual cuff and used it. With residents that had Afib, the auto cuff was never accurate. As for my manual, one of the perks of having a husband that calibrates much more elaborate medical equipment for his career is that he has the tools to check mine. I would have felt really bad if I was sending a resident to the ER due to a crazy BP only to find out that the EMT got a normal reading when there to transport. This would be a time that I wouldn't blame them for assuming I was an idiot just because I worked there (I have seen a different attitude with EMS when I worked there vs. a hospital. It was a culture shock when I saw it the first time).

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Specializes in ED, psych.
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.

I also work in a hospital, but there are times I don't trust the automatic ones. One in particular, actually. This one keeps making its way back on the floor, despite readings that are way off base, every time (high).

I think the ones on the psych floor are probably not nearly as well taken care off as ones on an ICU floor. So, definitely like you said, in most cases. I think perhaps people place too much faith however in them and should always have those critical thinking skills handy.

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I always go behind with a manual if the BP is abnormally low or high.

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Specializes in Cardiology, School Nursing, General.

What I was taught, it's common practice. If the machine gave a weird reading and the person isn't showing symptoms of High Blood Pressure or Low Blood Pressure, then it's manual. Or even if I feel the machine is being iffy, it's manual time.

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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.

If false readings are common, your facility needs to call somebody in to fix those. It's that simple. When people's lives depend on those readings it's important they work correctly.

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I also work in a hospital, but there are times I don't trust the automatic ones. One in particular, actually. This one keeps making its way back on the floor, despite readings that are way off base, every time (high).

I think the ones on the psych floor are probably not nearly as well taken care off as ones on an ICU floor. So, definitely like you said, in most cases. I think perhaps people place too much faith however in them and should always have those critical thinking skills handy.

That makes sense but not trusting 'one in particular' means you calibrate by using a different one. I just think it is silly that we have all these very sophisticated medical devices and when we don't like the number we say "I don't believe that." That's not saying we shouldn't double check, but it doesn't have to be a manual check. People should put faith in the devices they use. To me the mistake is to say the manual is 'better.' In some cases it may be, in some cases it may not. The most prudent thing would be just to recheck with a similar device (another machine). When I was in the ER if something wasn't right with a BP I wouldn't go grab a manual cuff, I'd go grab another machine and see if I got similar results. If all else failed then maybe do a manual. I have nothing against doing it manual, just that as a policy it should first be to check your equipment's reading against similar equipment that way if the equipment was in need of servicing you addressed that issue as well as the patient care one.

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Specializes in ED, psych.
That makes sense but not trusting 'one in particular' means you calibrate by using a different one. I just think it is silly that we have all these very sophisticate medical devices and when we don't like the number we say "I don't believe that." That's not saying we shouldn't double check, but it doesn't have to be a manual check.

Eh, we've had ours thrown around so much (weapons by patients, for example) that sometimes, it's just easier to get the manual (in certain settings).

To be honest? I wouldn't mind if we just manually did it altogether and kept the automated ones in back of the nurses station for emergencies. Ours get tossed around way too much (even when staff are being our safest, it happens ... we even keep them back there when not in use but more often than not, they're being used).

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Specializes in Critical Care.

Yep, this is policy at my facility. I actually had an instance just last week where I was consistently getting high pressures that just didn't seem right on a patient, re-checked manually, and the manual pressure was much lower. Fortunately, this didn't drive medication dosages for this patient, but I did have an awkward 30 minutes with her where I kept repositioning her and questioning her about headache/visual disturbances for no reason.

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P&P will vary by facility.

Before performing any intervention that resulted from a parameter obtained by a machine... I verified that parameter with my human skills.

Machines fail all the time. Takes a minute to do a manual pressure.

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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

Holy cow did you just have a stroke?! Maybe somebody took your blood pressure wrong and undermedicated you??

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Specializes in Psych, Peds, Education, Infection Control.

I work in child/adolescent psych currently, so 90% of the time, what the machine gives me is in what I consider an acceptable range and I move on with my day. I'll recheck a high/low reading myself, manually. My kids get vitals twice daily (AM shift and PM shift) and I review them. If one looks strange, I find the kid and check it myself (with the automatic first, then manual if it's still weird). The techs have ranges that, outside of which, they need to find me right away to assess - and those ranges are VERY narrow, so a lot of times I glance at it and declare it fine. They're also not totally developmentally calibrated, so I get a lot of "their pulse is out of range" on the child unit. We have really crappy stethoscopes on my unit, so I've been known to borrow a med student's occasionally, if they're around. Honestly, with the general noise level of my unit and the quality of my manual equipment (I'm pretty sure the cuff wouldn't look out of place in a 1970's medical drama) if it's in range, I'd trust the machine more, but our equipment maintenance guy calibrates them pretty often. I pay more attention, obviously, if the kids are on a BP med or one likely to affect BP - or, as I mentioned, symptomatic.

Now on the rare occasion I get floated to the detox or gero units in our adult building, I'm much quicker to grab a manual cuff and do a recheck on anything that strikes me as odd. Especially if there's an intervention required, or I'm monitoring for withdrawal complications.

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Specializes in Nephrology, Cardiology, ER, ICU.

Actually research has proven that auto BP is more accurate than manual BP:

Automated BP monitoring (with multiple readings taken while the patient is resting) is more accurate than manual BP monitoring in primary care patients with systolic hypertension. The results have obvious clinical implications, such as limiting unnecessary treatment.

Medscape: Medscape: Medscape Access

The ENA clinical practice guideline for NIBP monitoring in the ER: https://www.ena.org/practice-research/research/CPG/Documents/NIBPMCPG.pdf

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