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Manual Blood Pressure Reading

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nursechilespice has 2 years experience as a LPN.

1,412 Profile Views; 24 Posts

What do you prefer? The one step, or two step method?

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52 Posts; 1,175 Profile Views

Never heard of these. Do tell :)

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nursechilespice has 2 years experience as a LPN.

24 Posts; 1,412 Profile Views

Hey! Sorry I should have been more descriptive... Within my pn program in Canada, there are two methods of obtaining a BP reading one or two step. Basically one step is just using the base BP reading as a reference to go 30mmHg above to have an 'accurate' systolic pressure, two step is also looking at the base reading, but if there is no base available to palpate the brachial artery while pushing air into the arm cuff, and obtaining a 'predetermined' systolic by going 30mmHg above the point where the brachial pulse can not longer be palpated, then when air is slowly released from the cuff the point where you can feel the pulse is the predetermined. From there you go 30mmHg from the predetermined to obtain a systolic pressure. Sorry for the long explanation! Hopefully I explained well enough

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14 Posts; 548 Profile Views

I have not mastered the coordination it sometimes takes to get a BP still so going for the pulse is out haha.

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akulahawkRN has 5 years experience as a ADN, RN, EMT-P and specializes in Emergency Department.

2 Followers; 3,447 Posts; 27,828 Profile Views

The two-step method, as I recall it, is to take a palpated blood pressure first. You record that pressure as, say, 162/P and then you auscultate the BP, inflating the cuff 20-30 mmHg above the previous reading and slowly release pressure so that you can catch the systolic pressure and later the diastolic pressure.

My method is more like a single step (and some NIBP monitors) where I will palpate the brachial pulse right at the AC fossa, place the stethoscope head right there and inflate the cuff while listening. I'll pause after I hear sounds (and see a slight pulsation on the needle) just long enough to confirm steth placement and then continue inflating. I'll go about 20 mmHg or so past the last sounds I hear so that I'm not accidentally stopping in the auscultatory gap and start deflating the cuff slowly to hear the SBP. Then I'll deflate more quickly because I have an idea where DBP is and slow down the deflation as I approach the DBP and I'll get that accurately too...

I've been doing manual BP's for a very long time (about 17 years now), to the tune of nearly 22,000 measurements over the years. Using NIBP machines is relatively new to me (starting about 4 years ago). I'm faster at acquiring a manual BP than most machines are just because I'm very practiced at it.

While you're learning, do the two-step. Then as you get better and better at it, change over to a one-step. Incidentally, the palpated BP is usually legal as a BP because you're indicating you got a palpated pressure and by definition, you cannot obtain a DBP that way and it also means you were unable to obtain an auscultated BP. This can be due to equipment problems, high ambient noise, very quiet Korotkoff sounds, etc. Just check your local rules to find out if a palpated BP is accepted there.

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367 Posts; 9,523 Profile Views

In school we are taught to palpate the pulse first, wait a minute and then take the BP inflating the cuff 20-30 mm Hg above where you could no longer feel the pulse. The rationale is that you obtain an accurate BP this way. The problem you can run into with the one step method you described is that if you have a pt who has a BP that runs in a wide range for some reason or is critically ill you may not maintain an accurate reading. I am fairly sure this method is based on evidence based practice.

For now definitely do it the way your instructors want you to for now, in my program you would fail the BP reading part of the physical assessment check off if you use any other method than the two step method for BP readings.

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mrsboots87 has 3 years experience and specializes in Neuro, Telemetry.

1,761 Posts; 16,853 Profile Views

In school we are taught to palpate the pulse first, wait a minute and then take the BP inflating the cuff 20-30 mm Hg above where you could no longer feel the pulse. The rationale is that you obtain an accurate BP this way. The problem you can run into with the one step method you described is that if you have a pt who has a BP that runs in a wide range for some reason or is critically ill you may not maintain an accurate reading. I am fairly sure this method is based on evidence based practice.

For now definitely do it the way your instructors want you to for now, in my program you would fail the BP reading part of the physical assessment check off if you use any other method than the two step method for BP readings.

Aside from accuracy, a main reason for a two step or any variation thereof is actually for patient comfort.

Getting your our arm squeezed very tight hurts. For some people who have a lower BP, why inflate to 180 if you don't have to?

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