(Manual BP) Can't find systolic through palpation. What am I doing wrong?

FL_Nurse92 · Sep 17, 2016

I think I am misunderstanding the question....what exactly are you palpating?

Banana nut, BSN, RN, EMT-B · Sep 17, 2016

She is palpating the radial pulse. You should feel it before you pump the cuff then as you start pumping the pulse will stop at some point. When you notice you dont feel the radial pulse anymore pump 30 more mmhg. Then slowly deflate the cuff. When you start feeling the radial pulse again that's your systolic over Palp. You can write it as 120/p for example.

FL_Nurse92 · Sep 17, 2016

I was just taught to place the stethoscope over the pulse... simple

chare · Sep 17, 2016

I was just taught to place the stethoscope over the pulse... simple

Not exactly. Some patients have an auscultatory gap. During this gap, although you don't hear anything the pulse is still palpable. If you palpate the pulse as you inflate the cuff, and continue until the pulse is no longer palpable, this helps ensure that you get an accurate blood pressure.

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Zyprexa_Ho · Sep 18, 2016

Honestly, it just takes time to get used to. I have been a CNA for a long time and I was never taught this method until this semester when I started nursing school. Finding that brachial pulse is difficult.

Ladyscrubs · Sep 19, 2016

Start with warm hands, use finger tips second, third and fourth, and don't press hard. I tell my students to close their eyes, (don't laugh) regulate their breathing and "become one with the pulse," then they will be able to palpate it. Open eyes, finish procedure. Biggest problem seems applying too much pressure, just a light touch.

marienm, RN, CCRN · Sep 24, 2016

I'm sure the method described by Noctor works fine, but I was taught to do it with the brachial pulse. 1) Wrap cuff around arm, get the dial where you can see it, etc, put your stethoscope in your ears, 2) Find the brachial pulse, 3) Pump up the cuff at moderate speed & keep your finger(s) on the pulse. 4) Note the number where you can't feel the pulse any more. 5) Pump up 30 more mmHg. 6) Position your stethoscope over the pulse. 7) Release pressure & listen for the first 'tap.'

OP didn't describe which pulse, so maybe this helps? OP, you are not dumb!

jussway · Sep 24, 2016

This was how I was taught as-well, so that you know where their actual artery is and how high to pump up to.

marienm, RN, CCRN · Sep 24, 2016

I should clarify from my comment above that we were just taught to do this to locate the artery and know how tight to make the cuff. However, remove my instructions about the stethoscope above and you could just leave your finger in place and feel for the return of the pulse. (Having re-read OP's post, I figured I should clarify.) If you're not finding it, are you going too fast in releasing the cuff? If your partner is young and healthy and their HR is 60, and you release your cuff at a speed of 10mmHg/second, your palpated SBP will, at best, have a 10mmHg margin of error (1 heartbeat per second). Also, you'll usually see the first flicker of the BP cuff needle before hearing the first 'tap' when auscultating, so I assume it precedes the first plapable pulse and might give you a bit of warning.

I must admit I don't really see a purpose in this as a clinical 'skill'...in a doctor's office or the hospital, you're going to need the systolic and the diastolic. I can see it as a useful teaching tool for students: what blood 'pressure' means is the amount of pressure in the vessel and you can measure that by figuring out how much pressure is needed to occlude that vessel with a cuff. It's also a skill you can teach to patients who need to monitor their BP at home...with some practice, a pt can learn to do it alone and record their daily systolic pressure. I don't work in outpatient care, so I have no idea how many patients are taught this vs. how many get a prescription for a home BP machine.

Banana nut, BSN, RN, EMT-B · Sep 25, 2016

I should clarify from my comment above that we were just taught to do this to locate the artery and know how tight to make the cuff. However, remove my instructions about the stethoscope above and you could just leave your finger in place and feel for the return of the pulse. (Having re-read OP's post, I figured I should clarify.) If you're not finding it, are you going too fast in releasing the cuff? If your partner is young and healthy and their HR is 60, and you release your cuff at a speed of 10mmHg/second, your palpated SBP will, at best, have a 10mmHg margin of error (1 heartbeat per second). Also, you'll usually see the first flicker of the BP cuff needle before hearing the first 'tap' when auscultating, so I assume it precedes the first plapable pulse and might give you a bit of warning.
I must admit I don't really see a purpose in this as a clinical 'skill'...in a doctor's office or the hospital, you're going to need the systolic and the diastolic. I can see it as a useful teaching tool for students: what blood 'pressure' means is the amount of pressure in the vessel and you can measure that by figuring out how much pressure is needed to occlude that vessel with a cuff. It's also a skill you can teach to patients who need to monitor their BP at home...with some practice, a pt can learn to do it alone and record their daily systolic pressure. I don't work in outpatient care, so I have no idea how many patients are taught this vs. how many get a prescription for a home BP machine.

This is a fantastic explanation! Thank you. From what I've learned we really only use Palp pressure out in the field when a pt. Is severely hypotensive and we are unable to auscultate a sbp. We are talking

Erythropoiesis · Sep 25, 2016

Pump up VERY slowly or it's easy to pump right through the point where you feel the systolic stop. You need to be going slowly enough to where you can feel everything as you pump up and feel the second you lose that pulse.