manual or electronic BPs in your clinic?

[SHGR]

Hi,

We do all electronic blood pressures (family medicine clinic).

The MAs say they forgot how to do manual ones and "would need to be retrained."

I think electronic cuffs only belong in critical care settings where you need a reading q2 minutes or something like that.

Do you do automatic electronic ones, manual, or some of each in your clinic?

[SHGR, MSN, RN, CNS]

I need to do a more thorough lit search on BP in very obese individuals- but here is one example Palatinia, P and Parati, G (2011).Blood pressure measurement in very obese patients: a challenging problem. Journal of Hypertension 29:425–429

"When the arm circumference near the shoulder is much greater than the arm circumference near the elbow, a cylindrical cuff may provide inaccurate BP measurements." varying by as much a 30 points.

For those of you who do a manual after an abnormal electronic reading, how do you define "abnormal?" Different from the patient's usual, or do you have a certain SBP or DBP cutoff?

[klone, MSN, RN]

I work in specialty where only large BP abnormalities really 'matter' to us. I love using the dynamap because I can keep talking to the patients while its working, so it saves me time and keeps things moving.

I try to avoid speaking to patients while the BP is running, because conversation may cause an inaccurate reading (as can having legs crossed, not sitting all the way back in the chair, and not having the arm resting at heart height).

[klone, MSN, RN]

For those of you who do a manual after an abnormal electronic reading, how do you define "abnormal?" Different from the patient's usual, or do you have a certain SBP or DBP cutoff?

We have standard parameters in which a BP reading should be followed by a manual check, and then different parameters in which the care provider needs to be notified immediately. Within that, however, I use clinical judgment. If a patient has cHTN and her "normal" is 140/90, I'm probably not going to recheck it manually.

[xoemmylouox, ASN, RN]

Manual only. My employer is to cheap to invest in electronic, not to mention I prefer a manual reading.

[vintagemother, BSN, CNA, LVN, RN]

For those of you who do a manual after an abnormal electronic reading, how do you define "abnormal?" Different from the patient's usual, or do you have a certain SBP or DBP cutoff?

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Abnormal is any measurement indicative of hypo/hypertension eg sbp greater than 130-149 and Dbp greater than 90. Or sbp

[Fractal-5]

We typically do manual BP at my clinic.

[SHGR, MSN, RN, CNS]

Thanks again for all of your responses.

I am presenting at our monthly QI meeting this week and will mention "standard practice at other noncritical care settings based on responses from active members of an online nursing forum." Not the most scientific sample, obviously, but definitely a valuable way to benchmark and see what others are doing. I have gone to other clinics in the area to see others' practice, firsthand, as well.

[BuckyBadgerRN, ASN, RN]

Manual only. I've never even seen an automatic system at work. There is a wall mount sphygmomanometer with three cuffs and a littman in every room. I'm in a specialty clinic and my md requires a bp every single time you walk through the door. This week alone I had two extremely hypertensive patients whom we sent immediately over to their internist.

[BuckyBadgerRN, ASN, RN]

"Forgot" how to take a manual? Sorry, this sounds like a lazy cop out