On your med-surg floor, who routinely takes vital signs -- you or your nurse's aide? Do you rely on an automatic bp cuff or do you take the bp manually? What about when a patient comes back post-op and needs frequent signs?
The aides routinely take vital signs manually only. Of course, I always check signs prn and before a cardiac med... Also when I admit a patient from surgery, I literally try to catch them on the stretcher/bed BEFORE I settle them (and the PACU RN leaves) and take my own vitals manually -- also gives me a chance for a quick visual assessment.
From a personal note, I find that manual BP is more accurate. I helped with a mini in-service for the nurses aides to compare: bp differences in arms (alot of carotid stenosis in my patients), and manual vs. automatic bp cuffs. And we always always always check a radial or apical pulse -- don't rely on the pulse shown by the pulse ox machine.
Manually is more accurate. We use a Welch-Allyn vital sign machine (aka 'Robo Nurse') but if we get an unusually high or low value we alwayscheck it manually before calling anybody.
Manual is always the best. Non-invasive BP cuffs- are secondary to manual. Non-invasive can be false for a number of reasons, pts are moving arm, the cuff is too big- too small- the non-invasive (manuals) are taking the BP by vibration. And many factors can alter the vibration.
Of course, art lines are the gold standard. But on the floors, manual should be the gold standard.
I agree! When I worked the tele floor, we checked manual pressures on all pt's in A Fib. If I disagreed with what a CNA obtained with the machine then I checked a manual pressure.
Now that I'm an ICU nurse, we typically use art lines but I've had CV surgeons ask me when I've called regarding Low BP not responding to pressors what the cuff pressure is.
Here's one for you: my husband had been moved from Recovery Room to a semi-private. His vitals were stable and while he was alert and oriented, he was still groggy. The nurse came into his semi- private and applied the automatic cuff to his arm. She set the timer and left the room. I ventured out behind her to find a bathroom. I then decided to go and find a soda machine. After about 15 minutes I returned to find my hubby's arm blue right down to the fingers. The automatic cuff had not deflated and apparently there was not a functioning alarm to alert anyone.
I know you guys are busy, but nothing beats the manual cuff for accuracy, comfort and safety...IMHO.
LoriAnnRN
40 Posts
Manually is more accurate. We use a Welch-Allyn vital sign machine (aka 'Robo Nurse') but if we get an unusually high or low value we alwayscheck it manually before calling anybody.