Do you trust automatic "vitals" machines?? - page 2
At our hospital the CNA's use "robo nurses" to take vitals. It is relatively fast for them, taking BP and pulse and o2 sats at the same time. However the more I work, the less I trust them. It... Read More
Feb 2, '07Occupation: RN Specialty: * Cardiology * Oncology * Medsurge RN ; Joined: Dec '06; Posts: 1,220; Likes: 855talk about something that causes pain, especially to fragile old ladies with bruises on their arms from this beast!
and sometimes blood pressures that would otherwise be low are not detected by this miracle machine....
the machine does save time, but i would prefer manual bps. had a chance to work rehab as a cna and loved doing it..you really get more of a feel for the state of your patient. especially hearing a low afib weak heart that pauses then beats up again after the pacemaker kicks in omg!Last edit by CaLLaCoDe on Feb 3, '07
Feb 2, '07Joined: Aug '05; Posts: 650; Likes: 731Something interesting I learned about NIBP machines is that they calculate the BP using the oscillation method, which is different from auscultating a BP. I occasionally wonder about the accuracy of the machines, but I also sometimes wonder about the accuracy of manual BP readings on significantly bradycardiac patients, particularly those with an irregular heart rate. Any thoughts?
Feb 2, '07Occupation: Med/Surg Specialty: 19 year(s) of experience in Ortho/MS, SICU,Home Health ; Joined: Dec '06; Posts: 711; Likes: 152quote:
originally posted by cher1983
honestly, to do all the bp's manualy on a med/surg unit, there wouldnt be enough time in a day to get everything done.
Quote from tazzirni had to laugh when i read this. first, i'm not retired, second, when i worked med-surg we didn't have a machine for years and did all bp's manually . oh yes, we still managed to get everything done .uhh.......i wouldn't say that too loudly........there are lots of retired nurses here..........
[color=#483d8b]thank goodness for progress but i swear, we do become a bit dependent on it. i don't know how they did it 60 70 yrs. ago. i give them oodles of credit because they sure deserve it!
Feb 2, '07Occupation: 20+ yr RN Specialty: 15 year(s) of experience in Critical Care ; From: US ; Joined: May '05; Posts: 7,520; Likes: 4,030The machines can be very accurate and useful. You were told in school to do manual bps not because the machines are inherently inaccurate but because YOU needed practice taking bps.
Like any piece of equipment, you treat the patient, not the machine. If the machine doesn't seem to be an accurate assessment of that patient, then you investigate.
The biggest and most sophisticated piece of software involved with any machine is YOUR brain.
Feb 2, '07Joined: Dec '02; Posts: 41,761; Likes: 48,081Quote from TigerGalLEI worked as a tech for about 6 months. Some evenings I would have 18 patients to do vitals on, feed, turn ect. I was a patient care technician so i could also do blood draws, catheters, dressing changes, blood sugars.... I trusted the machines b/c usually if it was high or low i would check it manually and get the same thing. The pulse was always accurate when compared to the hand held pulse Ox machine. I would count as well if it was high or low and they would be accurate.
If I had to do vitals manually I wouldn't have time to do anything else!! So I am very thankful they exist.. But if you ever doubt them.. definately check it manually!!
Techs do blood draws, catheters, dressing changes, blood sugars . . ?!
I read this occasionally and it still makes me shake my head . . . . what do nurses do then?
Our CNA's do vital signs with a machine and baths and beds and ambulate patients but they do not do what I consider a nurse's job . . .
Amazing the differences in practice . . . .
oh, the op's question . . . . for the most part, yes I trust them if they are used correctly. I always recheck if it seems inaccurate . . . by looking at the patient and assessing the patient and not relying on a machine, as Tim said.
Feb 2, '07Occupation: Staff nurse Specialty: ICU, Med/Surg ; From: US ; Joined: Feb '07; Posts: 805; Likes: 1,005Ha yea... well sometimes the nurses would make me so angry as a tech. I would literally work my tail off for 12 hours... taking sugars, drawing blood, inserting catheters, baths, beds, ambulating..... And then the nurses would walk out of the room and say.. hey that patient needs to be put on the bed pan... (as I was on my way to take a sugar or draw blood) ... I mean seriously... they acted like they couldn't do it!!!
I learned from them though.. I just graduated and passed my boards.. I will not be one of those nurses!
Feb 2, '07Occupation: Adolescent psych Specialty: Adolescent Psych, PICU ; Joined: Feb '03; Posts: 2,164; Likes: 384Quote from stevielynnI'm a tech and we do all the above as well.Techs do blood draws, catheters, dressing changes, blood sugars . . ?!
Feb 2, '07Joined: Jan '07; Posts: 6Automatic machines are used in the OR- & where I work, these are the same machines we use in PACU & in ICU. When we have a patient w/an A-line- and this depends on positoning too-- it is very close to what we get on the automatic machines, so yes, I trust them!!! I asked one of the CRNAs once what they did years ago-- he said they used to have to take every BP manually in the OR- AND w/no Sa02 monitors they were watching their patients VERY closely-- this was also in the days of ether! I would say if you're getting all high one shift and all low another then you need to look at the technique of the people taking them, and whether or not your machines are regularly maintained to function optimally. What I DON'T trust are the tympanic thermometers!!! I have heard the temporal ones are more accurate, but that's what they used to say about the tympanic ones. (the mercury ones were alot more accurate but not as quick)
Feb 2, '07Joined: Dec '02; Posts: 41,761; Likes: 48,081Quote from marilynmomAs I said . . .amazing.I'm a tech and we do all the above as well.
dali92 - I agree with you about temps . . .those tympanic things are useless in my mind and I'm not sure about the temporal . . . I went to an inservice with the guy selling the temporal and he took my temp and it was high so he waited and did it again and got a different number and then did it again and the number was different.
I just think oral or rectal are the best . . . . You'd be hardpressed to take a rectal on a 33 year old father of two though . . . .
Feb 2, '07Occupation: RN Er/ ICU Specialty: 11 year(s) of experience in ER/ ICU ; Joined: Oct '06; Posts: 345; Likes: 17I prefer manual blood pressures- they are more accurate, especailly if you are dosing meds based on pressures. I don't mind the temps and HR.
Feb 2, '07Joined: Jan '07; Posts: 9No,call me old fashion, but the ears don't lie. If the patient is running a-fib, both the pulse and b/p will not be accurate. Also, our cardiologists will always ask if it was manual if you call to report abnormalities.I usually try to get my own vita when I do my original assessment so that I have something to use as a baseline. It dosnt always work tha.t way, but that is my aim
Feb 3, '07Specialty: 5 year(s) of experience in ICU, telemetry, LTAC ; Joined: Apr '04; Posts: 1,483; Likes: 1,003No, I don't trust the machines.
1. I don't see too many people cleaning them, god knows what we're passing around germ-wise. Ugh.
2. blood thinners, old age, and the fact that the thing takes a minute or so to mash someone's arm to all heck and back before deciding on a number is just plain cruel. It takes me 30 seconds or less and I'm done.
3. A-fib makes the machines do some crazy stuff.
4. Use the manual and you're 1/4 of the way done with a skin assessment when you do your BP.
Now I have a good tech. She's priceless! Any wonky crap out of the machines and she will do a manual BP and tell me the difference. I usually follow her the first time around and do my assessments while she's on vitals so if it's screwy, I can help right then and there. But honestly, I don't work with her too often. So I'm used to doing my own vitals and I don't have it in my mind to even look for a machine. I grab a thermometer, a hand held pulse ox if there is one, and go. (Pulse ox's are in our rooms but they are way up on the walls... long story!) During the VS I notice: what the inside of the mouth looks like when I take a temp, what IV's and tubes are where, when I do BP, skin assessment on arms for BP, oh yeah, JVD during temp! For pulse ox I'm seeing cap refill, temp of hands, tremor, are the fingers arthritic, etc. I can hold their hands if they need a little TLC. There's a conversation going on the whole time if the patient's awake, so I can get a lot of work done in the few minutes it takes to get vitals. From there it's natural to finish the assessment and it doesn't seem to take me more than 5-8 minutes to do my assessment and VS together. I take less time on VS later in the shift 'cause I've already got a good idea of what the patient looks like.
My assessments go faster when I've got a tech helping with VS but I always wonder what I missed.
Feb 3, '07Occupation: RN Specialty: * Cardiology * Oncology * Medsurge RN ; Joined: Dec '06; Posts: 1,220; Likes: 855[mouse]Quote from TigerGalLE[/mouse]I learned from them though.. I just graduated and passed my boards.. I will not be one of those nurses!
Oh yeah!!!! And you won't have a large derriere from bossing someone around while you're sitting down all the time!