Do you trust automatic "vitals" machines?? - page 3

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

  1. by   abundantjoy07
    Quote from Indy
    No, 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.
    This is very true...the BP cuffs especially the automated (Dynamaps) that are used are very rarely cleaned in between patients. You just go room to room checking BPs and not cleaning them...

    And yes, doing some things like pulses and even BPs is much more efficient manually. It's quicker, easier, more reliable, and for gosh sakes...did I say QUICKER!

    There's just something about a Dynamap that takes them 5 minutes to get a BP that you could get in 30seconds...without all the repeated arm squeezing because of errors.

    As far as trust. The thing I trust the most is myself. I have gotten some very strange readings from some machines...only to check myself and get something closer to what I expected.

  2. by   Schatzi RN CEN
    At the place where I work we now issue cuffs to our patients, that get marked with their name and stay in the room. Yhis has cut down significantly on cross contamination.

    The other issue about trusting the machine brings something to mind that we heard over and over in Nursing School: Treat the patient and not the machine. I think it is great to use dynamaps or passport machines, if you still use a dose of good old nursing judgement. Does your assessment correspond with what the machine tells you? Have you ever ran down the hall, because a telemetry read v-tach or worse, and been met by a smiling patient that is just a little bewildered by the look of panic on your face? I think the same goes for automatic BP's, pulse counts and SaO2.

    Especially the O2 sat is often misleading. Our patient may have a sat in the 90's, but how much effort is he putting into maintaining that O2 sat?

    These are all questions that can only be answered by one thing and that is a good nursing assessment.
  3. by   Tiwi
    I have found that electronic sphygmos in the main, are accurate, and really help when it is difficutlt to hear a BP. But I have found them to be totally in accurate when there is an arrhythmia, eg AF, which then means that a manual is essential. What I often find inaccurate are the "ear thermometers" - how embarrassing, I can't remember the proper name! And these days there are no manual instruments around as anything containing mercury is banned...
  4. by   Grammie1
    Indy can be my nurse any day!
    I was taught by an excellent preceptor to do the first set of vitals manually, then if the machine agrees, ok. However if the machine later tells me something else, check it and see if I agree. Another thing she said was "Before you do CPR on a patient who's telemetry says they've coded, ask them if they have a pulse, if they say yes then don't start CPR!" Of course we all know about v tach with a pulse, but the basic principles she taught me still work.
  5. by   UM Review RN
    By the time I have a machine hooked up and working properly, I could've done ten BPs. We have the worst machines in the world.

    Besides, as others have noted, if the patient's pulse is irregular, they're useless. This is why I check HR and rhythms up at the monitors before I ever step into a patient's room.

    As far as cross-contamination is concerned, we have manual cuffs in every room--and they're never changed with each patient. I'm sure some of them have been there since the Ice Age. And who knows when the machines were actually washed; I have a hard enough time trying to clean off the tele leads and monitors when patients are DC'd.

    I don't blame the hospital, though. The equipment is very expensive and theft is such a problem, not from visitors or patients, but from one department to another, that it's a wonder that we still have the equipment that survived.

    One unit went so far as to modify the label on our machines so that it looked like that machine "belonged" to that unit! How utterly gauche.

    So I use my own manual cuff, the tele monitor, the bedside thermometer, and I hunt down one of the two pulse oxes floating around the unit, which may or may not be accurate.

    Any wonder why I hate doing vitals?

    And for the poster who noted how many tasks the CNAs were assigned and then asked, "What do the nurses do?" the answer is that we know how to troubleshoot and fix all the problems associated with the wrong answers that the CNAs get. Nursing is a whole lot more than simply performing tasks and charting.
  6. by   TigerGalLE
    I completely agree with everyone about doing the first set of vitals manually. And when I was a tech I always wondered... How can these nurses not ever want to do the vitals themself... Just to get an idea of their patient's status? They just trust the techs completely; which I guess made me feel good? But also concerned me...

    But to stick up for the techs... Cavi wipes are attached to our "nurse on a stick" and I do clean them between every room. And our isolation patients have their own BP cuff and thermometer that stays in the room.

    I start as a nurse on monday (I just passed boards) HURRAY!! And y'all have given me some great assessment tips... How to do vitals and my assessment all at once! So thanks!! I'll take all the tips I can get!
  7. by   t.guest75
    I'am a nursing student right now doing clincials and I started out doing B/P manually but by the end of day i didnt have enough time to do alot of my other agenda's done, so i started using the automatic machines. I really havent thought that much about what your talking about but it really makes me start to think about how accurate they are! thanks for bringing that message up!
  8. by   colleennurse
    I can't even get that manual BP machine to work for me The few times I have tried to use I spent more time trying to get it to work and could have taken a manual in half the time. The other night one of the techs on my unit was using the machine and I got a fresh post op, so she was in there with me and it took about 10 minutes to get a BP, I just kept wanting to say why don't you just get the manual cuff!
  9. by   nservice
    During a code a few weeks ago, I got a palp B/P of 60. (After getting a rhythm back of A fib). One of the fairly new nurses on the floor started yelling, "No, the dynamap says his B/P is 100/50". Although a code is not the ideal time to explain why the dynamap could not be trusted with an irregular rhythm, I tried. She would not listen to reason. The doc, of course, started Dopamine and then asked loudly for a Manual B/P.

    I guess I know what my next in-service will be about!

    The last hospital I worked at had a policy that B/P's must be checked manually once a shift. I think that's a good idea.
  10. by   Spidey's mom
    Quote from Angie O'Plasty, RN

    And for the poster who noted how many tasks the CNAs were assigned and then asked, "What do the nurses do?" the answer is that we know how to troubleshoot and fix all the problems associated with the wrong answers that the CNAs get. Nursing is a whole lot more than simply performing tasks and charting.
    That would be me . . . . .

    Dressing changes, blood sugars, foley caths, blood draws . . . those are all RN or LVN duties where I live. Within the scope of practice of nurses. Not CNA's or patient care techs.

    There are specific guidelines for what nurses do and I guess I'm just seeing more and more of nursing responsibilites given over to others (med passes by CNA's, etc.)

  11. by   MARIAN202
    In The Operating Room It's The Only Type Of Machines Used For Vitals.
  12. by   SEOBowhntr
    Quote from berry
    In controlled trials automatic NIBPMs perform constantly more accurate then manual auscultation. I will add this involves proper size and placement of cuff. If you have frequent errors (everybody’s pressure is up or down) it is far more likely operator error than machine
    BINGO!!!! The NIBP's (at least the newer one's I've used, less than 10yrs old) ARE MORE ACCURATE!!! They actually sense the MAP, rather than figure it like we do, and they absolutely CANNOT give you a false high BP. I've heard nurses question them, then re-check, and say that they got something 40pts lower than the machine, and I tell them you'd better go re-check, because that machine CANNOT get a false HIGH. Many nurses are so set in their ways, that they cannot see the light, which is that sometimes machines do part of our tasks better than we do. The exception to NIBP's being more accurate IS with very irregular rhythms (A-fib, Heart Blocks, etc) or extreme brady patients. I actually showed one of my new orientees one night because she (little Ms. Know-it-all, didn't really know much, ended up failing her orientation, and was transferred to a lower acuity department) argued with me that the NIBP's were wrong, when our pt. had a 200/110 BP. I went in w/ the double stethoscope, and showed her that the pt. indeed was 200/110, not 160/80 like she tried to tell me. Nothing worse than a LIAR on my unit!!!! Game, set, match, she was done after a couple more Dishonest interactions with staff and doc's.
    Last edit by SEOBowhntr on Feb 3, '07 : Reason: edit
  13. by   Fairlythere
    Oh I wasnt talking about the OR and PACU vitals which are hooked up to monitors and I am sure are VERY accurate! I was indicating the rolling "robo nurse" that the CNAs wheel from pt. to pt on the floors.

    Thanks everyone, I will definately bring up the contamination factor and the idea of indiviual cuffs per pt. that could be cleaned by CS in between.

    I cant count the number of times an aid has come to me with a low pulse ox reading and they didnt realize the machine needs certain perameters to read correctly, like a good pulse.