Do you trust automatic "vitals" machines?? - page 4
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 3, '07Occupation: LPN Specialty: 3 year(s) of experience in TCU, LTC ; Joined: Jan '07; Posts: 63; Likes: 3I don't like the fact I don't get the "hand-on" aspect of autos. I like to feel my pulses and hear my sounds, I also get a chance to check skin moisture and temp. Autos are kind of dehumanizing, I think. I've also had pts complain of pain from the cuff squeezing too tight, I never get that doing it manually.
The OR is different, it's not reasonable to take vitals q10min. And their machines are calibrated (hopefully) and the operators should be skilled in their use.
Feb 3, '07Joined: Nov '05; Posts: 499; Likes: 71Quote from SEOBowhntrCorrect. The automatic machines actually calculate the systolic and diastolic from the measured MAP.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.
Feb 4, '07Occupation: CNO Specialty: 11 year(s) of experience in Rural ; From: US ; Joined: May '06; Posts: 74; Likes: 18Actually the individual cuffs that we issue are not cleaned between patients, that get thrown away after the patient is discharged. If the patient is transferred to another unit, they go with the patient. We actually have some frequent fliers that keep their cuff and bring it back on their next admission.
Feb 4, '07Specialty: 5 year(s) of experience in ICU, telemetry, LTAC ; Joined: Apr '04; Posts: 1,483; Likes: 1,003Quote from Schatzi RN CENAmen! Especially the part about what I call "ventilation versus O2 sat." You know what I mean; the patient who has a sat of over 90 but how'd you get it? Oh, you had to put it on his nose?! Well that's not good! His resp. rate is what? 39? Tell ya what, you call the doc, ask for ABG's, then call respiratory while I get the crash cart.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 .
If I'm not getting an answer on the O2 thingy pretty quick, and it's not a stubborn little handheld that won't admit it has batteries in it, there's a problem. Probably, it's a problem with the patient! I mean, no one should have to work like a mule pulling a tank uphill in summertime just to breathe while sitting up. Every once in a while we get the doc who'll try to treat the O2 sat, and I gotta explain that the ventilation is so crappy the patient can't last long regardless of what the pretty little machine says. I've seen a sat of 89 on a patient with a bicarb of 6. Sat, Schmat. Ventilation's where it's at.
Feb 4, '07Joined: Sep '05; Posts: 1,277; Likes: 359Quote from berryBerry - I'm with you on this - I think the manual cuffs depend too much on operator interpretation, and the accuity of their hearing.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
For a proper reading the patient has to be on their back with their arm still. I've seen just as many wide ranges done manually as with the machines.
Feb 4, '07Occupation: staffnurse at a residential center for children with behavioral issues Specialty: Brain injury,vent,peds ,geriatrics,home ; Joined: Nov '06; Posts: 498; Likes: 47I personally prefer to do vitals manually,the "old fashioned way"you do use some of your assessment skills in this manner, You.can hear an irregular Pulse or heart rate Especially if the patient recives antihypertensives and I personally think it is quicker to do vitals manually.There've been too many times I would have to repeat doing BPs and HR because the machine would say error.We dont have time to waste like that.It really doesnt take that much longer to do it manually.
Feb 6, '07Occupation: RN, ER Case management, precertification. Specialty: ICU-Stepdown ; Joined: Dec '02; Posts: 862; Likes: 53Quote from emtrachelI know irregular heartbeats can (and often do) throw off the mechanized readings (and they really mess with those who are inexperienced at taking vitals manually -how often have you watched someone take a '15 second heart rate, multiply by four, to get the beats per minute' on someone with an irregular rhythm? ) but as was mentioned before, I'll usually trust the machine as long as the rhythm is regular, AND the vital signs are in line with what the patient has been doing (I always start my shift with manual ones, and I know I'm doing it correctly -once I get to know a patient (especially when I've had 'em for several shifts) I don't mind letting the machine do them -and I follow up with any readings that are out of the norms for that patient).Something 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?
When in doubt, do 'em yourself, the old fashioned way.
Feb 7, '07Specialty: Med/surg,orthopedics,emergency room, ; From: MD, US ; Joined: May '05; Posts: 76; Likes: 92You know, machines ar eokay, but if you have an abnormal reading, how do you know it's abnormal, if you've never done a manual bp? The machines are good for convienence, but we shouldn't become so complacent as to rely on them more than our own skills.
Feb 7, '07Joined: Feb '06; Posts: 33; Likes: 6The manual equipment is far more accurate. However, it helps when the equipment is new and working. The automatic BP machines are not accurate. Do not rely on them. They, I have found, report a much higher BP.
Feb 7, '07Joined: Feb '04; Posts: 386; Likes: 151Thanks for the machines, if you would have to do manual blood pressure in critical care unit, if will take up all your time, especially if somebody on pressors and you are checking vitals every 5-15 minutes.
We usually recheck BP manually if reading is abnormally high/low or inconsistent with the trend. I personally never caught the machine lying.
Feb 7, '07Occupation: FNP Specialty: Rural Health ; From: US ; Joined: Nov '04; Posts: 1,179; Likes: 379Quote from stevielynnAs a tech - I did all the above as well with 12-18 patients. Great experience, hell work though - VERY tired after 12 hour shifts as a tech. Sure the RN's would pitch in, but they were busy with their 5-7 patients as well. And where I work we don't have LPN's anymore, so techs have had to learn to fill in the role of the LPN and techs have a very expanded role than they did say 5 years ago when they used LPN's. Great experience for a NS student though.......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.
To the OP, no I don't trust those machines - I didn't when I was a tech, still don't now as an RN. Sometimes it's operator error (you can only use a child size cuff on a child or a very small adult) but my patients are mainly in A-fib so the Dynamap is pointless.
And I've seen some crazy places that people put pulse ox's at to get a reading...what is scary though - a reading must take place on the area the probe is designed for. If you get a finger probe and place it on the forehead, that is not an accurate reading and a defense attorney will tear you to shreds if it ever came to that. We had some staff get fired when g-ma had sats in the 80's, was hypoxic and the RN and RT placed the probe on the forehead to get a sat in the 90's. Didn't call the doc, didn't get ABG's, just left it on the forehead and went about their day as normal because g-ma had sats in the 90's now. That's when we learned that was a big no-no. G-ma died, doctor was angry, it just got very ugly.
Feb 8, '07Specialty: 5 year(s) of experience in ICU, telemetry, LTAC ; Joined: Apr '04; Posts: 1,483; Likes: 1,003Good gravy. Yah, if I have to put a probe on a forehead, that person's heading to ICU. I'm not interested in how well they perfuse their head, 'cause the body does that right up until the end.
Feb 8, '07Occupation: I'm a Mom, and a full time college student! Joined: Jan '07; Posts: 108; Likes: 57I'm not yet a nurse, but I know that for me at lest, the auto BP machine's ALWAYS up my bp. I've also had them mess up, and acutally bruise my arm, because it kept retaking it, and squeezing the crap out of me. I told the nurse that this was happening, and she said "Oh that's normal" I said, "I've had my bp taken MANY times, and never once has it felt like this" She said "It'll be over soon", it beeped, she took off the cuff, and well I hope next time she will listen when someone tells her something isn't right...