Oh man bp is tough

mstearns09 · Oct 15, 2013

Manual BP is something that comes with practice. The more you do it, the better you get. I finally mastered it after I discovered that your diastolic number is the moment you stop hearing the systolic number. I was also told that if you have trouble getting the diastolic number, watch for the needle to jump? Not sure if that is correct or not. I practiced a lot to get to a point I was good at it. Now I would rather take it manually over using the machine due to the accuracy.

Supa K · Oct 17, 2013

I have only done manual BP in class (just wrapped up a 90-hour CNA course, but state certification is a few weeks away).

Tips that worked for me:

1) Release the air slowly. There's no need to rush, even if that's how you see your instructor or another student do it. When we practiced in class, I could typically pump up the pressure to about 180 mmHg and let it release on its own for a while before slowly turning the dial to release more air.

2) Don't always expect the systolic (first beats you hear) to be in the 110-120 range, nor think you can gauge the BP based on a glance at your "patient." I missed one classmate's BP entirely because it was 98/60 and I figured that once I had passed 100 with nary a sound, I had done something wrong. Likewise, another classmate (a teeny, tiny 18-year-old woman) had a systolic near 120 -- I missed it because I wasn't ready for it to show up that quickly.

3) Once you have found your systolic and are listening for it to reach diastolic, watch your pressure gauge. There's a sweet spot where you can see the beats reflected in the needle movement.

4) Place the cuff higher than you'd expect (probably touching the armpit, even), so that there is room for your stethoscope to rest on the inside of the upper arm, above the elbow joint. If you are instructed to find the brachial pulse, and you do but it's right in the crease of the elbow, don't think that's where you have to place your stethoscope. Play around a bit in practice and you'll probably find that you can always get a reading on the inside of the upper arm.

Hope this helps!

StudentOfHealing · Oct 17, 2013

Hey nursing student here! (:

Make sure the diaphragm is right above the brachial pulse ... This is KEY!

brithoover · Oct 17, 2013

The "needle jump" is a guide but is not always accurate. You need to hear it. Practice lots (:

Supa K · Oct 17, 2013

Edit: Just a guide on the "needle jump," that's what I meant to say -- thanks!

emtb2rn, BSN, RN, EMT-B · Oct 18, 2013

Make it easy in yourself, listen as you inflate the cuff. You should hear the "thumps" as you increase pressure past what will eventually become your diastolic reading. Once the "thumps" stop, inflate another 30mm and then slowly deflate. Also, don't press too hard with the scope and don't have your thumb on top of the bell.

And lotsa practice.

OwlieO.O · Oct 18, 2013

I know it sounds dumb, but are you placing the earpieces in right? They should be pointing forward (toward your field of vision), not backward. Also, are you avoiding crepitation while auscultating? Get a good stethoscope, too. I hear everything with my cardiology iii.

Nurseeverywhere, CNA, LVN · Oct 23, 2013

I hadn't been over to check out my responses but I want to clear up any confussion about not hearing the bp. I do very well with my own stethoscope but its mainly with the teacher/student one that I don't hear squat!!!! I can barely hear the systolic but I will continue practicing and hopefully it is extremely quiet when state exams come around

evaughan · Nov 14, 2013

Just keep practicing. Close your eyes and focus on the thump thump lol. Those teaching stethoscopes are HORRIBLE. I had that same problem in my CNA class. I just practiced a ton on everyone that would let me. Try doing it in a quite room and focusing on the sound as best you can. Also, I agree with other posters, don't be fooled by the "needle jump" it is not always accurate. Also, letting the air out slow is key when you are new to BP. I got yelled at in my clinical exam when I did the BP because I let the air out too slowly. I suggest practicing a ton before the test so you're decent at it before the test. I didn't practice enough. Always check your ear pieces to make sure they're in right, make sure you open your diaphragm on the stethoscope, make sure you can feel the brachial pulse before you put your stethoscope on the arm, place your cuff high enough on the arm….I can't think of anything else right now! Those things helped me.

havehope · Nov 19, 2013

Manual BP is something that comes with practice. The more you do it, the better you get. I finally mastered it after I discovered that your diastolic number is the moment you stop hearing the systolic number. I was also told that if you have trouble getting the diastolic number, watch for the needle to jump? Not sure if that is correct or not. I practiced a lot to get to a point I was good at it. Now I would rather take it manually over using the machine due to the accuracy.

After lots of practice, I noticed that the needle does jump and and the last "jump" would be the diastolic and the first "jump" would be systolic. But, like someone said don't depend directly on that. I use it as a guide, especially when you are in a hospital room taking a manual BP and they have 15 family members with children crying, etc. Just practice, practice, practice. Ask your instructor what they recommend since you cannot hear with her stethoscope. Because, when the skill evaluation comes you will not be able to use your stethoscope. Good luck!

NICUmiiki, DNP, NP · Nov 20, 2013

I usually hear things before the needle jumps and after it stops jumping. DO NOT use the needle jumping to determine BP.