Problem with taking Blood pressure. grr.

KCbaby57 · Aug 3, 2011

you have to press harder than other pulse sites and sort of under the bicep muscle to find the brachial pulse, just keep trying. also it sounds silly but make sure you have your stethoscope's ear pieces on the right way...i was wearing mine backwards for like a month and was always frustrated that i couldn't hear anything. they are supposed to go in the uncomfortable way...

Thujone · Aug 3, 2011

Have the person you are taking BP reading on pop their forearm out, it will tighten the skin, therefore making it easier to find the brachial artery, but like KCbaby57 said, sometimes the brachial artery is just a bit higher up and on the inner side of the bicep.

tech1000 · Aug 3, 2011

Make sure the stethescope is on right (I've had a hard time hearing the BP with it on the right way, so I had asked a nurse to do it and she put hers on backwards! I was shocked she even got a BP. Also, I've seen nurses put the stethescope on the wrong side of the arm for the brachial artery, so make sure you're actually putting it in the right spot.

Dorali, BSN, LPN, RN · Aug 3, 2011

It's straight up from the pinky finger, if that helps any. Didn't see any mention of that yet.

boogalina, ADN, ASN, BSN, MSN, LPN · Aug 4, 2011

You might want to purchase an inexpensive BP cuff (I got one at a pharmacy for about $15) and then practice, practice. This will help your confidence on this skill. Good luck! You can do it!

Sheenabush · Aug 4, 2011

Thanks! helped a lot today! i could actually find it better. yea i wear it the uncomfortable way. with the ear things going in toward the ear. and yea i have my own stethoscope, i will probably need to go get the cuff now. i thought they were expensive so i havent got one yet but i will look at a local drug store/pharmacy to see if they have a cheap one. everyone coming over to my house will be my victim! lol & i can usually feel it when i use a little pressure, but i am afraid i will press TOO hard on the residents. i found that the little things pulses also, but cant rely just on that for the testing. thanks for the youtube also! watching the videos help quite a bit

akulahawkRN, ADN, RN, EMT-P · Aug 4, 2011

Taking a BP isn't that hard... once you know what to feel and listen for. Make sure the cuff is properly sized for the patient and applied snugly - tight enough that it won't fall off if the patient points his or her arm straight down at the floor. Keep the elbow as straight as possible and the nice big biceps artery will be palpable just inside the biceps tendon, above the elbow joint. Once you know where that artery is on that patient, put the steth head (diaphragm side) right over that spot and don't change anything... inflate the cuff while listening and you should start hearing the sounds. Keep inflating until about 20mmHg after you stop hearing the sounds and note the point when you start hearing the sounds again as you deflate the cuff slowly. That's your SBP. Keep deflating until you no longer hear the sounds. That's your DBP.

There will be people that are almost impossible to get a good BP on. The good news is that after doing BP's a few hundred times on different patients, you'll know the sounds you're listening for and you'll be able to pick them out despite normal background noise. Watching for needle bounce is a secondary means of verifying that you're hearing sounds at the right time, but this is not a precise method of taking a BP. Our eyes aren't sensitive enough to do oscillometric BP measurements like auto cuffs can.

In time, this will all become second-nature to you and you'll just do it without putting much thought into the skill and you'll get to be fairly speedy and efficient about the whole process.

Something else I should add... sometimes the sound you hear is not so much a sound as it is a pressure against your eardrums. Most of the time though, the sounds will be quite discrete and unmistakeable.

Sheenabush · Aug 4, 2011

i have been able to hear it maybe once or twice, really well. others it is impossible for me to hear for some reason. but i am thinking if i just keep at it, it will get easier. like you said, after doing it a lot, it will probably be much easier, once i get used to the sounds and everything. and yea, iknow not to rely just on the thing moving. because my luck, for the test, it will be completely wrong. so that is why i am trying to get the bp down. but for some reason this is the only thing i am having a problem with, and it seems like it is the easiest part!

CarolinaGirl1112 · Aug 5, 2011

I can tell you what helped me in class. Have the patient/guinea pig stick their arm out palm up and completely straighten it so that their elbow locks. Then, using a finger or just your eyes, trace a straight line from their pinkie finger to the inner aspect of their elbow. You should be able to find the pulse a lot easier this way, but it's really important that the elbow is locked as it does make a difference if it's bent a little.

Oh, and I'm not sure if it makes a difference, but one of our instructors pointed out that in our skills book it says that we have to feel for the brachial artery, not actually find it. Just something to keep in mind.

Best of luck to you!

Starletta, CNA · Aug 5, 2011

As CarolinaGirl said, follow a line from the pinkie finger. And you do have to press harder than you would with a Radial Pulse. Although, my Instructor said you may not always feel it. So, put your Stethoscope where the Brachial pulse should be and try taking the BP. You'll probably still be able to get the BP.

I practiced on my husband many times without actually locating the pulse, and was still able to get a BP reading. Of course, you have to be somewhat in the right area. :)

fuzzywuzzy, CNA · Aug 5, 2011

I could never hear a thing in class, partly because it was noisy and mostly because the stethoscopes they gave us were lousy. Once I started working I was nervous about having to take manual BPs but the first time I did it, I had no problem. Once it "clicks" you can do it all the time, so keep practicing.