Taking blood pressure. Confused. Help!!

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So I am a first year nursing student (from the UK) doing my training in Italy. I've lived here for the past 15 years (love gets you every time... :redbeathe: :rolleyes::D

So. Yes. Taking BP... I'm a bit confused. We've been told to palpate the radial pulse, inflate the cuff and take the reading when the pulse disappears. This should be the systolic pressure. Then deflate the cuff and WAIT 1-2 MINUTES!! (Erm, what?? Who has time to do this on a busy ward?!)

Then apply the sphyg (under the cuff), inflate to the systolic pressure found previously (still palpating radial pulse), then when pulse disappears, inflate a bit more (20-30 mmHg above systolic pressure) and chart the systolic and diastolic values found by auscultation.

Did you get all that?

I am perplexed on various counts.

1) I have had my BP measured at various times throughout my life in various countries (I'm now 39), and no-one, I repeat NO-ONE, measures BP this way. Rarely is the radial pulse palpated while BP is taken, much less is the cuff deflated between the two readings.

2) Is it really practical to deflate the cuff between readings, especially on a busy ward with tons of vitals to take? Especially as a newbie (first placement next month...)

3) Here they tell us to put the head of the sphyg under the cuff, yet on the Ultrascope site it says the sphyg shouldn't even touch the cuff...

:confused:

Any input would be greatly appreciated. Thanks!!!

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Specializes in geriatrics.

No one has time to wait 1 to 2 min. We were taught to wait 20 seconds. However, realistically, you won't have time to even do that. I usually feel for both the radial and brachial pulses, pump the cuff up while listening, and then pump up 20 to 30 mmHg beyond where I first heard the systolic pressure. I then let the valve out slowly and listen until I don't hear any more sounds. That's your diastolic pressure.

Go by whatever method you are being taught at school. Some instructors will vary slightly.

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Specializes in cardiology/oncology/MICU.

The text books will say to palpate radial pulse and all of that stuff you just said. As far as putting the manometer under the cuff? I put it where I can see it. I have worked on busy floors where lots of thepatients have HTN. I generally do not find anyone with a systolic greater than 180, though it does occur, and that is where I begin. If I pump the cuff to 180, it will almost always occlude the radial pulse. You put the stethescope on the brachial art just above the elbow slightly underneath the cuff. If I can here the whoosh immediately, I go to 220. If not, I proceed with the measurement. Just one more difference between txt book nursing and reality. Educators might not like the deviation from the "book" but then again most educators aren't charged with taking care of multiple patients with multiple needs anymore. This method works and will correlate to an art line that is properly zeroed any day!

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That's the same method i was taught by tutors in a classroom, but as soon as i started clinicals the RNs in the hospital said NEVER to do it that way, that inflating the cuff more than once was causing unnecessary discomfort for the patient... Im still a student but i haven't done it the 'theoretical' way since my very first day of clinicals, its not realistic.

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Specializes in Hospital Education Coordinator.

Your school is trying to teach you the correct way, whether or not that is actual practice. If you just pump up to an arbitrary number the systolic reading could be lower than actual. If you do not wait between pumping for subsequent readings you are not allowing the artery to refill, which means you do not get an accurate reading. Getting a reading and getting an accurate reading is not the same thing. Busy or not, BP is a vital sign. There are lots of signs patients may exhibit, but a few are VITAL. So take the time to do it right and make whoever does your BP do it right too. Otherwise decisions are made based on bad information. You go girl!

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Specializes in Ambulatory Care, Case Manager.

3) Here they tell us to put the head of the sphyg under the cuff, yet on the Ultrascope site it says the sphyg shouldn't even touch the cuff...

:confused:

Any input would be greatly appreciated. Thanks!!!

I think you meant the head of stethoscope, not the sphygmomanometer.

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I think you meant the head of stethoscope, not the sphygmomanometer.

:D Hahaha... yes! Oops, did mean the head of the steth, not the sphyg... ;)

Thanks for pointing that out! :up:

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Specializes in LTC, Memory loss, PDN.

Just get a machine ;), just kiddin'. Actually, the patient may not have the 2 minutes to spare, sometimes you gotta get it quick and then is not the time to practice. I do like to palpate during inflation. Some pt's are more sensitive than others, but it's not necessary and also takes extra time to pump to almost 200 only to find a systolic of 110.

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And if you want accurate readings, make sure that you're using the correct size of cuff for each patient. The inflatable portion of the cuff should cover about 80% of the circumference of the upper arm, and lengthwise the cuff should cover about 2/3 of the distance from the elbow to the shoulder.

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The AHA has an "off the cuff" training module that teaches the correct blood pressure taking just as the OP stated-mind you it is possibly more feasible in an office setting.

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Specializes in ICU.

There are many things that you will be taught in nursing school that is not practical in the real world. The key is to realize that nursing school is the ideal way to do things (ie. no budget or time constraints, no staffing shortages) and the real world is, um, real. I'm not saying one is right and the other is wrong, just different for different focuses.

To answer your question, yes, this is how I was taught to take a BP in school too.

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Thanks everyone - you've been a massive help!!! :up:

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