Taking blood pressure. Confused. Help!!

[purplesteth]

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:

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...

Any input would be greatly appreciated. Thanks!!!

[nurseprnRN, BSN, RN]

Biggest error I see in BP measurement is when the cuff isn't completely let down between measurements, or even when you discover that the systolic is higher than 180 :). This matters because the diastolic pressure will be artificially elevated if the venous system in the arm is full of blood that couldn't escape because the cuff was pumped up above the venous pressure (think: how hard is it to occlude venous outflow? You do it every day with little tourniquets if you draw blood). If the arterial line you're "calibrating" your cuff pressure to is on the same arm, it too will show an elevated diastolic pressure. This does not prove that you did it right, only that a transducer can read pressures:).

Answer is to let the cuff down to zero and raise the arm up to drain the veins (look at the veins on the back of your hand while sitting at your keyboard and then raise it above your head-- see?). Then start over. And don't take all day letting it down , either, for the same reason. With practice you'll get a better feel for timing. Just remember the physiology of what you're reading and why it works like that.

[greatshakes]

There is a little rhyme in regard to blood pressure which I heard in recovery but I can't remember it. Something about raising the head if (blood pressure was) high or the lower end if low or maybe I have it vice versa. It was really good though. Can someone throw any light on it please?

[akulahawkRN, ADN, RN, EMT-P]

A real-world way to quickly obtain an auscultated BP without causing to much discomfort is to palpate the radial artery, inflate the cuff until you feel the pulse disappear, make a mental note of it, as you continue inflating 20-30 mmHg beyond that point, place your steth head and listen while you deflate the cuff. The first sounds you hear should closely correspond to the point where the pulse disappeared (SBP) and the last you hear should be the diastolic pressure. It's a lot easier to do than to explain it.

This way, that patient with a SBP of 110 doesn't get hugely squeezed while that patient with the 190 SBP only has to have their arm squeezed hard once every time vitals are done. Is it exactly the book method? No. It still works.

If you're particularly dextrous, take a palpated pressure as you do an auscultated one.

[nurseprnRN, BSN, RN]

"There is a little rhyme in regard to blood pressure which I heard in recovery but I can't remember it. Something about raising the head if (blood pressure was) high or the lower end if low or maybe I have it vice versa. It was really good though. Can someone throw any light on it please?"

This is to help you remember what to do. We also teach it to Boy Scouts, who obviously don't take blood pressures but the principle is the same based on physical appearance.

Face is pale. raise the tail (for pallor/low BP, Trendelenburg)

Face is red, raise the head (elevate head if BP is high)

[greatshakes]

Thanks so much wowland. Easy to remember.

[Jenni811, RN]

we've been taught that way too in nursing school, but doing 2 step method causes the need for it to be inflated twice. This causes discomfort, twice. Not ideal in elderly patients who yell it hurts, or a combative patient who is giving you "one shot".

Usually what i do, is i will look at their previous blood pressures to see what they have been running. Lets say for example they run usually around 120. I will pump the cuff up to 140 or so, then listen for when it starts, and when it stops. This way i don't have to pump it up to 200 (ouch!!). Obivously, if i start at 140 and hear something right away, then maybe i need to go a little higher....

i dont know if i explained that good, but it works, you get accurate BP and you only have to do it once (majority of the time)

[Jenni811, RN]

"There is a little rhyme in regard to blood pressure which I heard in recovery but I can't remember it. Something about raising the head if (blood pressure was) high or the lower end if low or maybe I have it vice versa. It was really good though. Can someone throw any light on it please?"

This is to help you remember what to do. We also teach it to Boy Scouts, who obviously don't take blood pressures but the principle is the same based on physical appearance.

Face is pale. raise the tail (for pallor/low BP, Trendelenburg)

Face is red, raise the head (elevate head if BP is high)

I like it :-D