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How To Do A Manual Blood Pressure

Which Arm To Measure Blood Pressure Right Or Left

How to Take a Blood Pressure Manually

To check the blood pressure manually, sit in a relaxed position with the arm at rest on a table. Secure the cuff on the bicep and squeeze the balloon to increase the pressure. Watch the aneroid monitor and increase the pressure to about 30 mm Hg over the normal blood pressure, or to 180 mm Hg if this is not known.

Before You Measure Your Blood Pressure

  • Avoid things that can raise your blood pressure in the short term. Dont measure your blood pressure within half an hour of eating, smoking, drinking caffeinated drinks such as coffee, or exercising. These can all raise your blood pressure temporarily. If you need to use the toilet, go before you measure your blood pressure.
  • Wear loose-fitting clothes. Wear a short-sleeved t-shirt or something with sleeves you can push up easily, nothing tight. This is so that you can fit the cuff around your arm.
  • Rest for five minutes before you take your reading. Sit down somewhere quiet, ideally at a desk or table. Have your back supported with your arm resting on a firm surface and your feet flat on the floor. Stay in this position while you take your blood pressure.
  • Make sure your arm is supported and at the same level as your heart. Position yourself so that your arm is resting on a surface and is at the same height as your heart. Keep your arm and hand relaxed, not tensed.
  • Make sure you are relaxed and comfortable. If you are anxious or uncomfortable, your blood pressure will rise temporarily.

The Sounds Of Blood Pressure: What Are We Listening For

Ever wonder what doctors and nurses are listening for when they are manually taking your blood pressure?

Blood pressure. Its one of the most important measurements in medicine. And yet, taking it correctly is kind of an art. Its fluid, it changes, and it can be impacted by something as simple as being at the doctors office.

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Clinical Early Warning Signs Of Patient Deterioration

  • Partial airway obstruction
  • Sp02 90 95%
  • Respiratory Rate 5 9 bpm or 30 40bpm
  • Pulse Rate 40 50 or 120 140
  • Systolic BP 80 100 mmHg or 180 240 mmHg
  • Poor peripheral circulation
  • Urine output < 200mls over 8 hours
  • Greater than expected drainage fluid loss
  • A drop in GCS of 2 points or GCS < 12 or any seizure
  • New or uncontrolled pain
  • ABGs
  • BE -5 to -8 mmol/L
  • BSL 1 3 mmol/L
  • Automated Vs Manual Blood Pressure Readings: The Importance Of Hypertension Home Monitoring

    Blood pressure measurement

    Blood pressure is one of the four vital signs that can indicate a persons current health state. When the blood pressure reading is accurate, it can provide information on how blood circulated through the arteries. High blood pressure intervals could indicate hypertension, so its always best to measure your blood pressure at least twice before jumping to any conclusions, especially if the results are high.

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    Your Readings Exhibit Prejudice

    Prejudice for normal readings significantly contributes to inaccuracies in blood pressure measurement. No doubt, youd be suspicious if a fellow EMT reported blood pressures of 120/80 on three patients in a row. As creatures of habit, human beings expect to hear sounds at certain times and when extraneous interference makes a blood pressure difficult to obtain, there is considerable tendency to hear a normal blood pressure.

    Orthostatic hypotension is defined as a decrease in systolic blood pressure of 20 mm Hg or more, or diastolic blood pressure decrease of 10 mm Hg or more measured after three minutes of standing quietly.

    There are circumstances when BP measurement is simply not possible. For many years, trauma resuscitation guidelines taught that rough estimates of systolic BP could be made by assessing pulses. Presence of a radial pulse was thought to correlate with an SBP of at least 80 mm Hg, a femoral pulse with an SBP of at least 70, and a palpable carotid pulse with an SBP over 60. In recent years, vascular surgery and trauma studies have shown this method to be poorly predictive of actual blood pressure .

    Noise is a factor that can also interfere with BP measurement. Many ALS units carry doppler units that measure blood flow with ultrasound waves. Doppler units amplify sound and are useful in high noise environments.

    What Is Blood Pressure

    Blood pressure is a measure of the pressure exerted by the blood as it flows through the arteries. It is measured in millimetres of mercury .

    The purpose of taking a blood pressure measurement may be to:

  • Determine a persons haemodynamic status
  • Gain a baseline and
  • Monitor for changes from the baseline.
  • Blood pressure measurements take into account:

    • Systolic measurements and
    • Diastolic measurements .

    A normal systolic range for an adult is 100-140mmHg and a normal diastolic is 60-89mmHg.

    Influencing factors include but are not limited to anxiety, cardiac output, vascular resistance, blood volume and blood viscosity, age, exercise, stress, ethnicity, gender, medications, body weight, diurnal variations, disease processes, hypervolaemia and hypovolemia.

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    Automated Blood Pressure Monitor Insight

    Automatic blood pressure monitors are normally indicated for people who have trouble using a stethoscope, like those with hearing problems. When your experience hearing problems, you wont be able to identify the sounds that indicate to check the aneroid monitor and write down your systolic and diastolic pressure.

    These monitors are different from one brand to another, but manufacturers should always provide step-by-step instruction on how to use the device and get the best results when monitoring your own blood pressure. If you are confused about how to use it, your doctor will surely explain the steps, and aid you into discovering how to get the most accurate readings.

    Talk to your doctor about taking the device with you the next time you visit their office. With the help of the doctors reading, you can calibrate the machine for better accuracy. Its crucial to purchase a high-quality machine that offers accurate reading, in order to avoid unnecessary treatment changes.

    To Complete The Procedure

    How to Take a Blood Pressure Manually | The Correct Way!

    Once a blood pressure recording has been obtained, remove the blood pressure cuff.

    Explain to the patient that the procedure is now complete.

    Discuss the blood pressure results with the patient, including any furthersteps that may need to occur .

    Thank the patient for their time.

    Dispose of PPE appropriately and wash your hands.

    Document the lowest blood pressure recording in the patients notes.

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    This Old Tech: Why Manual Blood Pressure Monitors Still Play A Role In Healthcare

    Ernie Smith is a contributor to HealthTech and a tech history nut who researches vintage operating systems for fun.

    A routine part of almost any visit to the doctor involves a quick check of a patients blood pressure.

    And despite increasingly more advanced ways to do so, an inflatable cuff with a built-in measuring unit remains the most common way to perform this basic task.

    For roughly 150 years, the blood pressure monitor more formally known as the manual sphygmomanometer has remained the preferred way to check a persons vitals. Heres why:

    Estimate An Approximate Systolic Blood Pressure

    To begin with, you need to determine an approximate systolic blood pressure. This is helpful in preventing over-tightening of the cuff during the accurate measurement of blood pressure.

    1. Ensure the valve on the blood pressure cuff is closed.

    2. Palpate the patients radial pulse, located at the radial side of the wrist, with the tips of your index and middle fingers aligned longitudinally over the course of the artery.

    3. Inflate the blood pressure cuff until you can no longer feel the patients radial pulse. Note the reading on the sphygmomanometer at the point at which the radial pulse becomes impalpable. This reading is an approximate estimate of the patients systolic blood pressure.

    4. Open the valve and deflate the blood pressure cuff.

    • Palpate the radial pulse
    • Inflate the cuff until the radial pulse is no longer palpable
    • Note the reading when the radial pulse is no longer palpable

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    Automated Blood Pressure Machines

    The easiest and most accurate way to measure the blood pressure at home is to buy an automated blood pressure monitor with an upper arm cuff.

    The instructions for use may vary with each machine, and a person should follow them carefully to ensure proper operation. If the instructions are difficult to understand, a local pharmacy or doctors office will be able to show a person how to operate the machine correctly.

    Doctors may ask a person to bring their at-home machine to the office during their next visit to test the accuracy compared to the doctors reading.

    Using a high-quality machine is important, as inaccurate readings may cause unnecessary or harmful changes in medications or treatments.

    A variety of blood pressure monitors are available for purchase online and in most drug stores. A person may wish to speak to a doctor about which brand they recommend.

    There are apps and wrist devices that claim to measure the blood pressure, but these results are frequently inaccurate and are not a reliable way to monitor a persons health.

    Apps that log blood pressure results may be helpful for people who need to take regular blood pressure tests, however.

    Recording a set of readings into these apps may help doctors identify trends in blood pressure and recommend treatments.

    Digital Blood Pressure Cuffs Are Inaccurate

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    A 2017 study compared manual versus automated blood pressure management in intensive care units, coronary care, and ER settings. It recorded that blood pressure was frequently recorded higher, often differing by as much as 15 mmHg higher.

    Their conclusion was that they could not completely trust digital blood pressure cuffs in a hospital or critical care settings.

    Although digital blood pressure cuffs are easier to use and can still produce accurate readings, because an aneroid model, when properly calibrated and operated, is more reliably accurate with a small margin of error, it wins out.

    For home use, quick readings, and situations where clinical accuracy isnt required, digital blood pressure cuffs are fine. But in clinical settings, hospitals, clinics, and emergency services, the aneroid blood pressure cuff sets the standard for accuracy and reliability.

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    Manual Blood Pressure Readings

    Blood can only be heard through a stethoscope if it is turbulent. As the cuff is inflated, the artery is compressed, making the blood flow through the artery turbulent. When the artery is completely closed, there is no blood flow and no sound. As pressure in the cuff is reduced, the point at which the artery is open just enough to let the blood pass, is the systolic blood pressure.

    This is detected by turbulent blood flow heard through the stethoscope. As pressure in the cuff is further reduced, the vessel will once again be completely open and non-turbulent. At this point, no more sound is heard and diastolic blood pressure has been reached.

    Performing A Manual Blood Pressure

    Example Skill

    This is an example of one of the skills included in “The Nursing Toolbox”. This particular skill page relates to “Performing a Manual Blood Pressure”, however there are many more skills available once you subscribe to “The Nursing Toolbox”.

    Please remember to scroll right to the bottom of this page to view the accompanying video!

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    Youre Using The Wrong

    The most common error when using indirect blood pressure measuring equipment is using an incorrectly sized cuff. A BP cuff that is too large will give falsely low readings, while an overly small cuff will provide readings that are falsely high.

    The American Heart Association publishes guidelines for blood pressure measurement . recommending that the bladder length and width should be 80 percent and 40 percent respectively, of arm circumference. Most practitioners find measuring bladder and arm circumference to be overly time consuming, so they dont do it.

    The most practical way to quickly and properly size a BP cuff is to pick a cuff that covers two-thirds of the distance between your patients elbow and shoulder. Carrying at least three cuff sizes will fit the majority of the adult population. Multiple smaller sizes are needed if you frequently treat pediatric patients.

    Korotkoff sounds are the noises heard through a stethoscope during cuff deflation. They occur in 5 phases:

    • I first detectable sounds, corresponding to appearance of a palpable pulse
    • II sounds become softer, longer and may occasionally transiently disappear
    • III change in sounds to a thumping quality
    • IV pitch intensity changes and sounds become muffled
    • V sounds disappear

    Wrap Cuff Around Partner’s Arm

    Blood Pressure Measurement: How to Check Blood Pressure Manually
    • Tuck the end of the cuff through the metal loop and slide onto your partners arm. Using the Velcro on the cuff, secure the cuff roughly one half inch above the bend of the elbow.
    • The cuff will have a line or arrow marked on it so that it can be properly placed around the arm.
    • Make sure the line or arrow lines up with the brachial artery in the inner elbow. The pulse felt in step one gives the general position of the brachial artery.
    • The cuff should fit snugly so that the skin is not pinched.
    • It should be possible to fit two fingertips under the cuff, but not the entirety of the fingers.

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    Second Step: Measure Blood Pressure

    Now, you can start to measure blood pressure. Place the bell of the cleansed stethoscope over the brachial artery using a light touch and complete seal. Inflate the cuff to the maximum pressure inflation number . Open the valve slightly. Deflate the cuff slowly and evenly at about 2 mm Hg per second. See Film Clip 5.3 which focuses on the speed of the needle when deflating the blood pressure cuff.

    Note the points at which you hear the first appearance of Korotkoff sounds and the point at which the Korotkoff sounds go silent . These sounds are called Korotkoff sounds and vary in quality from tapping, swooshing, muffled sounds, and silence. The pressure at which the first Korotkoff sound is noted signifies the systolic pressure, while the pressure at which the Korotkoff sounds are no longer heard marks the diastolic pressure. See Audio Clip 5.1 to listen to Korotkoff sounds and noting systolic and diastolic blood pressure. Alternatively, if viewing textbook as a pdf, use this link:

    Film clip 5.3: Deflation rate of sphygmomanometer

    Alternatively, if viewing textbook as a pdf, use this link:

    Youve Placed The Cuff Incorrectly

    The standard for blood pressure cuff placement is the upper arm using a cuff on bare skin with a stethoscope placed at the elbow fold over the brachial artery.

    The patient should be sitting, with the arm supported at mid heart level, legs uncrossed, and not talking. Measurements can be made at other locations such as the wrist, fingers, feet, and calves but will produce varied readings depending on distance from the heart.

    The mean pressure, interestingly, varies little between the aorta and peripheral arteries, while the systolic pressure increases and the diastolic decreases in the more distal vessels.

    Crossing the legs increases systolic blood pressure by 2 to 8 mm Hg. About 20 percent of the population has differences of more than 10 mmHg pressure between the right and left arms. In cases where significant differences are observed, treatment decisions should be based on the higher of the two pressures.

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    Questions To Ask Your Doctor

    • Why do I need to monitor my blood pressure at home?
    • How often do I need to measure my blood pressure?
    • What type of monitor should I use?
    • What do my blood pressure readings mean?
    • What is considered a normal blood pressure for me?
    • What should I do if my readings are abnormal?
    • Are there any lifestyle changes I can make to help manage my blood pressure?
    • Do I need to take medicine to manage my blood pressure?
    • What other things can affect a blood pressure reading?

    Measure The Blood Pressure Accurately

    How To Check Blood Pressure Manually

    Now that you have an approximate systolic pressure, you can perform an accurate assessment of systolic and diastolicbloodpressure.

    1. Close the valve on the blood pressure cuff.

    2. Position the diaphragm of your stethoscope over the brachial artery.

    3. Re-inflate the cuff 20-30 mmHg above the systolic blood pressure you previously estimated.

    4. Then slowly deflate the cuff at around 2-3 mmHg per second.

    5. Using your stethoscope, listen carefully for the onset of a pulsatile noise. The first of these pulsatile noises is known as the first Korotkoff sound. The pressure at which the first Korotkoff sound becomes audible represents the patients systolic blood pressure.

    6. Continue to deflate the cuff, whilst listening through your stethoscope until the pulsatile sound completely disappears. The final pulsatile noise you hear is known as the fifth Korotkoff sound and represents the patients diastolic blood pressure.

    7. If the patients blood pressure is outside of the normal range you should repeat the assessment on the same arm after a few minutes and also consider assessing blood pressure using the patients other arm.

    • Palpate the brachial artery
    • Place the stethoscope over the brachial artery
    • Re-inflate the blood pressure cuff
    • Slowly deflate the cuff
    • Listen for first Korotkoff sound and note the systolic blood pressure
    • Listen for fifth Korotkoff sound and note the diastolic blood pressure
    • Remove the blood pressure cuff
    Blood pressure abnormalities

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    What Does Your Blood Pressure Reading Mean

    If this is your first time taking your blood pressure, discuss the results with your doctor. Blood pressure is a very individualized vital sign reading, which means it can be very different for each person. Some people have naturally low blood pressure all the time, for example, while others may run on the higher side.

    In general, a normal blood pressure is considered anything less than 120/80. Your own personal blood pressure will depend on your gender, age, weight, and any medical conditions you have. If you do register a blood pressure reading of 120/80 or over, wait two to five minutes and recheck.

    If its still high, talk to your doctor to rule out hypertension. If your blood pressure ever goes over 180 systolic or over 120 diastolic after a repeat reading, seek emergency medical care right away.


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