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Friday, October 20, 2017

How to Read Blood Pressure Manually

For clinicians, nurses, and caregivers managing care and treatment for patients with chronic illness, skills like taking pulse and heart rate, reading temperature, measuring oxygen saturation levels, and tracking blood pressure readings are basic day to day necessities.

Many of these vitals rely on digital devices for accurate and fast measuring and reading, however, it is helpful that care providers know how to manually record stats in the event that a device malfunctions (i.e. low battery, error, etc).

Reading blood pressure manually requires only a few tools and a handful of basic steps. Equipment needs include:

-    Good quality stethoscope
-    Blood pressure cuff that appropriately fits the patient
-    Blood pressure reading device like an aneroid sphygmomanometer

Keeping equipment in good condition means storing or carrying it around in a case or bag that prevents it from colliding with other instruments or getting damaged. Click here to read more about the best stethoscope cases.

Following these steps for manually reading blood pressure is critical to accurate readings and patient comfortability.

First a patient must be relaxed for as little as five minutes, and if possible, sitting upright in a chair with their feet flat to the ground. For patients with mobility limitations, sitting up in a wheelchair or hospital bed will also suffice. Avoid speaking with the patient while taking a blood pressure reading so that they are not agitated or excited, and so you can properly hear through your stethoscope. Remove any excess clothing that could cut off blood flow to the arm or cause an erroneous reading like jacket sleeves, etc.

Secondly, you’ll want to have your patient raise their left arm so the upper arm is positioned at the height of the heart. You will want to wrap the blood pressure cuff around the patient’s upper arm high enough so the bell of the stethoscope can fit easily in the crease where the arm bends over the brachial artery. Use the range notations on the cuff to make sure the circumference of your patient’s arm falls within the recommended index and you know you don’t need a larger or smaller cuff. A mark on the cuff which points to artery should be positioned above the brachial artery - this artery runs along the inside of the upper arm.

Put your stethoscope on, place the bell accordingly on the antecubital fossa (bend of the arm) on top of the brachial artery and listen for strong pulse sounds. Inflate the cuff by pumping the bulb until pulse sounds are no longer audible through your stethoscope. Inflate until you reach between 160 to 180 mmHg on the dial (or 30 to 40mg over your patient’s normal blood pressure reading). There should be a few seconds between deflating and hearing pulse sounds again, so if you hear them right away, try inflating the cuff to a higher level.

Begin deflating the cuff at around 2 to 3mmHg per second, listening out for two distinct sounds. The first will be your systolic pressure reading. A tapping or rhythmic sound as you deflate the cuff and blood begins flowing back through the brachial artery will begin. Note the reading at this point, and listen on for the moment when the pulsing sound stops (that will be your diastolic pressure reading).

Write down or digital record the reading in a log that track blood pressure over time. For patients and caregivers, make sure you are checking blood pressure at roughly the same time each day to formulate a clearer baseline.

The Mayo Clinic recommends taking two readings at a time to measure for accuracy, about five minutes apart. Patients who have recently smoked, drank coffee, are stressed, are cold, or are on certain medicines may have slightly higher than normal readings for them. In these cases, two readings can help to record a successful measurement. White coat syndrome, or the phenomena where patients exhibit higher than normal blood pressure readings but only at a doctor’s office or other clinical setting, can also lead to inaccurate readings that require a second measurement.

With rates of hypertension at an all time high, 1 out of 3 adults over 20 living with hypertension, understanding how to precisely and successfully read a blood pressure reading manually is a helpful skill for clinicians, caregivers, and patients.

This is a guest blog entry.

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