Monday, January 6, 2014

Blood Pressure Trouble-shooting Guide: How to Keep BP Accurate and Avoid Common Mistakes

Tips for Taking an Accurate Blood Pressure - Photo by deanjenkins
Checking a patient's blood pressure is one skill that that requires particular precision. Being able to accurately take a blood pressure is imperative because this information may play a pivotal role in determining options for an appropriate plan of care.

Many students find this procedure to be difficult. It involves using pieces of equipment of which the student may be just learning to use and involves using the eyes, ears, and hands in ways that are unfamiliar. Many students are nervous when learning how to check a blood pressure, but many caregivers master this skill with a little practice and perseverance.

This trouble-shooting guide is based on taking a manual blood pressure on a patient's upper arm. Always use equipment according to the manufacturer's directions. If a patient appears to be in distress, has no pulse, has stopped breathing, or becomes unconscious, the caregiver should summon assistance and begin appropriate care per facility policy.

This guide assumes that the patient is not in distress and that trouble-shooting would be appropriate. Caregivers who are unsure that the blood pressure reading is accurate should ask for assistance from another caregiver.


Problem

Check the following
I cannot hear any beats.
  • Are you checking BP on an area of the patient's body that is safe and without contraindications?
  • Are you using a correctly sized cuff that is properly positioned and functioning?
  • Have you turned the patient's arm so that the palm is up?
  • Have you placed the cuff on the patient's bare arm in the proper position?
  • Have you reduced distractions?
  • Did you pump up the cuff high enough?
  • Did you listen while letting out the air slowly and steadily until you reached a low number, such as 30 (If the patient's BP is 40/20, for example, you won't hear a sound until you get to 40)?
  • Is the diaphragm/bell on the stethoscope in the correct position (check to make sure you can hear noises through the stethoscope)?
  • Are the stethoscope ear pieces the correct size for your ears?
  • Are the stethoscope ear pieces angled to the front (toward your nose) and in your ears?
  • Is the stethoscope positioned over an artery?
  • Are you applying enough pressure to keep the stethoscope in place over the artery but not so much pressure that you are occluding circulation?
  • If you have a hearing deficit, have you looked at adaptive devices, such as a stethoscope with a volume control?
  • Can you hear a BP on others and only have the problem with this patient - if so, are other caregivers having the same problem?
I can barely hear the beats.
  • Are you checking BP on an area of the patient's body that is safe and without contraindications?
  • Are you using a correctly sized cuff that is properly functioning?
  • Have you turned the patient's arm so that the palm is up?
  • Have you placed the cuff on the patient's bare arm in the proper position?
  • Have you reduced distractions?
  • Is the stethoscope positioned over an artery?
  • Are you applying enough pressure to keep the stethoscope in place over the artery but not so much pressure that you are occluding circulation?
  • If you have a hearing deficit, have you looked at adaptive devices, such as a stethoscope with a volume control?
  • Can you hear a BP on others and only have the problem with this patient - if so, are other caregivers having the same problem?
The beats are gone before I can figure out the numbers.
  • Have you tried letting the air out of the cuff more slowly?
  • Are you tightening the bulb just enough to hold the air but not so tightly that you have a hard time loosening it?
  • Is the gauge positioned so that you can easily see it?
  • If you have difficulty seeing the gauge, have you had an eye exam, and are you wearing glasses if needed?
  • Have you practiced looking at the gauge so that you can quickly determine the number at a glance?
I hear beats as soon as I begin to let the air out of the cuff.
  • Have you tried pumping the cuff higher?
  • Have you tried palpating a radial pulse while pumping up the cuff and then pumping about 30mmHg higher before letting any air out?
I hear beats, then they disappear, but then I hear beats again.
  • This may be an auscultatory gap rather than a procedure error - make sure to alert the nurse to this finding because it could indicate a heart issue.
The patient says his/her arm is hurting while I'm checking the BP
  • Have you double-checked to see if there might be contraindications for checking BP in this arm?
  • Have you checked the patient's skin under the cuff?
  • Are you pumping the cuff too high for this patient? (You only need to pump it about 30mmHg higher than the systolic number.)
  • Are you immediately letting the air out at a steady pace once you have pumped the cuff sufficiently and avoiding pauses in the procedure while the cuff is inflated?
It seems to take me forever to take a BP.
  • Have you practiced on friends, families, classmates, etc.?
  • Don't worry - you'll get more proficient as you get more experience and practice!
I forget the BP before I can record it.
  • Do you carry paper and pen with you?
  • Have you tried writing down the numbers as soon as you finish checking the BP so that you can transfer it to the patient care record as soon as possible? (You may need to have a designated pen and small writing tablet that stays in the room if the patient is under transmission-based precautions.)
  • Have you reduced distractions immediately after the procedure to give you time to record the information?

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I hope you find this resource to be helpful to you. Check out my other articles, flash cards, practice tests, and articles at my Student Survive 2 Thrive blog.

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