Review trouble-shooting tips, including proper technique and equipment, for taking a manual blood pressure (BP) to ensure that the measurement is accurate.
Manual blood pressure readings are considered more accurate than most non-invasive electronic blood pressure monitoring systems, but many people, especially those who are inexperienced measuring blood pressure, may discover that the accuracy of the reading often depends upon the technique utilized. Review common problems and solutions below.
Nothing is Heard When Trying to Take a BP
If the patient has a palpable pulse, he should also have a blood pressure, but sometimes the pressure may be difficult to hear. Improve sound quality with the following checks:
Does the environment have excessive background noise? If possible, decrease environmental noise to aid in ability to hear the beats. As providers get more practice and become more comfortable taking blood pressures, they can often check a blood pressure with quite a bit of background noise, particularly if emergency care is being provided. Using a palpated technique might be one option if hearing the beats is impossible.
Are the earpieces of the stethoscope in the provider’s ears? It may help to angle the earpieces slightly forward to point toward the provider’s nose if having trouble hearing. Many stethoscopes have various sizes of earpieces that may also help if the provider is having trouble hearing through them. Special stethoscopes with adaptive devices with a volume control are available for those with hearing deficits.
Is the diaphragm/bell of the stethoscope turned in the correct direction? An easy and quick way to check this is to lightly tap on the side the provider wishes to place against the patient’s skin. This tapping will be quite loud if it is turned to the correct side.
Is the stethoscope placed directly over the brachial artery? The patient’s palm should be turned up and the provider should palpate the brachial artery before placing the stethoscope on the skin. The cuff should be positioned approximately one inch above the bend in the elbow. Other areas of the body might also be used if an arm pressure cannot be taken, and the location of the artery could be achieved in a similar manner.
Has the provider pumped enough air into the cuff initially? For example, if the cuff is only inflated to 130 at the start of taking a blood pressure, someone with an unusually high blood pressure, like 210/150, would have an inaudible reading because the cuff was not sufficiently inflated.
Is the provider “giving up” and letting the air out of the BP cuff too quickly? Some people may assume that they will not hear anything if the gauge reaches 100 or so and then quickly lets all the air out. Sometimes a person’s systolic pressure may be 90 or less, so a wise practitioner will continue to slowly and smoothly let the air out of the cuff until the gauge has reached well below the expected systolic number.
Avoiding Inaccurate Manual Blood Pressure Readings
Proper technique and equipment are critical for obtaining the most accurate blood pressure readings.
Use proper equipment in order to get an accurate BP reading, and be sure to do the following:
- Inspect all equipment, including the stethoscope and sphygmomanometer, to ensure proper working order and properly calibrated.
- Use equipment per manufacturer’s directions.
- Use a properly sized cuff.
Incorporate correct technique to ensure that a manual blood pressure is as accurate as possible by:
- wrapping the cuff properly on bare skin
- positioning the arm or other extremity so that the gauge is clearly visible
- using the same arm or other extremity for all readings
- ensuring that the gauge level is at zero and at eye level before beginning
- knowing how to read the gauge at a glance
Providers should also avoid deflating the cuff too quickly or slowly – the air should be let out steadily and smoothly until the last beat is heard. If there is a long pause and then the beats begin again, this is known as an auscultatory gap and should be reported and recorded.
Providers should also avoid checking blood pressure on an extremity that is contraindicated for BP, such one that has:
- an IV
- a dialysis fistula or shunt
- a mastectomy on that side
- paralysis
- impaired circulation
- an injury, burn, or fracture
- a pressure ulcer or other wound or cast
- excess fluid or edema
Alternate extremities include areas such as the forearm and thigh. Some patients may need to have blood pressure checked by invasive means if non-invasive measurements are impossible to obtain.
If the patient is sitting, ensure that her legs are not crossed before taking the blood pressure. Some patients have “white coat hypertension,” which results in inaccurately high blood pressure readings due to anxiety.
The Importance of Accurate Blood Pressure Readings
Assessment and treatment is often based on blood pressure readings, so accurate measurements are critical in order to provide safe and appropriate care to the patient. Utilizing proper equipment and technique can significantly improve the accuracy of manual blood pressure readings.
Providers who wish to practice their skills may find it helpful to listen to the beats and record blood pressure measurements in this practice BP test. Readers may also wish to read the following articles:
- How to Speak to Someone Who Cannot Speak gives practical tips for communicating with someone who has aphasia.
- Does No Code Equal No Care? gives information about DNR orders and how they relate to patient care.
- How to Make a Bed With Someone in It provides practical step-by-step instructions for changing an occupied bed.
Information in this article is not medical advice. People with questions regarding diagnosis and treatment of blood pressure are encouraged to seek the advice of their personal healthcare provider. Anyone experiencing life-threatening symptoms should seek emergency care immediately. Readers are welcome to post comments in the box below.
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