Manual Blood Pressure Measurement

Introduction

• Manual blood pressure measurement is a crucial skill, often challenging for nursing students.
• Essential in scenarios like extremely low or high blood pressure to ensure accuracy before medication administration.

Equipment and Preparation

• Cuff Size: Ensure the cuff is the right size for the patient.
• Cuff Positioning:
  • Place on the bare upper arm, 1 inch above the elbow bend (intercubital space).
  • Tubing should be over the front center of the arm.
  • Secure cuff snugly—not too tight or too loose.
• Visibility: Ensure the pressure gauge is visible for accurate reading.

Procedure

1. Close Airflow Valve:
   • Use thumb and forefinger to screw it clockwise.
2. Palpate the Brachial Artery:
   • Essential for accurate measurement.
   • Place stethoscope on palpated area.
3. Stethoscope Placement:
   • Ear pieces in ears, listen for pulse.
4. Inflate the Cuff:
   • Squeeze bulb multiple times; inflate to 30 mmHg above expected systolic level.
   • Verify expected range by asking patient or checking previous records.
5. Release Pressure:
   • Slowly open airflow valve counterclockwise.
   • Gauge should decrease by 2-3 points per heartbeat.
   • Listen for the first pulse beat (systolic pressure) and the last (diastolic pressure).

Key Points for Accuracy

• Cuff Inflation: Ensure it's 30 mmHg above known systolic range without hearing pulse.
• Gauge Monitoring: Keep a close eye on the decreasing points, release pressure slowly.
• Reading the Gauge:
  • First pulse sound = Systolic (Top Number).
  • Last pulse sound = Diastolic (Bottom Number).

Tips and Tricks

• Use index lines on cuffs to ensure correct sizing.
• Position the arm and cuff to easily view the gauge.
• Practice the release of the valve to prevent quick drops in pressure.

Conclusion

• Practice and dexterity are critical in mastering manual blood pressure measurement.
• Always validate readings by ensuring the proper technique and attention to detail in each step of the process.