Manual Blood Pressure Measurement – Vital Signs (Nursing)

00:00 Let's talk about how we obtain a manual blood pressure. This is a skill guys, I will tell you as a nursing student they typically struggle with. But I will tell you, me personally I used to work on the stroke floor and we used to do manual blood pressures as a nurse all of the time. Because if a patient has an extremely low or sometimes an extremely high blood pressure, we have to make sure it is accurate before I provide medications. So let's talk about how we do this. So first of all, as you remember, making sure that cuff you are using is the appropriate size for that client. Now, we're going to place the cuff on the client's bare upper arm about an inch above the bend in their elbow or otherwise what we call the antecubital space. Now, we want to make sure that tubing is over the front center of the arm and secure this cuff snugly before you inflate. Now, when we say snugly it just needs to lightly hug the arm and not too tight or not too loose. So we need to make sure we can see the pressure gauge. Now, this is important because that pressure gauge is where we get our readings. So as you're taking the blood pressure, make sure you can see this. Now, we can pick up the bulb, close the airflow valve. So on this image here, you see the little screw where the image is touching? That's what we call the pressure valve. We want to make sure we pick up the bulb, close the airflow valve, and then turn and screw that clockwise with your thumb and forefinger. Now, we want to go ahead and palpate what we call our brachial artery. So this is important to make sure we're taking a blood pressure from this location. We're going to place our stethoscope on that same place where we palpated the brachial artery, put the stethoscope, ear piece is in our ear, and you should hear the pulse in your stethoscope. Now, we can go ahead and pick up that bulb, inflate the cuff by squeezing the bulb multiple times with our hand and it's going to depend if you're right handed or left handed, whatever is more comfortable with you. Again, this skill takes a little practice. Now, if you see this image, this is that pressure gauge we want to look at. We want to keep inflating the cuff until the gauge reach about 30 points or so mmHg above what our patient's expected systolic blood pressure range is. So it's also really helpful.

02:29 So before you start if you talk to your patient ask where their general blood pressure is, what their trend is. This will give you a point to inflate about 30 points above that. Now at this point, once we've inflated you should not hear any pulse in your stethoscope because again we're above what the patient's trend is. Now, we're going to really carefully keep your eyes on that gauge and slowly guys, slowly but smoothly release the pressure in the cuff by opening that airflow valve counterclockwise and the gauge should only fall about a couple of points with each heartbeat. This is the point that we have to practice as a nursing student. When you release that valve if we do it too quick, you'll see the gauge go whoop and fall and it's really hard to get a blood pressure this way. Right? Really hard to check an accurate reading on that gauge. So we want to practice this piece and the dexterity of it to make sure we do this only about 2-3 points with each heartbeat smoothly and slowly so we can read this. And of course, listen carefully for that first pulse beat and that's the first reading we're going to note on this gauge. This is our systolic blood pressure. This is what we call our top number. Then once we hear that first beat, we're going to continue to slowly deflate the cuff, you'll see the gauge go down until the sound disappears again. Now once that happens, we're going to note this reading on the gauge.

04:03 This is what we call our diastolic blood pressure or our bottom number. Once we've gotten that diastolic, we could quickly deflate the cuff and then remove the cuff from the client's arm. Let's take a live look on how we take a manual blood pressure. So of course, the first thing we've got to do is make sure that our cuff size and our equipment is appropriate.

04:29 So here is a great example. I obviously would not want to use a pediatric cuff on my client here today for Brandon. So when we start, let's place the cuff on the client's bare arm.

04:41 This is important because ideally you want it as close to the skin as possible and that way we can also auscultate his brachial artery. So let's take the cuff and place it now. So when we do this, we need to talk about a few things. So I want to go about an inch above the bent of his elbow or otherwise known as the AC. So I'm going to bring this up. The other thing I want to show you as well, notice this really handy arrows. This is what should be pointing to the patient's brachial artery. So when you put this on, you want it pretty snug so it doesn't keep sliding down on you. Here's another really important piece I want to show you with the manual blood pressure cuff. Most manufacturers put these really helpful lines to ensure it's the right size for your patient. So here's what I'm talking about. You see this really nice index line? That's so very helpful because if you look at the cuff there's a range. So that makes it really helpful that as long as it falls within this range, this index line, then we know it's the right cuff for our patient and the right size. So I'm going to go ahead and put this back on Brandon's arm. Okay, so now I'm going to go ahead and just have him relax and position his arm. It's also a great idea just to kind of turn this in front so we can see our pressure gauge. So as you notice, it's snug on his arm, it's not sliding down. And I'm also going to take this and kind of tuck this in. This makes it really helpful to see. So we want to make sure that we can see our pressure gauge here. This is where we're going to obtain our reading. Now I'm going to go ahead and pick up my bulb and close off my airflow valve here. So I'm going to keep closing this off with my thumb and my finger.

06:32 Then, once this is closed off, I'm going to palpate his brachial artery here. This is where I'm actually going to place my stethoscope. Now, we can put the stethoscope in our ears and once we listen with our stethoscope, you should hear the pulse. So, I'm going to go ahead and pick up the bulb and inflate the cuff by squeezing the bulb multiple times with my right hand. So as you see, the needle is increasing and jumping which is good. Now, if it was not, that means we need to tighten up our airflow valve. So we're going to watch the gauge and inflate the cuff about 30 points from our patient's baseline. Now at this point, we should not hear a pulse in the stethoscope. Then we're going to keep our eyes on the gauge and slowly release the pressure in the cuff by opening the air valve. And this should go only about 2 or 3 points and not too fast. Okay, so now once we've done this, we're keeping again our eyes on the gauge and when we're slowly releasing that valve we should do this carefully.

07:57 Now, the first pulse beat that you hear, that's what we notice as the systolic blood pressure. So you'll hear that first beat, that's our systolic then you'll hear a beat, beat, beat, beat and that last one we hear note that as the diastolic blood pressure. So a really big tip is when you first start taking the blood pressure, you'll still see the needle jump.

08:23 Well that's not what we're noting. You'll start seeing it jump and then wait until you hear that first pulse beat, which again is the systolic then it will continue to beat and the last one is our diastolic blood pressure. Then we'll continually slowly deflate that cuff until we obtain our reading then we'll quickly deflate the cuff once we have obtained this and remove it from the arm.