How to Take Blood Pressure Manually: Step-by-Step

Nursing Knowledge

How to Take Blood Pressure Manually: Step-by-Step

Manual blood pressure measurement is a non-invasive and cost-effective method that can be performed in various clinical settings. Evaluating this vital sign provides important information about a client’s health status. Knowing how to take blood pressure manually using a stethoscope and manual BP cuff is an absolutely essential skill for all nurses. Keep reading for a step-by-step guide to learn how to choose the appropriate cuff size, how to inflate and deflate the cuff, and how to accurately measure systolic and diastolic pressure.
Last updated: December 11, 2023

Table of contents

What supplies are needed to take a manual blood pressure?

You only need a stethoscope and a manual blood pressure cuff, and a place for the client to sit and rest their arm. 

How to choose the appropriate cuff size for a client

Choose the cuff size based on the client’s arm circumference.

Arm circumference, cmCuff size
16–219×18, child
22–2612×22, small adult
27–3416×30, adult
34–4416×36, large adult
45–5216×42, adult thigh

How to take manual blood pressure: step-by-step guide

The steps for taking a manual blood pressure are as follows:

  1. Ensure the cuff you’re using is the appropriate size for your client. 
  2. Place the cuff on the client’s bare upper arm, approximately one inch above the bend in their elbow. Make sure the tubing is over the front center of the arm. Secure the cuff snugly before inflating it.
  3. Make sure you can see the pressure gauge (it may be separate or attached to the wall). 
  4. Close the airflow valve on the bulb by turning the screw clockwise with your thumb and forefinger.
  5. Palpate the brachial artery and place your stethoscope on the point where you palpated the pulse. Put the stethoscope earpieces in your ears. You should be able to hear the pulse. 
  6. Inflate the cuff by squeezing the bulb multiple times with your right hand. 
  7. Watch the gauge. Keep inflating the cuff until the gauge reads about 30 points (mm Hg) above your expected systolic pressure. At this point, you should not hear a pulse in the stethoscope. 
  8. Keep your eyes on the gauge and slowly release the pressure in the cuff by opening the airflow valve counterclockwise. The gauge reading should fall by only 2–3 points with each heartbeat. Stop twisting the valve when this occurs and allow the cuff to steadily deflate
  9. Listen carefully for the first pulse beat and note the reading on the gauge. This reading is your systolic pressure. 
  10. Continue to slowly deflate the cuff until the heart sound disappears again, and note the reading on the gauge. This reading is your diastolic pressure. 
  11. Quickly deflate the remaining air from the cuff by fully releasing the twist valve and remove it from the client’s arm. 

How to palpate the brachial artery

Locate the brachial artery in the inner aspect of the bicep, slightly above the elbow crease. Palpating the brachial artery is easier to feel if the arm is slightly bent at the elbow. Use your index and middle fingers to apply moderate pressure at the location; you should feel a pulse under your fingers. 

What is the difference between systolic and diastolic pressure?

Systolic pressure is the force of blood against the arterial walls as the heartbeats, while diastolic pressure is the blood pressure between heartbeats.

Interpreting blood pressure readings 

ClassificationReading (systolic/diastolic, mm Hg)
Normal120 or less/80 or less
Elevated120–129/< 80 
Stage 1 hypertension130–139/80–89
Stage 2 hypertension140 or higher/90 or higher
Hypertensive crisis> 180/> 120

For a hypertensive crisis, immediate medical attention is needed.

What are common mistakes to avoid when taking a manual blood pressure?

Can lead to elevated readings ⬆Leads to readings that are too low ⬇ 
Wrong cuff sizeToo small for clientToo large for client
PositioningArm below heart levelArm above heart level
ActivityNot allowing a client to rest before measuringTalking/distractions during measuring
  • Deflating cuff too quickly can lead to missing the sounds → inaccurate readings
  • Not inflating the cuff enough to occlude the artery may lead to first sounds being missed → underestimation of systolic pressure
  • Stethoscope being improperly placed or held too loosely or tightly → sounds may be muffled or missed
  • Using cuff over clothing may keep it from constricting artery properly → inaccurate reading


How to Take Blood Pressure Manually: Step-by-Step

Free Download

Nursing Cheat Sheet

Learning how to take blood pressure manually is an essential skill for every nurse.

Master the topic with a unique study combination of a concise summary paired with video lectures. 

User Reviews