How To Take A Manual Wrist Blood Pressure

[Caterina Haggins]

Bloodpressure levels are one measurement used in conjunction with other signs and symptoms to evaluate a patient. In some situations, such as a motor vehicle accident or if an injury site is close to active machinery, noise levels may be high enough to interfere with measuring blood pressure with a stethoscope. An alternative method is to measure blood pressure by touch or palpation. This method is not as accurate as auscultation (using a stethoscope to listen for the pulse sounds), but can be helpful in emergencies.

Wrap the blood pressure cuff securely (but not too tightly) around the upper arm of the patient. Position the cuff so that it is approximately 1 inch above the elbow and center the bladder (the part that fills with air) over the brachial artery.

Locate the radial pulse on the arm bearing the blood pressure cuff. If possible, turn the patient's hand so that the palm is facing up. Place three fingers in the middle of the patient's wrist (do not use your thumb). Slide your fingers toward the thumb-side of the wrist and apply moderate pressure until you can feel the pulse beats.

Confirm that the valve on the pressure gauge is closed and begin pumping the bulb to inflate the cuff. Continue pumping until you can no longer feel a pulse, note where the needle on the gauge is located and inflate the cuff an additional 20 mmHg (millimeter of mercury is the unit of measure on the blood pressure gauge).

Slowly deflate the cuff by opening the valve and releasing air from the bladder. Notice the reading on the gauge when you are once again able to feel the radial pulse. This is the patient's systolic pressure.

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Blood pressure is the term for the amount of force that the blood places on the blood vessels in the body. A blood pressure reading includes two numbers that indicate the pressure inside the arteries as the blood flows through the body.

The upper number, called the systolic pressure, measures the pressure inside the arteries as the heart contracts to pump blood. The lower number, called the diastolic pressure, is the pressure inside the arteries as the heart rests between beats.

According to the American Heart Association (AHA), normal blood pressure is anything below 120/80 millimeters of mercury (mm Hg). Higher measurements often indicate that the heart is working too hard in pumping blood through the arteries.

Accurate blood pressure readings are important, as high blood pressure often causes no symptoms. Some symptoms, such as a headache, may occur if blood pressure reaches or exceeds 180/120 mm Hg. At this point, the person may be experiencing a hypertensive crisis, which is severe hypertension requiring urgent medical care.

Monitoring blood pressure at home usually requires a machine that insurance may or may not cover. A doctor may recommend monitoring blood pressure at home if a person needs to know their blood pressure at specific times of the day or after taking certain medications.

Using a high quality machine is important. Inaccurate readings can be misleading if they are too low or cause unnecessary stress if they are too high. If a person is checking their blood pressure at home as part of a treatment plan, inaccurate readings could lead to harmful changes in medications or treatments.

However, apps that log blood pressure results may be helpful for people who need to take regular blood pressure tests. Recording a set of readings in these apps may help doctors identify trends in blood pressure and recommend treatments.

High blood pressure is a common condition in adults that's associated with "really bad consequences," such as heart attacks, strokes and dementia, Shimbo said. To diagnose and track it, doctors often ask people to check it at home. But even professionals can get tripped up on the proper procedures for home blood pressure monitoring.

Dr. Karen Margolis, senior research investigator at HealthPartners Institute in Minneapolis, puts it this way: "The top number is when your heart is squeezing. The bottom number is when your heart is relaxing." If you're using a stethoscope, where a heartbeat sounds like "lub-dub," the "lub" is the squeeze, and the "dub" is the relaxing.

Modern digital monitors don't use mercury, but the principle is the same: A cuff around your arm cuts off blood flow in the artery inside your elbow. As the cuff is loosened, the "whoosh" of blood starting to flow again provides the systolic reading. When the noise stops, that's the diastolic number.

Margolis and Shimbo agreed that proper self-monitoring of blood pressure starts with a validated device. Both co-authored a 2020 policy statement from the AHA and American Medical Association about home blood pressure monitoring.

"I just find them really difficult to use," Margolis said of the wrist devices. "They're touchy. Your arm has to be in exactly the right position." Still, people with medical issues that preclude compressing the arteries of both upper arms might need a wrist device, she said.

This is "surprisingly hard," Margolis acknowledged. Before taking a reading, you should avoid caffeine. Don't exercise for 30 minutes beforehand. If you smoke, don't smoke. Go to the bathroom. "Ideally, you want to wait until 30 minutes after you've had a meal."

Then sit quietly without any distractions for five minutes, Margolis said. "And when I say no distraction, I mean don't watch TV. Don't listen to a podcast. Don't read a book. Definitely don't read the newspaper or listen to the news."

According to guidelines from the AHA and ACC, sit in a chair that supports your back. Keep your feet flat on the ground. Don't cross your legs. Position and support your upper bare arm at heart level. Keep your palm up and your arm muscles relaxed. Don't talk.

Blood pressure tends to be highest in the morning, decreases through the day and is lowest during sleep. To account for that, when diagnosing high blood pressure, you'll be asked to take two readings in the morning and two in the evening over the course of a week.

Some people get "white coat hypertension," which is when readings are high in a doctor's office but not outside the office. Others experience "masked hypertension," where readings are normal in a doctor's office but high outside the office.

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The normal body temperature of a person varies depending on gender, recent activity, food and fluid consumption, time of day, and, in women, the stage of the menstrual cycle. Normal body temperature can range from 97.8 degrees F (or Fahrenheit, equivalent to 36.5 degrees C, or Celsius) to 99 degrees F (37.2 degrees C) for a healthy adult. A person's body temperature can be taken in any of the following ways:

Orally. Temperature can be taken by mouth using either the classic glass thermometer, or the more modern digital thermometers that use an electronic probe to measure body temperature.

Axillary. Temperatures can be taken under the arm using a glass or digital thermometer. Temperatures taken by this route tend to be 0.3 to 0.4 degrees F lower than those temperatures taken by mouth.

Body temperature may be abnormal due to fever (high temperature) or hypothermia (low temperature). A fever is indicated when body temperature rises about one degree or more over the normal temperature of 98.6 degrees Fahrenheit, according to the American Academy of Family Physicians. Hypothermia is defined as a drop in body temperature below 95 degrees Fahrenheit.

According to the Environmental Protection Agency, mercury is a toxic substance that poses a threat to the health of humans, as well as to the environment. Because of the risk of breaking, glass thermometers containing mercury should be removed from use and disposed of properly in accordance with local, state, and federal laws. Contact your local health department, waste disposal authority, or fire department for information on how to properly dispose of mercury thermometers.

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