Doing A Manual Blood Pressure

[Tony Phan]

Theblood pressure should be measured during the secondary examination, which begins with exposing the patient. This will ensure that the cuff is placed on the skin. The blood pressure cuff should never be placed over clothing, as doing so will increase pressure on the cuff and produce an inaccurate reading.

With the arm fully extended, feel for the pulsation of the brachial artery. Failure to fully extend the arm will result in difficulty both in locating the artery and in auscultating Korotkoff sounds. In most people, the pulse can be felt at the medial aspect of the antecubital fossa, where the artery comes closest to the skin.

While palpating the radial pulse, inflate the cuff until the pulse disappears. Release the pressure until the pulse returns, and note the reading on the sphygmomanometer at this point. This is your palpated systolic blood pressure.

Working for a company that develops blood pressure monitoring devices and technologies, I deal with blood pressure on some level every day. We make accurate and reliable blood pressure measurement our business...literally. So, it only makes sense that we should care about accurate blood pressure measurement from a fundamental perspective, which is the inspiration for my first blog post.

As most readers probably know, the typical method for blood pressure measurement has long been the manual auscultatory technique with a mercury column or mechanical aneroid sphygmomanometer. However, with the benefits that automated BP devices provide with a repeatable standardized technique and removal of observer bias, there has been a shift towards automated devices in clinical practice. As the American Heart Association (AHA) states in their most recent recommendations for blood pressure measurement, "there is a role for (automated) devices in office use, both as a substitute for traditional (manual) readings and as supplements to them." * However, the AHA goes on to recommend that a properly maintained monitor for manual measurement of blood pressure be available for routine office measurement.

Another observation the AHA makes is that although the auscultatory method has been the standard for blood pressure measurement for over 50 years, surveys indicate that physicians rarely follow the well published guidelines for their use. * This is where we feel it is important to remind all healthcare professionals of best practices related to manual blood pressure measurement, so without further ado...

Step 1 - Choose the right equipment:

What you will need:

1. A quality stethoscope

2. An appropriately sized blood pressure cuff

3. A blood pressure measurement instrument such as an aneroid or mercury column sphygmomanometer or an automated device with a manual inflate mode.

Step 2 - Prepare the patient: Make sure the patient is relaxed by allowing 5 minutes to relax before the first reading. The patient should sit upright with their upper arm positioned so it is level with their heart and feet flat on the floor. Remove excess clothing that might interfere with the BP cuff or constrict blood flow in the arm. Be sure you and the patient refrain from talking during the reading.

Step 3 - Choose the proper BP cuff size: Most measurement errors occur by not taking the time to choose the proper cuff size. Wrap the cuff around the patient's arm and use the INDEX line to determine if the patient's arm circumference falls within the RANGE area. Otherwise, choose the appropriate smaller or larger cuff.

Step 4 - Place the BP cuff on the patient's arm: Palpate/locate the brachial artery and position the BP cuff so that the ARTERY marker points to the brachial artery. Wrap the BP cuff snugly around the arm.

Step 5 - Position the stethoscope: On the same arm that you placed the BP cuff, palpate the arm at the antecubical fossa (crease of the arm) to locate the strongest pulse sounds and place the bell of the stethoscope over the brachial artery at this location.

Step 6 - Inflate the BP cuff: Begin pumping the cuff bulb as you listen to the pulse sounds. When the BP cuff has inflated enough to stop blood flow you should hear no sounds through the stethoscope. The gauge should read 30 to 40 mmHg above the person's normal BP reading. If this value is unknown you can inflate the cuff to 160 - 180 mmHg. (If pulse sounds are heard right away, inflate to a higher pressure.)

Step 7 - Slowly Deflate the BP cuff: Begin deflation. The AHA recommends that the pressure should fall at 2 - 3 mmHg per second, anything faster may likely result in an inaccurate measurement. *

Step 8 - Listen for the Systolic Reading: The first occurence of rhythmic sounds heard as blood begins to flow through the artery is the patient's systolic pressure. This may resemble a tapping noise at first.

Step 9 - Listen for the Diastolic Reading: Continue to listen as the BP cuff pressure drops and the sounds fade. Note the gauge reading when the rhythmic sounds stop. This will be the diastolic reading.

Step 10 - Double Check for Accuracy: The AHA recommends taking a reading with both arms and averaging the readings. To check the pressure again for accuracy wait about five minutes between readings. Typically, blood pressure is higher in the mornings and lower in the evenings. If the blood pressure reading is a concern or masked or white coat hypertension is suspected, a 24 hour blood pressure study may be required to assess the patient's overall blood pressure profile.

Fill out the form below to receive a free digital copy of the Tips for Accurate Blood Pressure poster. You can print it out and hang it in your practice or where ever you need reminders for how to take an accurate blood pressure reading.

Chaunie Brusie is a registered nurse turned writer, editor, and author. She has experience in critical care, long-term care, and obstetrical nursing, and her work has appeared everywhere from The New York Times to The Washington Post to Good Housekeeping.

Dr. Chris Young is an education specialist at the University of Kansas Health System in Kansas City, Kansas. She is an adjunct assistant clinical professor of nursing at the University of Kansas Medical Center.

Heather Hobbs (she/her) is an editor at Healthline Media and RVO Health. She has also worked in content creation, marketing, copy editing, and search engine optimization (SEO) for brands, agencies, and nonprofit organizations. A former educator, she earned her MA in teaching as well as a BA with a double major in English writing and Spanish, along with a minor in French. You can find her on LinkedIn.

Erica Hersh is a health writer, editor, and communications strategist based in Boston, MA. In 2014, she fulfilled her lifelong dream of being on Jeopardy. She did not, however, fulfill her dream of winning on Jeopardy.

One way to keep track of your blood pressure is to monitor it at home using an automated blood pressure machine, or by doing it manually. This article will walk you through how to check your blood pressure, along with tips to help ensure accurate readings.

Higher blood pressure measurements could also be caused by an internal force, such as the buildup of plaque or fatty deposits in your arteries. This can also cause your blood vessels to become narrower, which, in turn, can increase your blood pressure.

However, there are apps that can help you track your blood pressure results. This can be helpful in identifying patterns in your blood pressure. Your doctor may use this information to determine if you require blood pressure medications.

These apps can help you quickly and easily track your blood pressure readings. Measuring your blood pressure regularly on the same arm can help you most accurately track your blood pressure readings.

Blood pressure is a very individualized vital sign, which means it can be very different for each person. Some people have naturally low blood pressure all the time, while others may run on the higher side.

If one number falls into one of the other categories, your blood pressure is considered to be in that category. For example, if your blood pressure is 115/92, your blood pressure would be considered high blood pressure stage 2.

There are two ways to measure your blood pressure at home. The simplest way is to use an automated blood pressure cuff, which you can purchase online or at most grocery stores or drugstores. This method is recommended by the AHA for at-home blood pressure monitoring.

Jon is a writer from California and now floats somewhere on an island in the Mediterranean. He thinks most issues can be solved by petting a good dog, and he spends plenty of time doing so. Time not spent at his desk is probably spent making art or entertaining humans or other animals.

Jenneh Rishe is a registered nurse, having worked in many different specialty areas, such as internal medicine, trauma, kidney transplant, oncology, and leukemia/bone marrow transplant. She is the founder of The Endometriosis Coalition, a nonprofit organization focused on spreading awareness and promoting reliable education for endometriosis.

After working as part of the editorial team for Medical News Today, Markus wrote a large body of medical information articles for our Knowledge Center. Based in Edinburgh, he has qualifications in medical science and science communication and enjoys photography.

Jamie is fascinated by the intersection of health and humanity. Before writing for Healthline, she completed a B.A. in English. She hopes her work will help increase health literacy and pave the way toward a healthy future for all. She is currently studying Public Health and Biostatistics.

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