Click to edit Master title styleClick to edit Master title styleHow to Measure Blood Pressure

Vital Signs in the Ambulatory Setting:An Evidence-Based Approach

Cecelia L. CrawfordRN, MSN

Blood Pressure – An OverviewCAUSE SYSTOLIC BP CORRECTIVE ACTION

Sit without back support + 6 to 10 Support back (sit in chair)

Full bladder + 15 Empty bladder before BP taken

Tobacco/caffeine use + 6 to 11 Don’t use before clinic appointment

BP taken when arm is:Parallel to bodyUnsupportedElbow too highElbow too low

+ 9 to 13 + 1 to 7 + 5 False low

While seated in chair, patient’s arm must be straight out and supported, with elbow at heart level

“White coat” reaction + 11 to 28 Have someone else take the BP

Talking or hand gestures + 7 No talking or use of hands during BP

Cuff too narrow/small + 8 to 10Right-sized cuff properly placed over bare upper arm

Cuff too wide/large False low

Cuff not centered + 4

Cuff over clothing + 5 to 50 (Pickering et al., 2005; Perry & Potter, 2006)

BP – It’s all about the Numbers!

Terminal Digit Preference• Some people may show a preference for certain

numbers in auscultated BP readings* Zeros, even numbers, odd numbers Research study on BP revealed 99% of auscultated SBP/DBP

readings ended in zero

• Be aware you might “like” certain numbers more than others!

(*Roubsanthisuk, W., Wongsurin, U., Saravich, S., & Buranakitjaroen, P., 2007)

Blood Pressure – An Overview

•Automated BP machines give fast & accurate blood pressure measurement•Cannot be used in patients with:

Seizures, shaking, or shivers Weak pulses Agitation Any situation where the arm cannot be kept still

Blood Pressure – An Overview

•Equipment for accurate BP measurement Functional & calibrated machine Right-sized cuff Pen or pencil Flowsheet, chart, or medical record Clean hands and fingers!

•Patient in a comfortable & relaxed position•Wait 5 minutes if patient was active

Right Cuff in the Right Place•Cuff width = 20% more than upper arm diameter•Cuff width = 2/3 of upper arm length•Cuff bladder length encircles 80% of upper arm•Cuff arrow aligned with brachial artery

Inside of the elbow

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Blood Pressure Procedure

1. Wash hands & put on gloves, if appropriate

2. Provide privacy3. Assist patient to a

comfortable & relaxed position

4. Back supported, legs uncrossed

Blood Pressure Procedure4. Unplug & roll machine near the patient5. Ensure connecter hose will reach6. Turn on machine to self-test7. Select proper arm cuff size

Small adult cuff Medium adult cuff Large adult cuff Pediatric cuff

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Blood Pressure Procedure

8. Expose upper arm completely Do not put cuff over clothing! Machine can’t “hear” the pulse with

clothing

9. Upper arm properly supported at level10. Squeeze air from cuff & attach connector hose

Check for kinks11. Wrap flat cuff snugly around the upper arm12. Arrow mark on cuff is at inside of elbow

Blood Pressure Procedure

13. Set machine for adult or pediatric BP14. Press start button15. No talking or hand gestures by you or the

patient16. Check digital display for BP when cuff is fully

deflated17. Repeat BPs may be taken if 2 minutes apart18. Remove cuff and replace clothing

Normal BP MeasurementsAGE Normal BP

Newborn to 6 weeks * Systolic 50 - 70

Infant (6 weeks to 6 months) * Systolic 70 - 95

Toddler ( 1 to 3 years) * Systolic 80 - 100

Young Children ( 3 to 6 years) Systolic 80 - 110

Older Children (10 to 14 years) Systolic 90 - 120

Adults Systolic 90 - 120Diastolic 80 or less

(Mosby’s Critical Care Nursing Reference, 2002; Perry & Potter, 2006)

(* BP is often not taken on children less than 3 years of age)

Blood Pressure Problems•What if a BP cannot be obtained?•What if the cuff doesn’t fit?•What if a right-sized cuff isn’t available?

Consult with RN or MD for all troubleshooting issues

Blood Pressure Procedure

19. Inform RN or MD for:Very high or very low

BPDifficulty taking a BPUnable to get a BP

reading

Blood Pressure Procedure

20. Discuss BP with patient or parent

21. Remove gloves & wash hands

22. Clean cuff per facility protocol

Blood Pressure Procedure

23. Document the Results Flowsheet, clinic record, or clinic chart

24. Communicate the Results RN MD

What’s wrong with this picture?

More than one thing may be wrong.

Write down as many wrong things as you can find!

Are you ready for your big

wedding? Not really, there’s so much to do – I am very

nervous these days

(Blood Pressure Competency QuestionnaireKaiser Permanente Southern California Region

June 2006)

What’s wrong with this picture?

Are you ready for your big

wedding? Not really, there’s so much to do – I am very

nervous these days

• Provider and patient are talking

• BP cuff applied over clothing

• Arm supported above heart level

• Patient legs are crossed

• Selected size of the cuff looks big for the patient

(Blood Pressure Competency QuestionnaireKaiser Permanente Southern California Region

June 2006)

BP Measurement in the Clinic•YOU can make the difference:

Welcoming presence Decrease any anxieties &

fears Reassure patients &

family Accurate vital signs