Manual Blood Pressures

[Sundancer]

I was a little bit sad when the service I got hired for told me that they routinely use the Lifepak to take bp. I know it's a little more convenient to log the data electronically and to keep our hands free for other tasks, but I kind of miss taking blood pressures manually. I wonder, too, how the accuracy between the two compare?

 

[Medic Tim]

Just because others aren't doing them manually doesn't mean you can't. I usually do the first bp then hook them up to the lifepak. If there is a big difference or some sort of dysrhythmia I will do them manually.

 

[OnceAnEMT]

From those who I've talked to, they do the same as Tim. If the electronic BP isn't "normal", they'll do a manual.

In the hospital all we use is electronic, and manual is never even considered an option. I've never even seen a manual BP cuff here. There have been a few times where the machine would sit at 180 and choke out a kid's arm for a solid 30 seconds, then release when it feels like it. Times like those I would love to do a manual real quick.

 

[EpiEMS]

I prefer to take a manual first -- then use the LifePak for monitoring.

 

[Tigger]

I prefer to take a manual first -- then use the LifePak for monitoring.

Pretty much. Or at the very least get the LP to cycle while the ambulance isn't moving.

If a trauma alert is called at one of our receiving Level 2s a manual BP is required within a minute of the patient hitting the bed. It's one of the assigned roles for one of the techs on the trauma team.

 

[Sundancer]

I like to listen to the whooshing and/or tapping with my stethoscope. Simple pleasures, y'know.

 

[medicdan]

I was a little bit sad when the service I got hired for told me that they routinely use the Lifepak to take bp. I know it's a little more convenient to log the data electronically and to keep our hands free for other tasks, but I kind of miss taking blood pressures manually. I wonder, too, how the accuracy between the two compare?

I'm with Tim. My first pressure is always a manual (for my baseline), then i'll cycle an NIBP when the monitor is on to compare, and trend during transport. I understand manual pressures are nearly unheard of in some hospitals, but they have more sensitive equipment than I, and are not bouncing down the road. I trust my own ears and scope, and have been burned way too many times by inaccurate automatic pressures.
As well, any time I am treating a pressure or rhythm issue, I treat based on my pressure.

At at least one of the trauma centers around my area, the first pressure in the trauma room is a manual one-- the nurses know there are too many wires and tubes flailing around, and NIBP is often delayed because of IVs and assessments, by assigning a nurse to get a manual (or palp) pressure early, they prioritize having an early (if not accurate) way of quantifying cardiovascular output and perfusion.

So what if others at this service don't get manual pressures, it doesn't prevent you from doing so.

 

[Aprz]

I think what JPINFV said on his blog about 4 Phrases That Should Never Be Said on an Ambulance applies to this.

As such, diagnostic tests shouldn’t be discarded simply because they disagree with our assessment. As one of the actual useful Ayn Rand quotes from Atlas Shrugged goes, “Contradictions do not exist. Whenever you think that you are facing a contradiction, check your premises. You will find that one of them is wrong.” We need to troubleshoot both the test itself as well as our assessment. Did I miss something? Is there some preexisting condition that I’m missing? Am I assuming that there is only one new condition?

I think a manual blood pressure is overrated; it's just one way to check the patient's blood pressure. The benefits of using the cuff from the monitor has benefit of freeing up your hands, saving the values in the monitor which can be shown as trends, can be transferred easily to your ePCRs, and less variables changing (placement of the stethoscope, provider listening for the Korotkoff sound, and speed of inflation/deflation of the cuff).

The benefits of a manual blood pressure is that you can listen for bruits (rare) and you can be somewhat certain what the blood pressure is although that might be questionable if it's difficult to hear (maybe because of environment like in a concert or during transport on a bumpy freeway with the lights and sirens on, the provider has bad ears, stethscope placement, or it's just difficult to obtain a blood pressure on that patient for some unknown reason).

I personally prefer to take a blood pressure using the monitor. If it's what I expect, I don't do anything else. If it's not what I expected or it failed to take a blood pressure (it'll show ---/--- (0) on the monitor), I will press the button to do it again. If it's still not what I expect or failed, I will make sure everything is OK (readjust the cuff, make sure it's plugged in, try another arm, etc). If it still fails, I will finally do a manual blood pressure. This may seem like a waste of time to go through all of those steps before finally taking a manual blood pressure, but this also rarely happens. I think it's more of a waste of time trying to get a manual blood pressure on every patient.

 

[TheLocalMedic]

Our company has the policy that the first BP be manual, so if the monitor gives you something wildly different you should be suspicious. Sigh... I get it, but sometimes it's just dang inconvenient to sit there and take a manual pressure when the machine can do it for you while you get other stuff done.

On the other hand, I seem to be having a problem with the initial BP the monitor spits out (LP15). First one is frequently wildly inaccurate, so I have to just cycle up a second one right after to get a better result.

 

[Akulahawk]

Before I ceased working in the field, while we knew of NIBP machines, we were never allowed to have one unless we were working on the CCT bus, then we got to "play" with our Propaq Encore. Nice little monitor...

What that meant is that all of the vital signs we took were manually obtained when we weren't on CCT duty, and we were generally required to get 3 sets on every run (with few exceptions. What this led to was me doing somewhere in the neighborhood of 20k sets of vital signs (conservatively) during that time.

I trust my ears more than I trust the machine when I'm bouncing down the road. While that does tie me up for a while, it's not that long and I get some decent info that I trust. I do trust the machines when they're regularly maintained and they're reasonably accurate when stationary. Also, while I do kind of care about the values presented from moment to moment, I am far more concerned about trends, up, down, flat, widening or narrowing...

 

[SeeNoMore]

I still take manual blood pressures. It's a method. Just like NIBP, just like Invasive Monitoring etc. No big deal.

 

[Angel]

The LP 15 is really touchy. Too many bumps in the road and you get some obscene number. I (always) get my first BP manual then autocuff it an only recheck if I get a crazy number (pt is suddenly hyper/hypotensive)

One scenario ill never forget is *I* never took a manual the FD did and it was fine but my pt had an unknown ALOC but all the BPs were fine. In the ED he was 78/5?
I couldn't believe my eyes, strong palpable radial, conversing normally but I repeated it twice and the same (low) number came back. I'm just very skeptical of those things.

 

[MSDeltaFlt]

I was a little bit sad when the service I got hired for told me that they routinely use the Lifepak to take bp. I know it's a little more convenient to log the data electronically and to keep our hands free for other tasks, but I kind of miss taking blood pressures manually. I wonder, too, how the accuracy between the two compare?

You can look up the specs of your NIBP monitors for clarification. However, if memory serves, they will never state in black and white that they are as accurate as a properly calibrated manual sphygmomometer or a properly zeroed arterial line. They are, I do believe, trustworthy for trending. Not unlike a 4 lead ECG for monitoring and a 12 lead ECG for assessment.

 

[Akulahawk]

NIBP machines also suffer the same cuff size problems that manual cuffs do and will read "wrong" for the same reasons in the same way. Remember to use the correct size cuff when taking a blood pressure, no matter how you take it, auto or manual.

 

[Summit]

Know your machine. I think manual is overrated if you have a reliable auto reference. Still, I am one of the few RN s who will ask for a manual cuff very quickly on the rare circumstance I can't get an auto pressure I believe.

Pro-tip: palp or auscultate a pressure while the auto cuff is going to QC your reading. They should display numbers as they go. This will also help you learn to trust your machine.

 

[Carlos Danger]

I'm not sure why so many people are confident that their manual BP readings are always more accurate than automatic ones.

Sure, it makes sense to take a manual if you have reason to believe that the automated one is inaccurate for some reason, but that's different than making a policy of always taking a manual before an automated one. Just seems like wasted time and effort. I honestly can't even remember the last time I used a sphygmomanometer.