1. Click to edit Master title style How to Measure Blood Pressure Vital Signs in the Ambulatory Setting: An Evidence-Based Approach Cecelia L. Crawford RN, MSN

2. Blood Pressure – An Overview CAUSESYSTOLIC BPCORRECTIVE ACTION Sit without back support+ 6 to 10Support back (sit in chair) Full bladder+ 15Empty bladder before BP taken Tobacco/caffeine use+ 6 to 11Don’t use before clinic appointment BP taken when arm is:  Parallel to body  Unsupported  Elbow too high  Elbow 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 28Have someone else take the BP Talking or hand gestures+ 7No talking or use of hands during BP Cuff too narrow/small+ 8 to 10 Right-sized cuff properly placed over bare upper arm Cuff too wide/largeFalse low Cuff not centered+ 4 Cuff over clothing+ 5 to 50 (Pickering et al., 2005; Perry & Potter, 2006)

3. 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)

4. 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

5. 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

6. 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 http://connection.lww.com/products/evans-smith

7. Blood Pressure Procedure 1.Wash hands & put on gloves, if appropriate 2.Provide privacy 3.Assist patient to a comfortable & relaxed position 4.Back supported, legs uncrossed

8. Blood Pressure Procedure 4. Unplug & roll machine near the patient 5. Ensure connecter hose will reach 6. Turn on machine to self-test 7. Select proper arm cuff size  Small adult cuff  Medium adult cuff  Large adult cuff  Pediatric cuff http://www.pharmj.com/Hospital/Editorial/200501/meetings/p27ashp.html

9. 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 level 10. Squeeze air from cuff & attach connector hose  Check for kinks 11. Wrap flat cuff snugly around the upper arm 12. Arrow mark on cuff is at inside of elbow

10. Blood Pressure Procedure 13. Set machine for adult or pediatric BP 14. Press start button 15. No talking or hand gestures by you or the patient 16. Check digital display for BP when cuff is fully deflated 17. Repeat BPs may be taken if 2 minutes apart 18. Remove cuff and replace clothing

11. Normal BP Measurements AGENormal 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 AdultsSystolic 90 - 120 Diastolic 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)

12. 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

13. Blood Pressure Procedure 19. Inform RN or MD for:  Very high or very low BP  Difficulty taking a BP  Unable to get a BP reading

14. Blood Pressure Procedure 20. Discuss BP with patient or parent 21. Remove gloves & wash hands 22. Clean cuff per facility protocol

15. Blood Pressure Procedure 23. Document the Results  Flowsheet, clinic record, or clinic chart 24. Communicate the Results  RN  MD

16. 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 Questionnaire Kaiser Permanente Southern California Region June 2006)

17. 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 Questionnaire Kaiser Permanente Southern California Region June 2006)

18. BP Measurement in the Clinic YOU can make the difference:  Welcoming presence  Decrease any anxieties & fears  Reassure patients & family  Accurate vital signs