patient prep vitals
Blood Pressure Measurement (Manual)
Manual blood pressure uses a cuff and stethoscope to find the pressure at which blood-flow sounds first appear (systolic) and finally disappear (diastolic).
16 steps5 criticalLimit 5 minAlways tested
Steps
- 1Perform hand hygiene and identify the patient using two identifiers (for example name and date of birth)
- 2Explain the procedure to the patient and ask if they have any questions
- 3Critical stepSeat the patient quietly for at least 5 minutes with feet flat on the floor, back supported and legs uncrossed; no talking
- 4Check for conditions that rule out an arm (fistula, mastectomy on that side, IV line, clots) and use the other arm if needed
- 5Critical stepRemove or rearrange clothing so the cuff and stethoscope are on bare skin; do not leave a rolled-up sleeve under the cuff
- 6Select the cuff size from the upper-arm circumference: bladder width about 40 percent of it and bladder length 80 to 100 percent of it
- 7Support the arm at heart level (resting on a table or held by you, not held up by the patient)
- 8Critical stepPalpate the brachial artery, then center the cuff bladder over it with the lower edge about 1 inch above the bend of the elbow; fit the cuff evenly and snugly
- 9Palpate the radial pulse and inflate the cuff until the pulse is no longer felt; note that level, deflate rapidly, and wait 30 seconds
- 10Place the stethoscope bell or diaphragm lightly over the brachial artery
- 11Critical stepInflate the cuff rapidly to 30 mm Hg above the level where the radial pulse disappeared
- 12Deflate slowly at 2 to 3 mm Hg per second; the first Korotkoff sound is the systolic pressure
- 13Continue deflating at about 2 mm Hg per second; the point where the sounds disappear completely is the diastolic pressure
- 14Deflate the cuff completely and remove it from the patient's arm
- 15Tell the patient the reading, clean the stethoscope and cuff, and perform hand hygiene
- 16Document the reading, the arm used and the patient's position, and report significant deviations per facility policy
What graders are watching for
Tips
- Wrong cuff size is the most frequent error: too small reads falsely high, too large reads falsely low
- Rest first: the patient should avoid caffeine, exercise and smoking for at least 30 minutes beforehand, and neither of you should talk during the rest or the reading
- An unsupported back, crossed legs, or an arm hanging below heart level can all raise the reading
Common mistakes
- Wrong cuff size (the AHA statement calls miscuffing the most frequent error), giving a falsely high or low number.
- Skipping the rest period or letting the patient or you talk during the reading.
- Skipping the palpated estimate, so the inflation target is a guess.
- Deflating faster than the 2 to 3 mm Hg per second the sources give.
Practice this skill
Practise the sequence with critical-step highlighting and a rationale for each step.
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Sources and how we check them: How we verify.