Blood Pressure is one of the four vital signs we regularly take from patients. It tells us a lot about what is going on with our patients so taking accurate blood pressure is not only a  handy skill but also an important one.

Shout out to pinkcubs1, who commented on my YouTube video, suggesting that I make a video on how to take a manual blood pressure.

This one's for you.

What do you need in taking a blood pressure?

1. Stethoscope - If you are a beginner, it is preferred that you use a good quality stethoscope because the sounds are easy to miss if you aren’t used to them.

2. Manual blood pressure cuff with a sphygmomanometer - One more time, sfeeg-mo-mano-meter. There ya go!

The first thing you're going to want to do is to find the brachial artery.

(Remember your Anatomy!)

To find that, locate the front part of your elbow or what we call the Antecubital Fossa and feel your pulse located a little to the side of the midline.

Try practicing locating this pulse on both of your arms and familiarize where it is positioned.

It is easy to find the brachial pulse in healthy people, but harder to find in the emaciated, the overweight and the elderly. So what I normally do is I take my stethoscope, put it in the middle of the Antecubital Fossa, move it to the side a little bit, and try to listen to it. 

Let’s talk about the sphygmomanometer.

The sphygmomanometer has numbers on it that goes from 20 to 300. It is connected to a bulb that you will use to pump with your dominant hand. Remember to close the valve before you start taking the blood pressure. You have to familiarize how the valve opens and closes as well on your dominant hand. For me, since I am right-handed, I try to remember this by saying “closed towards me, open away”.

Position the cuff at least an inch or two finger-widths on top of the Antecubital Fold, with the tubes on top of the arm. Some Sphygmomanometer cuffs have labels and arrows on them as well, so you can follow that. Also, make sure that it is not wrapped around too tight or too loose. You should be able to insert two fingers inside the cuff to check if it is fitted correctly.

Now, the textbooks would tell you to pump the bulb up to about 10-20 millimeters of mercury (mmHg) above the expected systolic.

And since we're not psychics, we can't just guesstimate, "Yeah, your blood pressure's going to be 120”. There's a correct way to take the expected systolic and the way to do that is to find the Radial Pulse. 

The Radial Pulse is the Pulse on the side of our wrists, closer to the thumb side. 

What you have to do is to put on the Sphygmomanometer on your patient’s arm and pump the bulb up while feeling for the Radial Pulse. When you don't feel the pulse anymore, that is the estimated Systolic value.

In taking a blood pressure reading, position the cuff and place the stethoscope on top of the Brachial Artery where you felt the pulse. You need to use your ears to listen for the first and the last gushing sounds and you need to use your eyes to read the numbers on the dial as they happen.

Step by Step Guide on How to Take a Manual Blood Pressure.

1. Pump the bulb up to +20 mmHg of your expected Systolic. That means if your expected Systolic is 120mmHg, then pump the bulb up to 140mmHg.
   
   

2. After reaching 140mmHg, open the valve slowly to release the air steadily.
   
   

3. Listen to the first “boof” sound you are going to hear on your stethoscope, and take note on what level it was on your dial. That is your Systolic Pressure, the number written on top of blood a pressure reading.
   
   

4. Continue releasing air steadily. You are going to see the little tick on the dial pulse a bit and you will be hearing continuous “boof, boof, boof” sound. Listen for the last “boof” sound on your stethoscope, before it completely goes silent and take note on what level it was on the dial when you heard it. That is your Diastolic Pressure, the number written below a blood pressure reading.
   
   

5. Now, remember you can sometimes see the little tick go like that, but you're not actually hearing it. That's not your systolic. The correct systolic is the one that you see and hear at the same time, so you've got to look, and listen.
   
   
6. Remember, first “boof'' is the Systolic, the last “boof” is the Diastolic.
   
   
   If you are a visual learner, then check out this video where I go through all the steps on how to take a manual blood pressure:
   
   

Well, there it is!
It's not an easy thing to do and you do have to practice it a little bit to be accurate, but once you get used to it, it's going to get much easier from here.

You might want to check other Nurse Jenny How-To's!

How to Remove Kinks From Your Stethoscope Tubing

How to take the Diaphragm & Non Chill Rim Off & On: Littmann Lightweight II S.E.

If you want to join the conversation with other fellow Nurses and talk about all things Nursing, you can check out our Nurse Jenny facebook group. And If you have any questions regarding blood pressures and monitoring them, pop them in the comments below, or even better if you have any video suggestions that you would like me to do, write them down as well. and I will make sure to get back to all of you.
 
See you on my next blog!

Have a good shift and always remember, listen with your heart.

Nurse Jenny