Groundwork

Explain and discuss the procedure with the patient. The patient should be resting either sitting or lying and sometimes standing blood pressure is required, allow 3 minutes rest if the patient is lying or sitting and 1 minute rest if standing. Thirty minutes should be allowed to rest after physical/emotional activity or have smoked, eaten or drank alcohol or caffeine.

Equipment Required:

• sphygmomanometer with appropriate cuff size (size = 80% of arm circumference)
  
• stethoscope
• alcohol swabs
• observation chart

Usual infection control policies apply, e.g. handwashing. Special precautions may be required depending on patients condition, e.g. MRSA.

Procedure

1. Ensure patient is resting in a comfortable position .
   
2. If a comparison between lying and standing blood pressure is required, the lying recording should be done first.
3. Ensure that tight or restrictive clothing is removed from the arm.
4.  Apply the cuff around the arm, ensuring that the centre of the bladder covers the brachial artery, 2-3cm above the antecubital fossa (see image a).
5. Ensure that the upper arm is supported and positioned at heart level, with the palm of the hand facing upwards.
6. Position the manometer within 1 metre of the patient, place on a hard suface, facing you with so that it can be seen at eye level
7. Inflate the cuff until the radial pulse can no longer be felt. This give an estimation of the systolic pressure. Quickly release the cuff pressure and wait 20-30 seconds before continuing to measure.
8. If using a communal stethoscope clean the earpieces with an alcohol swab and check the stethoscope is turned to the diaphragm side by tapping with your finger.
9. The cuff should then be inflated 30mmHg higher than the estimated systolic pressure.
10. Place the diaphragm of the stethoscope over the artery, and hold it in place with your thumb while your fingers support the patient's elbow (see image b).
    
11. Deflate the cuff at around 3mmHg per heartbeat.
12. Systolic blood pressure is measured when a minimum of 2 clear repetitive sounds can be heard. Diastolic pressure is measured at the point when the sound can no longer be heard.

(image a)

(image b)

Post Procedure

Replace clothing and ensure patient is comfortable and discuss the findings. Remove equipment and clean with soap and water after use. Chart the blood pressure accurately and note the arm used, any variation from previous recording should be brought to the attention of the appropriate personnel.

Notes

If the patient is receiving IV therapy, avoid using the arm that has the cannula or infusion in progress. If recording lying and standing blood pressure, do not remove cuff between recording , but keep in the same position. The doctor may have also request that the patient be standing for at least 5 minutes before the blood pressure is measured. Be aware that patients may feel dizzy on getting out of bed for the standing blood pressure due to postural hypotension.

References

Bavin, C., Bedford-Turner, S., Cronin, P., Nicol, M. and Rawlings-Anderson, K. (2002) Essential Nursing Skills. Edinburgh: Mosby.

Baxter, A., Dolan, S. and Gale, N. (2001) Observations. In: Dougherty, L. and Mallet, J. (eds.) The Royal Marsden Hospital: Manual of Clinical Nursing Procedures. 5th Edn. London: Blackwell Science.