Before starting
· Introduce yourself to the
patient.
· Confirm his name and date
of birth.
· Explain the procedure and
obtain his consent.
· Tell him that he might
feel some discomfort as the cuff is inflated, and that the blood pressure
measurement
may have to be repeated.
Avoid white coat hypertension by putting the patient at
ease. Briefly discuss a non- threatening subject, such as the patient’s journey
to the clinic, or the weather.
The procedure
· Select an appropriately
sized cuff and attach it to the BP machine. This is usually a standard cuff in
all but children and the obese.
· Position the BP machine
so that it is roughly at the level of the patient’s heart.
· Position the measurement
column/dial so that it is at eye level (avoids parallax error).
· Position the patient’s
right arm so that it is horizontal at the level of the mid-sternum and free
from
obstructive clothing.
· Locate the brachial
artery at about 2 cm above the antecubital fossa.
· Apply the cuff to the
arm, ensuring that the arterial point/arrow is over the brachial artery.
· Inflate the cuff to 20–30
mmHg higher than the estimated systolic blood pressure. You can es-
timate
the systolic blood pressure by palpating the brachial or radial artery pulse
and inflating
the
cuff until you can no longer feel it.
· Place the stethoscope
over the brachial artery pulse, ensuring that it does not touch the cuff.
· Reduce the pressure in
the cuff at a rate of 2–3 mmHg per second.
· – the first
consistent Korotkov sounds indicate the systolic blood pressure
· – the muffling and
disappearance of the Korotkov sounds indicate the diastolic blood pressure
· Record the blood pressure
as the systolic reading over the diastolic reading. Do not attempt
to
‘round off’ your readings; to an examiner’s ear, 144/88 usually rings more true
than 140/90.
· If the blood pressure is
higher than 140/90, indicate that you need to take a second reading
after
giving the patient a one minute rest.
· In some situations, it
may be appropriate to record the blood pressure in both arms (to inves-
tigate
coarctation or dissection of the aorta), and also with the patient lying and
standing (to investigate for postural hypotension: a drop in BP on standing of
≥20 mmHg).
After the procedure
· Ensure that the patient
is comfortable.
· Tell the patient his
blood pressure and explain its significance. Hypertension can only be con-
firmed
by several blood pressure measurements taken over an extended period of time.
· Thank the patient.
· Document the blood
pressure recording in the patient’s notes.