68 What Should the Healthcare Provider Consider?

Manual blood pressure is reported in even numbers. Healthcare providers always measure blood pressure with pulse because these vital signs are closely related and data from both are needed to make accurate and informed clinical decisions.

What Should You Do if You Cannot Feel the Brachial Pulse?

• To locate the brachial pulse, palpate the bicep tendon, move medially about 2 cm, and move up about 2–3 cm
• Use three fingers including your index and middle finger to feel for the pulse
• You will usually need to press fairly firmly to palpate the brachial pulse and may need to modify the pressure. If you press too hard, you will obliterate the pulse (make it disappear) and if you press too lightly, you will not be able to feel the pulse
• You may need to reposition your fingers to find the best place to feel the pulse along the brachial artery
• Place the client’s arm with the palm up and elbow extended. You can flex the elbow in varying degrees to relax the muscle and accentuate the pulse
• Cup your opposite hand under the client’s elbow

What Should You Do if You Cannot Hear the Korotkoff Sounds?

• Use your bell and make full contact with skin
• Make sure the bell is positioned over the brachial artery
• Ensure the room is quiet
• Concentrate on expected sounds (swooshing, tapping, muffled sounds)
• Try different earbuds (hard or soft) on your stethoscope

Common Errors When Taking Blood Pressure

Many errors must be avoided when measuring blood pressure. Failure to determine maximum pressure inflation can produce a falsely low systolic reading. Deflating the cuff too slowly can produce a falsely high diastolic, and deflating the cuff too quickly can produce a falsely low systolic or falsely high diastolic reading. Inaccurate cuff sizes for the client’s arm size and shape can result in measurement error: a cuff that is too narrow or too loose can produce a falsely high blood pressure. A falsely low blood pressure can result from the arm being positioned above the level of the heart and a falsely high blood pressure can result from the arm being positioned below the level of the heart.