michigan hypertension core curriculum - State of Michigan

Table 1: Guidelines for Obtaining Accurate Blood Pressure Readings 2
I. Prepare the equipment:
A. Use equipment that has been (1) validated as accurate against a mercury
sphygmomanometer, (2) checked for disrepair of cuff (e.g., cracks or leaks in tubing,
breaks in stitching or tears in fabric), (3) checked that gauge is intact (mercury meniscus
or aneroid needle is at zero), (4) consistent with State Legislation.
B. Obtain appropriate cuff size by measuring circumference of the patient’s arm and
choosing the cuff size that corresponds to that measurement.
II. Prepare the patient
A. Assess (1) that patient has not recently had nicotine or caffeine and (2) that the patient
has been sitting quietly for 5 minutes prior to measuring BP
B. Position patient: (1) Use a sitting or semi-reclining position with the back supported
and the arm at heart level (middle of the cuff should be at mid-sternum level). (2) Legs
should be uncrossed with feet flat and supported on floor or foot rest (not dangling from
examination table or bed)
C. Bare the upper arm of any constrictive clothing (You should be able to get at least one
finger under a rolled-up sleeve). Palpate brachial artery, position center of cuff bladder
over the brachial artery
III. Take the measurement
A. Support the patient’s arm at heart level
B. For ausculatory measurements:
i. Obtain an estimated systolic pressure by palpation prior to auscultation
ii. Inflate the cuff as rapidly as possible to maximum inflation level (30 mmHg above
estimated systolic BP).
iii. Deflate the cuff slowly at a rate of 2 to 3 mmHg/second; (1) note the first of 2
regular beats as systolic pressure (palpation helps to avoid under-estimating
systolic pressure due to an ausculatory gap) (2) Use Kortokoff V (last sound
heard) as the diastolic pressure (3) continue deflation for 10 mmHg past last
sound to assure sound is not a ‘skipped’ beat.
iv. The measurement should be recorded as an even number and to the nearest 2
mmHg (round upward)
F. Neither the patient nor observer should talk during the measurement
G. If two readings are measured, record the average of the readings
IV. Record the measurement – document the following:
A. The obtained BP reading
B. Patient position (sitting, semi-recumbent, lying, standing)
C. Arm used, include arm circumference and cuff size used
D. Type of device used to obtain the measurement (mercury, aneroid, automated)
E. State of the individual (e.g., anxious, relaxed)
F. Time of administration of any drugs that could affect BP
(*Source: 8,2,3 )
NKFM & MDCH 15