Procedure for Determining Blood Pressure with a Manual Device

1. Prepare the Patient

  1. Explain to your patient that you will be taking their blood pressure.
  2. Seat the patient comfortably, with the arm slightly flexed, palm up and the entire forearm supported on a level surface even with the heart. Ensure the legs aren’t crossed.
  3. Use either arm unless otherwise indicated. For example, a person who is physically disabled. Repeat blood pressure readings should be completed on the same arm as differences in each arm can be as much as 10mm Hg.
  4. Take pressure on bare arm, not over clothing.

2. Apply the Cuff

  1. Apply the completely deflated cuff to the patient’s arm, supported at the level of the heart.
  2. Place the portion of the cuff that contains the inflatable bladder directly over the brachial artery. The cuff may have an arrow to show the point that should be placed over the artery (Figure 4). The lower edge of the cuff is placed one inch above the antecubital fossa (inside crease of the elbow). The key is to fasten the cuff evenly and snugly (Figure 5).
  3. Adjust the position of the gauge for convenient reading.
  4. Palpate the area between the antecubital fossa and cuff to locate the brachial artery pulse found on the inside of the forearm. The stethoscope end piece is placed over the spot where the brachial pulse is felt (Figure 5).
  5. Position the stethoscope earpieces in the ears, with the tips directed forward.
    Figure 4.
    ce490 fig04 bp postition
    Figure 5.
    ce490 fig05 bp postition
    • The patient should be seated, with one arm resting on the table at the level of the heart.
    • Wrap the deflated cuff around the arm snugly about 3cm above the elbow.
    • Try to keep the cuff as flat as possible.

    3. Locate the Radial Pulse

    1. On the same arm, feel the inside of the wrist, above the thumb with your index and middle fingers until you feel the pulse.
    2. Hold your fingers on the pulse.

    4. Inflate the Cuff

    1. Close the needle valve (air lock) counterclockwise attached to the hand control bulb firmly, but so it may be released readily.
    2. Pump to inflate the cuff until the radial pulse stops. Note the mercury level at which the pulse disappears.
    3. Look at the dial, and pump to 20 or 30mm Hg beyond where the radial pulse was no longer felt. This is the maximum inflation level (MIL). It means that the pressure of the cuff collapses the brachial artery and no blood is flowing through the artery.

    5. Position the Stethoscope End Piece

    1. Place the end piece over the palpated brachial artery, in the one inch space above the antecubital fossa, and slightly toward the inner side of the arm. Hold tightly in place.

    6. Deflate the Cuff Gradually

    1. Release the air lock slowly (2 to 3mm per second) so that the dial drops very gradually and steadily.
    2. Listen for the first sound: systole (“tap, tap”). Note the number on the dial, which is the systolic pressure. This is the beginning of the flow of blood past the cuff.
    3. Continue to release the pressure slowly. The sound will continue, first becoming louder, then diminishing and becoming muffled, until finally disappearing. Note the number on the dial where the last distinct tap was heard (not the muffled sound). This number is the diastolic pressure.
    4. Let the rest of the air out rapidly.

    7. Repeat for Confirmation When There is a Question About a Reading

    1. Wait 30 seconds before inflating the cuff region again. More than one reading is needed within a few minutes to determine an average and ensure a correct reading.

    8. Record

    1. Write the date and arm used.
    2. Record blood pressure as a fraction. Example: R Arm, Nov. 3, 20XX 120/80.