Automatic vs. Manual BP

[Dustdevil]

...the article claimed that NIBP in the hospital setting to be more acurate than manual BP. Something to think about...

Definitely! I'd love to see the study!

Of course, there are so many variables involved in this controversy that it's very difficult to come to any conclusions. What is "accurate"? It is widely accepted that an IPB is the standard, but is it really? All of our protocols are based upon "normal" and "usual" readings, which come from our experiences with manual BPs, not IBPs. So the question is two-fold. What is the gold standard, and what should be standard practice.

Think of how we take temperatures. Anal temps are the gold standard, giving us the core temp. However, oral temps are the standard for field practice. This doesn't present a problem to us, because we know the standard deviation between the two methods is ≈ 2 degrees F. Can a standard deviation be established between a manual and NIBP? That would be great, but I don't think it's possible. Whereas, there is certainly room for error in technique with oral temps, I doubt it is as common as that with manual BPs, so the deviation is not standard. But can a standard deviation be established between the IBP and NIBP? That is a possibility, but again, probably not likely.

I think at some point we may find ourselves having to admit that neither of the two methods are consistently accurate.

[FireMedic65]

Definitely! I'd love to see the study!

Of course, there are so many variables involved in this controversy that it's very difficult to come to any conclusions. What is "accurate"? It is widely accepted that an IPB is the standard, but is it really? All of our protocols are based upon "normal" and "usual" readings, which come from our experiences with manual BPs, not IBPs. So the question is two-fold. What is the gold standard, and what should be standard practice.

Think of how we take temperatures. Anal temps are the gold standard, giving us the core temp. However, oral temps are the standard for field practice. This doesn't present a problem to us, because we know the standard deviation between the two methods is ≈ 2 degrees F. Can a standard deviation be established between a manual and NIBP? That would be great, but I don't think it's possible. Whereas, there is certainly room for error in technique with oral temps, I doubt it is as common as that with manual BPs, so the deviation is not standard. But can a standard deviation be established between the IBP and NIBP? That is a possibility, but again, probably not likely.

I think at some point we may find ourselves having to admit that neither of the two methods are consistently accurate.

I would very much like to read it too. Too many people reply on slapping that NIBP on all their patients and the pulse ox and go from there. Relying too much on machines could lead to trouble in my honest opinion.

[WolfmanHarris]

Talking with a colleague, apparently the official opinion of the Sunnybrook-Osler Centre for Prehospital Care (Medical Driection for Toronto, Peel Region and others) is that NIBP is more accurate than manual, assuming a stable environment free of extremes, movement and when perfectly tuned; however, this does not reflect the reality of EMS and thus they should be primarily using manual BP and not relying on NIBP. Can't support this with a link I'm afraid as they're not my medical direction and I don't have a copy of their policies.

[MontvilleFire39]

I am going to try to do a medline search when I get off shift....

Something I have really made an effort to do is get my first BP be it manual or NIBP before we move the patient, similar to getting a good baseline EKG.

Also, out of curiosity I began to atempt to "combine" the two. Our new monitors (Philips MrX) show the pressure as it is being counted down. I try to palp the systolic BP as it is taking the NIBP. I found that my reading is alays 5-15mmHg or so different than the NIBP reading. Perhaps the NIBP is more sensitive than my delicate hands.

When we had our inservice with the sales rep, he described some sort of complex algorithm of taking multiple readings, averages, etc..I would like to learn the interacacies (sp?) of the technology before I feel I can make an educated opinion...

[mobey]

Manual BP by auscultation IS NIBP.....

Non

Invasive

Blood

Pressure

I am aware you are speaking of machine aquired blood pressure

[FireMedic65]

Manual BP by auscultation IS NIBP.....

Non

Invasive

Blood

Pressure

I am aware you are speaking of machine aquired blood pressure

but the button says NIBP and it does everything for me

thanks for clearing that up for some folk though

[boeingb13]

When we get on scene there is almost always a manual taken, every call is a minimum of 5 people so theres almost never one missed, in saying that the pressures are usually pretty close unless there is something going on that would cause drastic pressure drops or raises. Either way you almost always get both, with the manual being first. Every dept is different.

[Jeepluv77]

This is somewhat deviated off topic, but still kind of there. In class the other day my instructor said to try to have the same person get the bp's throughout the call for consistency. Is this a good practice? It seems to me that if you are taking a reading properly it shouldn't matter who's doing it. Btw, we are talking all manual here.

[akroeze]

every call is a minimum of 5 people

Wow

Some calls I would like that, but not many.

[HERBIE1]

I see the same flaws in this study as are mentioned above. In a stable ER setting, an automatic cuff is perfectly acceptable, although there have been many times when I questioned the readings and performed a manual BP to verify what the machine tells me. Sometimes they are right, and sometimes they are dead wrong. Personally, I trust my ears before a machine, and in the back of a rough riding ambulance, I question the accuracy of a machine. I think the bottom line here with either method is to chart a trend. Is the BP going up, down, or all over the place? The numbers are important, but I think the more important issue is what those numbers are doing and what does that tell you. Is the patient responding to treatment, are they decompensating, is the pulse pressure changing, are the numbers remaining the same?

Obviously you need to correlate the readings- however they are obtained- with the patient's condition. Just like we generally do not treat an EKG rhythm without checking the patient, if you get a BP that says the patient is not perfusing and is ready to code, and the person is busy telling you a joke, you might double check that BP reading.

Bottom line- like any of the toys we have, nothing can replace your skills, training, and experience. An automatic BP cuff can be a useful tool in the proper setting.