NIBP

[Canuck_EMT]

I was on my EMT practicum in the summer and I was doing a manual BP on a pt, after I pumped up the cuff and started to release I heard the systolic but wasn't sure if it was right so I pumped it back up another 20 mmHg to get a accurate systolic. After the call I was told by another EMT preceptor that I shouldn't be pumping it up like that after releasing it because I'm putting too much stress on the artery. I was confused by this because NIBP machines constantly do that if a pt moves even the slightest. What's your take on this?

[Arctickat]

It relates to the way that each blood pressure is detected.

In the case of a manual pressure, you are auscultating the korotkoff sounds of the artery as pressure is released. When the cuff is re-inflated it can result in a false lower reading. It's kinda like blowing up a nice new balloon. The very first time it's rather difficult and requires greater pressure to inflate, however, after letting the air out it takes much less pressure to inflate the balloon. The artery typically needs a few minutes to regain the resistance and resilience it previously had.

Oscillometric devices measure the amplitude of pressure changes in the occluding cuff as the cuff is deflated from above systolic pressure. The amplitude suddenly increases as the pulse breaks through the occlusion in the artery. The pressure at which this occurs is very close to the systolic pressure. As the cuff pressure is decreased further, the pulsations increase in amplitude, reach a maximum (which approximates to the mean pressure), and then diminish rapidly. The index of diastolic pressure is taken where this rapid transition begins.

Because the oscillometric BP measures when the blood breaks through the occlusion rather than the sound of the pulse against the artery it tends to be more reliable when re-inflating.

However, your preceptor was nit picking because the variance in blood pressure cause by re-inflating the cuff is really not that significant.

[wrmedic82]

I would have to agree with artickat. But let me encourage you to get good with manual BP measurements. This is a personal quirk of mine I know. But I make students do manuals all the time. They are not allowed to touch the NIBP ( I will put it on the patient during txp not the student). This is not to make myself holier than thou or to belittle the student. There have been many occasions where the NIBP was grossly wrong and if me and my partner had trusted the BP, it would have killed the patient. Even in my own care I want a manual BP as my baseline.

When you get out in the field it is completely up to you on how you do things. I know medics that swear and only use NIBP and never do manuals. Just be forewarned and know it can be deceptive.

[emtdennis]

I have found myself counting on the NIBP, until all of a sudden the battery was dead. What a rude awakening!! I had to do bp manually and was tough to do in the back of the rig while rolling.

Stick to manual every so often, if for nothing else than to keep up the skills or to "check" the NIBP.

[DwayneEMTP]

Like Kat said, they're splitting hairs. You'll find this very often when riding with people that aren't really qualified to be preceptors. They don't really know what to do, so they try and find obscure, unimportant things to illuminate to try and make themselves look smarter and more experienced than they are.

I spent a day a long time ago doing this on every patient. In this clinic we saw about 20 pts each per shift, so I had a lot of practice. I'd get an initial B/P, then reinflate the cuff and get the systolic again, and again, and though sometimes I'd see a few points difference, it wasn't significant, at least that I could find.

And wrmedic makes a good point. Taking B/Ps is a skill that takes practice. You're never going to learn to do it and then just be awesome at it for ever. Any time that you have time to take a manual pressure you should understand that you're just being lazy when you choose not to. (Have I been to lazy sometimes? Yeah, many times, but we should try and avoid it when we can.) You'll get better and better at it with time. The same is true with taking a pulse. Pulses have 'character' (unlike most medics that I know...ha. ha.) but it takes quite a while before you've felt enough of them to be able to see it. And once you can, it takes practice to be able to continue to get more information than just a rate.

Manual B/Ps, pulse quality, lung sounds....do them often, and most important, often on people that are healthy-ish for comparison, not only when they're indicated...it will serve you well in your career.

[Arctickat]

Yeah yeah, I know it's been said...but since I made such an awesome post i just wanna add....Every single one of your patients should have at least one manual BP taken. My preference is to make it the first set of vital signs checked. Use the automatic NIBP after that all you want, but if you get a suddenly whacked out reading that just doesn't fit...such as a change from 132/87 to 223/196...or down to 93/72 in a matter of 10 minutes...use the ears to confirm.

Far, far, far too many medical staff have mistreated a condition that didn't actually exist simply because of the NIBP reading.

[Just Plain Ruff]

Plus i would always use a manual cuff to check bp in a child and infant. With the kiddo moving around so much the nibp machine may have a significantly more difficult time obtaining a valid reading.

Plus you will get really proficient in taking peds bps which you need to be anyway.

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[Richard B the EMT]

Perhaps the equipment has improved over the years, but the last automated BP units I recall seeing all had notifications on them, "Not for use in moving vehicles".

[RuralKSEMS]

I was taught Manual as a baseline then the monitor PRN

[DFIB]

I have found myself counting on the NIBP, until all of a sudden the battery was dead. What a rude awakening!! I had to do bp manually and was tough to do in the back of the rig while rolling.

Stick to manual every so often, if for nothing else than to keep up the skills or to "check" the NIBP.

I get my first manual before the truck starts rolling. On our roads additional BP checks are tricky. Manual is all we have.