Manual Blood Pressure

• Wash hands, introduce self and check patient name and DOB.
• Explain to the patient that this might be uncomfortable but if they cannot tolerate it, let you know.  Gain consent.
• Position the patient’s arm level with their heart and relaxed.  This is most easily done by putting it on a pillow.
• Without the use of the stethoscope first:
  • Wrap the sphygmomanometer cuff around the patients bicep belly with the artery arrow overlying the brachial artery.
  • With your fingers feeling for the radial pulse at the wrist, inflate the cuff until this disappears.  This estimates systolic BP. Deflate the cuff
  • Next using the stethoscope (whether to use the bell or diaphragm is debated) over the cubital fossa, inflate the cuff to the estimated SBP +20 mmHg and slowly deflate the cuff at around 2 mmHg/sec.
    • At the SBP, you should begin to hear pulsatile noises (Korsakoff sounds).
    • At the DBP, these sounds disappear.
  • Deflate the cuff and record SBP/DBP.

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