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This article, the second in a two-part series, describes the procedures for non-invasive blood pressure monitoring. This article was originally an early online publication; it was updated on 27/07/2020
Blood pressure is measured for a wide range of diagnostic and monitoring purposes. Accurate results are essential to ensure patients receive the correct treatment and care in a timely manner. This article, part 2 in a two-part series, explains the different procedures for non-invasive measurement; part 1 discussed key principles and measuring equipment.
Citation: Jevon P (2020) Blood pressure 2: procedures for measuring blood pressure. Nursing Times [online]; 116: 8, 26-28
Author: Phil Jevon is academy tutor, Manor Hospital, Walsall, and honorary clinical lecturer, School of Medicine, University of Birmingham.
Blood pressure (BP) measurement is a commonly performed procedure in most healthcare settings, and provides essential information to aid diagnosis and monitoring. It is vital that measurement gives accurate results to ensure patients receive the correct treatment and care in a timely manner. Part 1 of this series discussed the key principles of BP measurement and the types of equipment used; this article describes the procedures for manual and automated measurement, and for lying and standing BP measurement.
All health professionals who undertake BP measurements should have adequate initial training and their competence at performing the skill should be periodically reviewed (National Institute for Health and Care Excellence, 2019). It is also important to ensure that, when new devices are introduced, staff training includes the equipment’s limitations and how to recognise artefacts (Medicines and Healthcare products Regulatory Agency, 2019).
Despite the growing use of automated devices, it is recommended that health professionals continue to receive training in manual BP measurement using auscultation (MHRA, 2019). Helpful videos demonstrating the correct procedure for manual and automated BP measurements are available on the website of the British and Irish Hypertension Society (BIHS).
“Despite the growing use of automated devices, it is recommended that health professionals still be trained to measure BP manually using auscultation”
The sphygmomanometer is an important tool for clinical assessment, but it can become contaminated by micro-organisms. As such, adherence to local infection prevention and control policies – including the cleaning of equipment between every patient contact – is essential.
Non-sterile gloves are not required routinely for measuring BP. However, nurses do neeed to:
Before undertaking a manual or automated BP measurement, ensure the patient is either lying on a bed or trolley (Fig 1a), or sitting comfortably in a chair that has a backrest, and positioned with feet placed on the floor and legs uncrossed (Fig 1b). Ideally, the patient should not have drunk alcohol or a caffeinated drink or smoked tobacco for 15 minutes before the procedure, and should be relaxed, not talking and should have been in position for at least five minutes (British and Irish Hypertension Society, 2017a).
Explain the procedure to the patient and obtain consent. Ensure there are no contraindications to using their arm such as lymphodema, IV infusion, recent trauma or surgery, or an arteriovenous fistula. If there are problems, use the other arm or consider measurement on the lower limbs (Dougherty and Lister, 2015). Remove any tight clothing that is restricting the arm, and support it at the level of the heart using a pillow, table or arm rest (Fig 2). Ensure the patient is sitting comfortably.
If the BP needs to be repeated, wait for at least one minute before each reading. Record each measurement immediately and avoid relying on memory (Beevers et al, 2015).
The routine measurement of both lying and standing BP is recommended in patients aged ≥65 years and those with diabetes or symptoms that suggest they may have postural hypotension; this is because these individuals can experience a significant fall in BP when standing up (NICE, 2019; NICE, 2013).
Before starting, ascertain whether you will need assistance from a colleague to help the patient to stand. Explain the procedure to the patient and obtain consent. Ideally, a manual BP measurement device should be used.
This procedure should be undertaken only after approved training, supervised practice and competency assessment, and carried out in accordance with local policies and protocols.
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