Taking Your Blood Pressure - Procedure

1. Have paper and your graph at hand for immediate recording of the pressure.

2. Seat the subject in a quiet, calm environment with his or her bared arm resting on a standard table or other support so the midpoint of the upper arm is at the level of the heart.

3. Estimate by inspection or measure with a tape the circumference of the bare upper arm at the midpoint between the acromium and olecranon process (between the shoulder and elbow) and select an appropriately sized cuff. The bladder inside the cuff should encircle 80% of the arm in adults and 100% of the arm in children less than 13 years old. If in doubt, use a larger cuff. If the available cuff is too small, this should be noted.

4. Palpate the brachial artery and place the cuff so that the midline of the bladder is over the arterial pulsation, then wrap and secure the cuff snugly around the subject’s bare upper arm. Avoid rolling up the sleeve in such a manner that it forms a tight tourniquet around the upper arm. Loose application of the cuff results in overestimation of the pressure. The lower edge of the cuff should be 1 inch (2 cm) above the antecubital fossa (bend of the elbow), where the head of the stethoscope is to be placed.

5. Place the manometer so the center of the mercury column or aneroid dial is at eye level and easily visible to the observer and the tubing from the cuff is unobstructed.

6. Inflate the cuff rapidly to 70 mm Hg, and increase by increments of 10 mm Hg while palpating the radial pulse. Note the level of pressure at which the pulse disappears and subsequently reappears during deflation. This procedure, the palpatory method, provides a necessary preliminary approximation of the systolic blood pressure to ensure an adequate level of inflation when the actual, auscultatory measurement is made. The palpatory method is particularly useful to avoid underinflation of the cuff in patients with an auscultatory gap and overinflation in those with very low blood pressure.

7. Place the earpieces of the stethoscope into the ear canals, angled forward to fit snugly. Switch the stethoscope head to the low-frequency position (bell). The setting can be confirmed by listening as the stethoscope head is tapped gently.

8. Place the head of the stethoscope over the brachial artery pulsation just above and medial to the antecubital fossa but below the lower edge of the cuff, and hold it firmly in place, making sure that the head makes contact with the skin around its entire circumference. Wedging the head of the stethoscope under the edge of the cuff may free up one hand but results in considerable extraneous noise.

9. Inflate the bladder rapidly and steadily to a pressure 20 to 30 mm Hg above the level previously determined by palpation, then partially unscrew (open) the valve and deflate the bladder at 2 mm/s while listening for the appearance of the Korotkoff sounds.

10. As the pressure in the bladder falls, note the level of the pressure on the manometer at the first appearance of repetitive sounds (Phase I) and at the muffling of these sounds (Phase IV) and when they disappear (Phase V). During the period the Korotkoff sounds are audible, the rate of deflation should be no more than 2 mm per pulse beat, thereby compensating for both rapid and slow heart rates.

11. After the last Korotkoff sound is heard, the cuff should be deflated slowly for at least another 10 mm Hg, to ensure that no further sounds are audible, then rapidly and completely deflated, and the subject should be allowed to rest for at least 30 seconds.

12. The systolic (Phase I) and diastolic (Phase V) pressures should be immediately recorded, rounded off (upwards) to the nearest 2 mm Hg. In children, and when sounds are heard nearly to a level of 0 mm Hg, the Phase IV pressure should also be recorded. All values should be recorded together with the name of the subject, and the date and time of the measurement, the arm on which the measurement was made, the subject’s position, and the cuff size (when a nonstandard size is used).

13. The measurement should be repeated after at least 30 seconds, and the two readings averaged. In clinical situations additional measurements can be made in the same or opposite arm, in the same or an alternative position.

Reprinted from the American Heart Association, “Human Blood Pressure Determination by Sphygmomanometry” Copyright 1994.
 

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