Measuring Vital Signs: How to Take Blood Pressure

INTRODUCTION

One of the most rudimentary tasks performed on a daily basis in a medical facility is measuring
patient’s vital signs. Everyone who has been in for a check-up or to the hospital knows the
rundown; a nurse or emergency room tech will take your temperature, pulse, height and
weight, and blood pressure. Being in the position of taking a patient’s blood pressure, it is
important to understand the physiological mechanism as well as the proper way to perform the
physical measurement.

Blood pressure is the force exerted on the walls of the arteries as blood is pumped through the
blood vessels. While blood pressure is present in all blood vessels throughout the body, blood
pressure as a vital sign is measured as the arterial blood pressure in the upper arm. For each
heartbeat, blood pressure varies between a maximum (systolic) and minimum (diastolic)
pressures. Blood pressure is measured in millimeters mercury (mmHg), and is expressed as
mmHg systolic pressure over mmHg diastolic pressure. A measurement of 120/80 is the medical
standard for healthy blood pressure. Blood pressures of 140/90 and above are considered
hypertensive, and put a patient at danger for cardiovascular disease.

In a medical setting, the device used to take blood pressure is called a sphygmomanometer,
comprised of an inflatable cuff to restrict blood flow, an inflation bulb and valve to regulate the
cuff, and a manometer to measure pressure. A sphygmomanometer is used in conjunction with
a stethoscope, which is used to hear the “Sounds of Korotokoff,” also known as the Korotokoff
sounds. These sounds are by turbulence of the blood as it flows through the artery, and will
present as thumping sounds (like a heartbeat) in the brachial artery. When taking a person’s
blood pressure, the cuff is inflated to a pressure that stops blood flow in the brachial artery in
the upper arm. When the cuff pressure decreases to a point where blood begins to flow (the
systolic pressure), the Korotokoff sounds can be heard through the stethoscope. These will
continue as the cuff pressures declines, and the diastolic pressure is measured as the pressure
when the Korotokoff sounds disappear and blood is flowing normally and easily through the
artery again.

This instruction set will outline the steps it takes to properly take a patient’s blood pressure. It
is broken into three main sections: preparing the patient, measuring systolic blood pressure,
and measuring diastolic blood pressure.
NOTE: There are several things that need to be done to get an accurate reading. The correct
size cuff needs to be selected, because one that is too big or too small for a person can lead to
inaccurate measurements. The American Heart Association recommends that the length of the
bladder should be 80% of the arm circumference. Also, a patient should be quiet and relaxed
during a reading, and should avoid stimulants or depressants prior to measurement.

WARNING: Inflating a blood pressure cuff too much can be painful and potentially dangerous
for a patient. Do not exceed maximum inflation by forcing the cuff to inflate far past the
patient’s radial pulse, which is when the pulse sounds stopped during inflation. A good rule of
thumb is to go 10 mmHg past the pressure you last heard the pulse, which is around 160 -180
mmHg for the average patient.

TOOLS
Sphygmomanometer Stethoscope
INSTRUCTIONS
I. Preparing the Patient

1. Have the patient sit with their back vertically against a chair with one arm resting on a
counter or table.

2. Choose the appropriate size cuff for the patient. There are child sized cuffs, regular
sized cuffs, and large cuffs, as shown in Figure 1 below. The regular size fits most adult
patients.

Figure 1. Shown are examples of the three general sizes of blood pressure cuffs.

3. Wrap the cuff around the patient’s upper arm as shown below in Figure 2, aligning the
bottom of the cuff about an inch above the inner elbow. Once the cuff should be
centered on the brachial artery, Velcro the cuff in place so that it is securely fastened.
Figure 2. The cuff is wrapped around the upper arm close to the inner elbow, and fastened

with Velcro.
 4. With your index and middle fingers, palpitate (feel for) for the brachial artery along the
upper inner arm. Place the diaphragm of the stethoscope partially underneath the cuff
on this spot (as shown below in Figure 3), and put the earpieces into your ears and listen
for the brachial pulse.

Figure 3. The diaphragm of the stethoscope is placed on the brachial artery to allow the
practitioner to listen for the Korotkoff sounds.

II. Measuring Systolic Pressure

5. Make sure the valve on the rubber bulb is screwed shut, and begin to squeeze the bulb
steadily and rapidly, as done in Figure 4. The cuff will begin to inflate and the needle on
the manometer gauge will increase.

Figure 4. The practitioner (in the pink) is pumping the rubber bulb of the sphygmomanometer
in order to inflate the blood pressure cuff.
 6. Once the reading on the dial on the manometer indicates 180 mmHg, slowly loosen (or
open) the valve to begin to release the pressure. A good rate to go by is to decrease the
pressure about 5 mmHg/second.

7. As the pressure slowly decreases, listen to the artery for the onset of consecutive beats
(the sounds of Korotkoff). The pressure these begin at is the systolic pressure. Pay close
attention to the pressure reading that these occur at, because this will need to be
recorded as the systolic pressure measurement.
**Always note blood pressure in even numbers, for example, 140mmHg, or 120mmHg.

III. Measuring Diastolic Pressure

8. The Korotkoff sounds will continue as the cuff pressure continues to deflate.

9. Listen for the cessation of these sounds. When the beating becomes a light
“whooshing” sound or disappears all together, this is the diastolic pressure. Note the
pressure indicated by the manometer that this occurs at.

10. Once the diastolic pressure is taken, open the valve and allow the cuff to completely
deflate.

11. Remove the cuff from the patient. If you could not hear the sounds well and did not get
a good reading, wait at least one minute before retaking the blood pressure.

12. Record the systolic and diastolic pressures as a ratio (for example, 120/80). Also note in
which arm the blood pressure was taken.