Lisbon Fire Department Standard Operating Guidelines and Policies

– ASSESSMENT TOOLS: BLOOD PRESSURE MEASUREMENT;

1. 
   To consistently obtain an accurate blood pressure measurement through the use of auscultory and palpatory methods
   
2. 
   To objectively measure the percent of circulating hemoglobin saturated with oxygen.
   
3. 
   To accurately measure the blood glucose level through the use of a glucometer
   

1. 
   Correctly size and position the blood pressure cuff
   
2. 
   Locate the brachial artery pulse in the antecubital space
   
3. 
   Inflate the cuff 30 mm Hg above the point at which the pulse is lost
   
4. 
   Deflate cuff proportionate to the rate of the pulse and record the results.
   

SKILL:

1. 
   PALPATION METHOD
   

1. 
   Position the patient with the arm at heart level
   
2. 
   Apply the cuff snugly around the extremity with the lower edge at least one (1) inch above the antecubital space with the cuff’s bladder centered over the brachial artery
   
3. 
   Palpate the brachial or radial pulse.
   
4. 
   Inflate the blood pressure cuff to 30 mm Hg above the point at which the pulse disappears
   
5. 
   Deflate cuff slowly while noting the reading at which the pulse is felt to return
   
6. 
   Record systolic blood pressure as #/P
   

Too small a cuff will give a false high reading.

1. 
   Position the patient with the arm at heart level
   
2. 
   Apply the cuff snugly around the extremity with the lower edge at least one (1) inch above the antecubital space and the cuff’s bladder centered over the brachial artery
   
3. 
   Insert stethoscope earpieces in ears with earpieces pointing slightly forward: test diaphragm for sound conduction by gently tapping on diaphragm
   
4. 
   Palpate or auscultate brachial artery while inflating cuff to 30 mm Hg above the loss of pulse
   
5. 
   Deflate cuff slowly with stethoscope diaphragm over brachial artery, noting the systolic and diastolic pressures
   

1. Do not depend on oximeter reading alone to assess patient’s oxygenation status

The accuracy of the measurement may be affected by low blood flow, CO poisoning, nail polish, gel nails, dirt, jaundice, pt. movement, bright light. If pulse does not correlate with the machine, the accuracy of the reading should be questioned

A. Select and place the appropriate transducer on the patient (finger, toe, earlobe, etc.)

1. 
   Clean site with alcohol wipe, if necessary
   
2. 
   Tape around great toe or foot –pediatric patient
   
3. 
   Tape across the bridge of the nose-pediatric transducer on adult patient.
   

C. Verify that pulse reading on oximeter is equal to patient’s pulse.

D. Note and record reading

1. 
   Use appropriate body substance isolation precautions
   
2. 
   Record reading in mg/dL
   
3. 
   Consider use on all patients with altered level of consciousness
   
4. 
   Ensure unit is calibrated
   
5. 
   Check expiration date on test strips
   

1. 
   Prepare equipment (glucometer, lancet device, alcohol wipes, band-aid) in advance, according to manufacturer’s recommendations
   
2. 
   Clean finger with alcohol prep pad, allowing alcohol to dry for 30 seconds
   
3. 
   Turn unit on
   
4. 
   Confirm test strip code with glucometer display reading
   

5. 
   Prick finger with lancet to obtain blood sample
   
6. 
   Apply sample to test strip
   
7. 
   Cover puncture site with band-aid if bleeding continues
   
8. 
   Properly dispose of lancet
   
9. 
   Note and record reading