NIBP vs Manual BP

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Background: NIBP use is nearly ubiquitous in healthcare. EMS is one of the few areas of healthcare where some providers are forbidden to use NIBP. There is almost no research on the topic in the prehospital environment (virtually impossible to get good data), but plenty of validation of modern NIBP accuracy in a hospital setting.


Analysis:

NIBP:

Pro – More frequent and regular readings, frees up provider time, automatically calculates relatively accurate MAP

Con – May have trouble reading with motion


Manual BP:

Pro – Can get a reading with an experienced provider in a situation where the NIBP struggles

Con – No MAP (rudimentary with manual calculations), interrupts other tasks, difficult in noisy/moving environments


NOTE: You can palp a pressure with either method for verification.

There are times that you have to get a manual BP, but the arguments against NIBP border on comical:

· Someone might record a bad NIBP accidentally? That same provider won't recognize a poorly performed manual BP either!

· Someone might record a bad NIBP out of laziness? That same provider will just fudge/make up a manual BP!

· You can hear an irregular beat during a manual BP? Taking a peripheral pulse while auscultating heart/lung the same thing… and comparing pulse/pleth vs EKG tracing does as well.


Conclusion:

NIBP means more frequent readings of more actionable vitals at more regular intervals (plus on demand) so that provider can focus on components of care that can't be automated. There are still good reasons to have a manual cuff and know how to take manual BPs.
 
I agree with most of what you say. My distrust is due to being around Zolls. They have a horrible NIBP. I hear the X series is a major improvement and looking forward to the switch.

I do find the LP 15 to at least give a believable B/P.

One other draw back to the NIBP is the death grip it gives to some people.

NOTE: You can palp a pressure with either method for verification. Not with a E series Zoll, it has no numbers showing until it's done
 
cruiseforever said:
I agree with most of what you say. My distrust is due to being around Zolls. They have a horrible NIBP. I hear the X series is a major improvement and looking forward to the switch.

I do find the LP 15 to at least give a believable B/P.

One other draw back to the NIBP is the death grip it gives to some people.

NOTE: You can palp a pressure with either method for verification. Not with a E series Zoll, it has no numbers showing until it's done
Click to expand...

Two key points here from your post.

First: Modern machines are vastly superior to the units of 10 ago.

Second if a machine does not show continuous live pressure during acquisition it's a lot like having a pulse oximeter that doesn't show a pleth. I would not trust either.

Even the $40 NI BP unit I got from Amazon shows continuous live pressure. So does the $20 pulse ox I got from Amazon show a pleth wave. How else can you judge the quality of signal and measurement except by Trend which may be changing?

One thing I learned in the ICU is that you never trust a data source without verification. Pulse oximetry will also give you pulse rate and nice ones will give you pulse index and other metrics in addition to the wave. If you have a poor wave or a poor pulse index or the pulse does not correlate to other pulse measurements (Ectopy notwithstanding) then you suspect any reading coming out of the pulse ox. If you can't palp your nibp, can't see it struggling by watching pressures, or another correlating quality metric like a nibp acquired pulse rate or signal quality indicators that many of the nicer units provide, of course it's easy to be suspect of your data and rightfully so.

Or maybe I'm just a spoiled ICU nurse. Where is my arterial line? Sometimes I asked that in the backcountry when I'm debating whether to open up the insulation to take a manual pressure on a patient when it's below freezing...
 
I like NIBP for the reasons you mentioned, especially on a more high acuity call, when I can just put on the cuff, hit the button and move on to the next task. My service uses the LP15's and I find it is accurate for the most part. If the patient is moving to much, or if the ambulance is driving on bumpy roads, then often it will take a while to get a reading or will be inaccurate.
It's important to be good at manual BP's though; some people get so dependent on the NIBP that they will sit there and fiddle with it and hit the button 3 or 4 times trying to get an accurate pressure because their so fixated on the machine. Sometimes it's better just to take a quick manual BP, it only takes 30 or 40 seconds in most cases.
 
I'll preface my post with this: I'm damned good at getting manual vital signs.

I use NIBP almost exclusively at my ED because of primarily two things: one (biggest factor for me) is that the machine allows me to offload that task so I can concentrate on other things. The other thing is that the machine reports what it gets to a central server which my EMR can "pull" from so it almost automatically reports vital signs data to the EMR. I just have to remember to "associate" the monitor with a particular patient. Like others, I have experienced moments when the patient is moving too much, fidgeting too much, or just won't hold still long enough and the machine doesn't get a "valid" reading so it has to retry. In those situations, I can (if I can find one in the ED somewhere) get a manual cuff out and get a manual measurement. If I can't hear a BP, either something is wrong with my steth or something is VERY wrong with the patient...
 
I am here on behalf of my manual BP peeps!!

First off, I don't have any paramedic experience with NIBPs (some as an EMT but not enough to recall the experience) only manual pressures. I'm not here to bash NIBPs, I see them used frequently and know they are an excepted method for obtaining a blood pressure. BUT I can't think of a single patient, in any condition, where getting a manual blood pressure took enough time to hinder patient care. I feel like there is an organic quality to a manual BP, actually hearing the beats, their quality, their strength, and their rhythm is all telling information that I would not get if I used a NIBP machine.

My impression of NIBP is similar to the impression I have when providers use a pulse ox probe to get a heart rate (instead of palpating one). It just misses the point, but it still gives you the answer. When do you trust your NIBP? Do you compare it with a manual pressure? Will you literally run a whole call without ever putting stethoscope to patient (NIBP + Pulse ox)?

I think every paramedic or EMT should be competent at getting manual vital signs, no questions asked. If NIBPs are used most of time thats fine but manuals vital signs should never be a skill thats lost.
 
Yes, but DG goes to the opposite extreme and doesn't use them at all. We still take manual pressures but also can do subsequent NIBP.
 
Arterial line > everything else :cool:


Usually if I am in a situation that I need a manual pressure is just palpate one. And I rarely trust manual BPs that I didn't obtain myself.

The keys to an accurate NIBP are cuff placement and lack of movement. If you are getting erroneous readings recheck placement and physically hold the patients arm still. If it's a confused patient tuck their arm into a blanket and tuck them it into the stretcher or use coban.
 
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Maybe when we get our new LP15s Ill have my faith restored in NIBP, our Phillips monitors can't be trusted. Right now I take manuals.

Sent from my SAMSUNG-SM-G920A using Tapatalk
 
The NIBP on the LP 15 isn't horrible. Equipment and technology is great to have for ease of use and freeing up a healthcare provider. But like all tech it's not going to be accurate 100% of the time. If I see the LP 15 giving me a blood pressure that's grossly wrong then I'll take a manual. It doesn't happen often but it does happen like with any other monitor.
 
I do a manual on all peds and people that actually looks sick. The vaginal itch will stick with NIBP.
 
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