Why do we trust Auto-NIBP?

[exodus]

Why do we actually trust Auto-NIBP? It's perfect for us as long as the BP comes up as somewhat normal. But as soon as it goes out of a range we deem as normal, then I see people bust out the manual NIBP..

So why is that we only consider the "normal" pressures accurate" but very often treat the "abnormal" pressures as inaccurate and then manually check those? If we need to recheck the abnormal pressures, why do we not recheck the normal ones?

I've been *****ed at before for taking a manual BP on a pt before putting them on a zoll. But that's the only way to verify the BP on the monitor...

 

[ffemt8978]

Why do we actually trust Auto-NIBP? It's perfect for us as long as the BP comes up as somewhat normal. But as soon as it goes out of a range we deem as normal, then I see people bust out the manual NIBP..

So why is that we only consider the "normal" pressures accurate" but very often treat the "abnormal" pressures as inaccurate and then manually check those? If we need to recheck the abnormal pressures, why do we not recheck the normal ones?

I've been *****ed at before for taking a manual BP on a pt before putting them on a zoll. But that's the only way to verify the BP on the monitor...

I don't trust them for normal or abnormal readings. I wish we would take everyone of them out of the ambulances and stick with manual BP's.

 

[6.5diesel_therapy]

I never use the auto BP devices. the smallest thing can change the reading, like the pt moving his/her arm or a bumpy road. no thanks i stick to what i can visually see and hear.

 

[18G]

First I think it comes down to the correlation of the outlandish NiBP with patient condition. If the past four pressures have been consistent at say 135/84 give or take a few points and then a pressure displays as 174/80 and the patient is still status quo, I would check the patients arm position, cord to the BP cuff, and just wait a few minutes and hit the NiBP button again. From my experience the majority of the times the next BP reading will be the patients baseline.

I don't manually verify an outlandish BP when the overall trend of BP has been persistent.... unless of course patient shows change of condition and other parameters begin to change as well.

I trust my $10,000 LP12 to take an accurate BP

 

[Bosco836]

I tend to agree with the comments made by some of the other posters - auto-NIBP can be thrown off quickly by patients moving around.

Having said that, if I get a manual BP first, and put the auto on after, and the values appear relatively similar, I feel reasonably confident that the BP is likely correct. Having said that, if I start to see the BP fluctuating on the auto-NIBP, I'm more inclined to verify it again with a manual pressure, just to confirm the NIBP's results.

I believe auto-NIBP has its place; however, I am also of the opinion that providers shouldn't let it deter them from obtain at least one manual pressure, to establish a baseline BP.

 

[18G]

So what happens when the human is wrong and the machine is right?

 

[medicRob]

I don't. I always get my first pressure manually, then if the NIBP seems strange, I will re-check it manually.

 

[SeeNoMore]

Well I am not sure how comparable they are, but they sure seem to trust them in the ER, even really good Docs go by what they say and take a manual bp when the pressure does not seem to match up with the pts conditioon.

TBH I know a lot of EMTS that take :censored::censored::censored::censored:ty bps, that can be way off. I am good, but I have also misheard some readings a few times, especially in the back of an ambulance with sirens going on. I like to get a manual if I have time on scene for reference and then use the automated to track the pts status while I am doing other things.


I think both are good, and I agree, a 12000 monitor is probably better than a human quite often.

 

[Bosco836]

So what happens when the human is wrong and the machine is right?

I suppose there is always that possibility. However, on a personal level, I'm fairly confident in my ability to take an accurate blood pressure, as it is a skill I use (virtually) daily. With that being said, I generally find that my results are on par with the auto-NIBP.

Obviously, if a provider is unable to obtain an accurate manual BP, the potential for your scenario (where the human is wrong and the machine is right) does exist. However, I would hope that most, if not all providers should be skilled in obtaining a manual blood pressure.

 

[ffemt8978]

Well I am not sure how comparable they are, but they sure seem to trust them in the ER, even really good Docs go by what they say and take a manual bp when the pressure does not seem to match up with the pts conditioon.

Because in the ER, the patient isn't bouncing down our wonderfully smooth roads at highway speeds.

 

[46Young]

I don't. I always get my first pressure manually, then if the NIBP seems strange, I will re-check it manually.

What he said. I believe that these monitors are really designed primarily for the in-hospital environment, not for the inside of a vibrating, moving ambulance.

 

[Epi-do]

I always get a manual BP first. As long as the lifepack is getting something similar, and my patient's condition hasn't changed at all, I trust it. If I suddenly get something that doesn't mesh, I will recheck it. If it comes up the same again, then I will get a manual again. Likewise, if things continue along without really changing, but my pt's condition has definitely changed, I will also recheck it, and then do a manual if I think it is warranted.

 

[SeeNoMore]

I have found that it is pretty easy to tell when a pts bp is low, the s/s tend to present easily. HTN can be a little more tricky, there have been pts with very very high pressures who were totally asymptomatic, sometimes post dialysis or just with unmanaged htn. No h/a no discomfort etc etc.

 

[bigbaldguy]

The policy at my department is to take a manual first on all patients. I assumed that was pretty much standard for all outfits? I know it's not always done but seems like it should be pretty much SOP.

 

[medicRob]

The policy at my department is to take a manual first on all patients. I assumed that was pretty much standard for all outfits? I know it's not always done but seems like it should be pretty much SOP.

Back when I was on a regular paramedic ambulance and had EMT students or Paramedic students, I would always make them do manual pressures (More so with the EMT students than paramedic). I just wanted to ensure that they were able to properly do them.

 

[shfd739]

The policy at my department is to take a manual first on all patients. I assumed that was pretty much standard for all outfits? I know it's not always done but seems like it should be pretty much SOP.

Same for us. If I get an auto reading not consistent with the manual or repeated autos it gets a manual recheck.

 

[DesertMedic66]

I like to get my own reading and then compare it to the auto. But for those long 2+ hours on a transfer are you going to want to be getting up and taking a manual BP every 15 mins? I'm not a lazy person but for those transports it's just alot more convient to use the auto.

 

[Melclin]

I don't trust them at all. I think they're a waste of time mostly.

To add to the reasons why they're appropriate for hospitals, consider how much our gear gets knocked around, dropped, kicked and spoken to in harsh voices. The manual cuffs, pulse oximeters and bsl kits bugger up with relative frequency, largely, I suspect because of the rough treatment. I don't see why the monitors would be impervious to similar abuse.

Although I've had moments lately with dehydrated young stick-girls at concerts where I would probably have appreciated a method of taking a BP that wasn't obscured by the rhythmic assault of [Insert whatever popular music act].

 

[usalsfyre]

So as I said in another thread, we trust our partners ears which may have been assaulted by sirens, diesel engines, gunfire, loud music ect, to obtain what can be a hard to hear sound that they may have never been correctly taught to pick up using a cheap stethoscope and correlate to a small gauge with a large amount of hashmarks representing numbers. Yet the auto-NIBP, which has been developed tested by the manufacturer at large cost to them, approved by the FDA, and is tested for accuracy every six should never be trusted?

Correlate it clinically. I'll check a "normal" auto pressure if it doesn't correlate with what's going on. I trust NIBP until it gives me a reason to distrust it. I care more about the MAP and trend more than I care about exact numbers anyway. I've had a lot of weird pressures show up on NIBP, but I've also had a lot of partners tell me the pressure was "122/86" when it was far higher or lower than that.

Again, the only pressure to trust completely is from a properly transduced arterial line with a good waveform. Baring that (damn medical directors ) everything else is some level of guess.

 

[18G]

So as I said in another thread, we trust our partners ears which may have been assaulted by sirens, diesel engines, gunfire, loud music ect, to obtain what can be a hard to hear sound that they may have never been correctly taught to pick up using a cheap stethoscope and correlate to a small gauge with a large amount of hashmarks representing numbers. Yet the auto-NIBP, which has been developed tested by the manufacturer at large cost to them, approved by the FDA, and is tested for accuracy every six should never be trusted?

Correlate it clinically. I'll check a "normal" auto pressure if it doesn't correlate with what's going on. I trust NIBP until it gives me a reason to distrust it. I care more about the MAP and trend more than I care about exact numbers anyway. I've had a lot of weird pressures show up on NIBP, but I've also had a lot of partners tell me the pressure was "122/86" when it was far higher or lower than that.

Again, the only pressure to trust completely is from a properly transduced arterial line with a good waveform. Baring that (damn medical directors ) everything else is some level of guess.

+1. Very well said.