I have been an RN for nearly 20 years and in many ways, I still practice “old school” style. Back in the old days, there was a manual sphygmomanometer at every bedside. When I began teaching a few years ago, I was shocked to find that the new standard of practice was to use automated cuffs on all patients. It is difficult to even find a manual cuff on the unit. I was initially very strict and insisted that the students only use a manual cuff when assessing blood pressure. After awhile, it became impractical and for the sake of time management, I allowed the use of automated cuffs.

Last semester,  a senior nursing student was caring for a patient  who became very tachycardic in response to a medication. As the patient’s heart rate increased, the blood pressure plummeted. As we were waiting for the physician and doing the usual interventions for a hypotensive patient (i.e., wide open fluids, trendelenberg, etc), the automated cuff continued to cycle, but was unable to get a reading. I grabbed the manual cuff and instructed the student to get a blood pressure reading “the old fashioned way.” She was completely unable to perform this basic nursing task. As she was fumbling around, the physician came into the room, followed by a couple of residents and some other staff members. I pushed her out of the way and quickly got the reading myself. Afterwards, she was in tears. She felt horribly embarrassed and felt helpless that she could not help her patient when the patient really needed help. I agreed.

From that day forward, I went back to my old ways. Manual blood pressures on every patient. In a critical situation, the automated cuff won’t cut it. In a patient with Afib, the automated cuff won’t cut it. I was pleased to see an article out of the U.K. yesterday that confirmed what I already knew – manual cuffs are better and more accurate. I hope this leads to a shift away from reliance on automated cuffs. Technology is not perfect, and is not a replacement for good old fashioned hands-on skills. Sometimes, old school is better!

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