Category: Other

NIBP vs manual. Are medics to take a manual?

Question#: 596


NIBP vs manual. Are medics to take a manual? When would they be obligated to take a manual besides the NIBP not working.


Hi Lee,

Thank you for reaching out with your question.

While previous versions of the BLS required that the first set of vital signs should be taken manually, this requirement is no longer in place.

In fact, if we examine the relevant standard (ACR Completion Manual, Documentation Standards, and ALS PCS), the only mention of requiring a manual blood pressure can be found in the Companion Document of the ALS PCS.

In this context, “prior to initiating a fluid bolus, two blood pressures (one of which should be manually obtained) indicating hypotension are preferred.”

While this is the only written instance of this procedure, we recommend using your clinical judgment as some clinical circumstance may benefit from obtaining a manual set of vital signs.

Keep in mind, that there are many factors that can influence the accuracy of the NIBP (e.g. traveling down a bumpy road, patient movement, improperly sized cuff, profound hypotension, incorrect cuff or patient positioning, bulky patient clothing, etc.).

If you’re at all concerned, it would be reasonable to take a manual BP, though manual BPs may not be superior to NIBPs. As a reminder, performing a manual blood pressure is a technical skill, and as with any other skill, it is important to practise, to ensure a reliable reading when it's done.

All of this to say, the RPPEO accepts both NIBP and manual blood pressures as valid, but please make sure to document appropriately on your ACR.

Thank you for your question and stay safe out there

RPPEO Education Team

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