Policy Manual sample

MDT Home Health Care Agency, Inc. 2.4 Ensure the valve control for the pump is closed. 2.5 If there is any evident damage e.g. cracked glass, the sphygmomanometer should be sent for repair. 3. The Automated Sphygmomanometer. 3.1 Do not interchange cuff attachments; each individual cuff is supplied with attachments for the air hose. To prevent loss or damage it is simpler to keep each cuff with the original cuff connectors. Do not cut or alter the length of the rubber tubing of cuffs. 3.2 Ensure cuff connectors do not cross thread onto the air hose. 3.3 Ensure there are no kinks in the air hose of cuff tubing prior to commencing reading. 3.4 Choose a cuff that will cover 80% of upper limb. 3.5 If rubber tubing is damaged e.g. cracked or split, then the cuff must be replaced. Procedure for Measurement of Blood Pressure using an Aneroid Sphygmomanometer (auscultation) 1.1 Patient should be relaxed (if patient is not relaxed this should be documented as the reading may be affected by up to 20%) 1.2 Place the centre of the bladder of the cuff over the brachial artery. Wrap the cuff evenly around the bare arm leaving the lower edge a minimum of 1.25cm above the brachial pulse. 1.3 Support the patient's right arm in a slightly flexed position and abducted to position level with patient's heart. 1.4 Palpate the brachial or radial artery (brachial artery is ideal as this will indicate where stethoscope is to be placed), inflate the cuff until the pulse disappears and then inflate a further 20 - 30mmHg. Place the stethoscope over the brachial pulse. 1.5 Hold the manometer at heart level. 1.6 Deflate the cuff slowly at a rate of 2-3mmHg per second 1.7 Note the first phase of the Korotkoff sound (faint tapping): this is the systolic blood pressure. 1.8 Continue deflating the cuff slowly until: i. Phase V of the Korotkoff sounds (all sound disappears) is heard: this is the diastolic blood pressure. ii. If Korotkoff sounds are heard to 0, repeat procedure deflate cuff until Korotkoff phase IV sound (abrupt muffling sound) this is the diastolic blood pressure. (NOTE IF PHASE IV HAS BEEN USED) 1.9 Quickly deflate the cuff completely when diastolic reading is achieved. 1.10 Immediately write the reading down, to the nearest 2mmHg. Do not round readings off to the nearest 5-10mmHg. 1.11 Delay repeating the reading for a minimum of 1 minute. 2. Procedure for Measuring Blood Pressure using an Automated (e.g. Dinamap) Monitor. 2.1 Ensure air hose is connected to front of monitor. 2.2 Select correct size cuff size that covers 80% of limb and attach to the air hose. 2.3 Ensure patient is sitting with arm supported at heart level. If the cuff is not at heart level addition or subtract of mmHg must be made per cm deviation from heart level as per manufactures instructions. 2.4 Palpate the brachial pulse and wrap the cuff around the limb. Ensure the artery mark on the cuff is aligned with the brachial pulse. 2.5 Select monitoring mode e.g. manual or auto (refer to manufacturers instructions). 3. Procedure for Measuring Blood Pressure using a Doppler. Home Health Agency Nursing Care & Procedures K-174