This guide is for students practicing in a skills lab. In a real clinic, follow your instructor, workplace rules, and patient safety steps.

Audience

Students learning the skill

This is for users who know what blood pressure is, but are still learning how to take it by hand.

Purpose

Teach the whole process

The guide shows what to do first, what to do next, and how to finish with a clear reading.

Success

A clear final number

At the end, the user should be able to write a reading like 118/76 mmHg and explain how it was taken.

Scope

One seated adult reading

This guide covers one manual blood pressure reading on a seated adult patient using a cuff, bulb, gauge, and stethoscope.

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Contents

Go where you need to go

01 Introduction 02 Equipment Needed 03 Cuff Sizes 04 Before You Begin 05 Prepare the Patient 06 Apply the Cuff 07 Locate the Brachial Artery 08 Inflate the Cuff 09 Deflate and Listen 10 Record the Reading 11 Common Mistakes 12 What Numbers Mean 13 Troubleshooting 14 Checklist

Choose a route

Pick the path that helps you most

Learning it first Start at the first step and move through the whole process. Something went wrong Jump to common mistakes and ways to fix them. Before a skills check Use the quick review and checklist before you practice.
Before

Prepare

Gather supplies, seat the patient, rest quietly, and position the arm.

During

Measure

Apply the cuff, locate the brachial artery, inflate, deflate, and listen.

After

Record

Write the reading, note important details, and repeat if the reading seems wrong.

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Introduction

What this skill does

Manual blood pressure is measured with a cuff, gauge, bulb, and stethoscope. First, you prepare the patient. Next, you listen for the sounds. Last, you write down the reading. A finished reading should look like 118/76 mmHg.

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Equipment Needed

Get your supplies ready

  • Manual blood pressure cuff with gauge
  • Stethoscope
  • Alcohol wipes or approved disinfectant
  • Pen, chart, or electronic health record
  • Chair with back support
  • Flat surface to support the arm at heart level
Manual blood pressure cuff, gauge, bulb, stethoscope, pen, and chart on a clean clinic desk
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Cuff Sizes

Choose the cuff that fits the arm

Cuff size affects accuracy. A cuff that is too small can make the reading look too high. A cuff that is too large can make the reading look too low. Measure around the middle of the bare upper arm before choosing a cuff.

  1. Wrap a tape measure around the patient's bare upper arm.
  2. Measure midway between the shoulder and elbow.
  3. Match the arm measurement to the cuff size chart.

After measuring the arm, use:

  • Small adult cuff: 22-26 cm arm circumference
  • Adult cuff: 27-34 cm arm circumference
  • Large adult cuff: 35-44 cm arm circumference
  • Extra-large adult cuff: 45-52 cm arm circumference
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Before You Begin

Set up the patient

Pause before measuring

Ask the patient to sit quietly for at least five minutes before the reading. Keep this time quiet.

  • Back supported
  • Both feet flat on the floor
  • Legs uncrossed
  • Arm bare and supported
  • Cuff at heart level
  • Patient silent during the reading
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Step 1: Prepare the Patient

Have the patient sit with their back supported and both feet on the floor. Ask them to uncover the upper arm. Support the arm at heart level.

Patient sitting with back supported, feet flat, and arm resting at heart level for a blood pressure reading
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Step 2: Apply the Cuff

  1. Wrap the cuff smoothly around the bare upper arm.
  2. Place the lower edge about 1 inch above the bend of the elbow.
  3. Align the artery marker with the brachial artery.
Close-up of a blood pressure cuff placed smoothly on a bare upper arm above the elbow
Check: the cuff is snug, smooth, and on bare skin.
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Step 3: Locate the Brachial Artery

Feel inside the bend of the elbow for the brachial pulse. Place the stethoscope lightly over that spot.

Stethoscope diaphragm placed lightly inside the bend of the elbow below a blood pressure cuff
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Step 4: Inflate the Cuff

  1. Close the valve on the bulb.
  2. Inflate until the pulse disappears, then continue about 20-30 mmHg higher.
Clinician inflating a manual blood pressure cuff with the bulb while the gauge is visible
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Step 5: Deflate and Listen

Open the valve slowly. Let the pressure drop about 2-3 mmHg per second while you watch the gauge and listen.

  • First clear sound: systolic pressure
  • Sound disappears: diastolic pressure
Clinician listening with a stethoscope while slowly deflating the blood pressure cuff
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Step 6: Record the Reading

Write the reading clearly so someone else can understand it.

Blood pressure cuff and stethoscope beside a clipboard where a sample blood pressure reading is recorded
Example: 118/76 mmHg
  • Arm used
  • Patient position
  • Time, if required
  • Your initials, if required
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Common Mistakes

Fix the problem before trying again

IncorrectCorrect
Legs crossedFeet flat, legs uncrossed
Patient is talkingPatient stays quiet
Cuff over clothingCuff on bare upper arm
Arm hanging downArm supported at heart level
Cuff is too small or too largeCuff fits the arm correctly

Decision point

Should you try again?

Take the reading again if the patient talks or moves, the cuff slips, you miss the sounds, or the number does not seem right.

Reading seems wrong? Yes Fix the problem Then Try again and record it
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What the Numbers Mean

Read the result correctly

Blood pressure is written as two numbers. The top number is systolic, which is the pressure when the heart beats. The bottom number is diastolic, which is the pressure when the heart rests between beats.

Category Systolic mmHg
(top number) and/or Diastolic mmHg
(bottom number)
Normal Less than 120 and Less than 80
Elevated 120-129 and Less than 80
Stage 1 hypertension 130-139 or or 80-89
Stage 2 hypertension 140 or higher or or 90 or higher
Severe hypertension Higher than 180 and/or and/or higher than 120
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Troubleshooting

When the reading seems wrong

Cannot hear sounds

Move the stethoscope back over the brachial artery. Make sure the earpieces face forward.

Reading seems too high

Check for talking, crossed legs, an unsupported arm, recent activity, or a cuff that is too small.

Reading seems too low

Check cuff size, arm height, valve speed, and whether you inflated the cuff enough.

Quick Reference

Quick review

  1. Rest the patient quietly for five minutes.
  2. Seat with back supported, feet flat, legs uncrossed.
  3. Apply the correct cuff to the bare upper arm.
  4. Place stethoscope over brachial artery.
  5. Inflate, then deflate slowly while watching the gauge.
  6. Record systolic over diastolic in mmHg.
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Practice Checklist

Use this before practice

0 of 10 checklist items complete

Reference Notes

Technique details are based on common manual blood pressure steps: rest the patient, use a bare arm, choose the right cuff size, support the arm at heart level, keep the patient quiet, and deflate slowly.

National Heart, Lung, and Blood Institute American Heart Association AHA Scientific Statement on BP Measurement CDC Measuring Your Blood Pressure