Training activity information
Details
Measure blood pressures, to include
- Non-invasive
- Invasive
- Arterial
- CVP
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Considerations
- Limitation of blood pressure measurements
- Application of appropriate techniques to patient
- Local and national guidance
- Interpretation and validation of waveform
- Interpretation of the waveform for diagnostic value
- Patient centred care and support
- Communication with patients, relatives and the clinical team
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
What does success look like?
- Identify what is expected of you in relation to measuring blood pressures using various techniques, including setting up arterial pressure monitors.
- Consider how the learning outcomes apply, specifically in relation to applying blood pressure measurement techniques and practicing safely.
- Discuss with your training officer to gain clarity of what is expected of you in relation to criteria defining accurate and safe blood pressure measurement for each technique (NIBP, invasive arterial, CVP).
What is your prior experience of this activity?
- Think about what you already know about the principles behind non-invasive and invasive blood pressure monitoring.
- Consider possible challenges you might face during the activity, such as obtaining a clear waveform, dealing with inaccurate readings, or troubleshooting issues like dampening or sensor application.
- Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example if you encounter difficulties with zeroing invasive lines or resolving a dampening artifact.
- Acknowledge how you feel about measuring blood pressures in the context of the training activity.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as setting up equipment and obtaining accurate measurements for both non-invasive and invasive monitoring.
- Identify the specific insights you hope to gain into the differences between non-invasive blood pressure (NIBP) and invasive measurements or troubleshooting common issues like dampening.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of this activity or similar tasks.
- Identify important information you need to consider before embarking on the activity, such as patient factors affecting measurement accuracy, equipment setup requirements, and zeroing procedures for invasive lines.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst measuring blood pressures, to include non-invasive, invasive, arterial, and CVP?
- Are you encountering situations such as:
- You get unexpected readings (e.g., much higher/lower than anticipated, non-pulsatile trace for invasive)?
- You encounter technical issues with the equipment (e.g., waveform damping, transducer levelling problems, cuff errors)?
- Measuring blood pressure in this situation compares differently to previous experiences, especially considering the different types (NIBP, invasive, arterial, CVP)?
How are you reacting to the unexpected development?
- How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to checking connections, recalibrating, or checking patient position if readings were unexpected or equipment malfunctioned? Did encountering difficulties affect your ability to get a reliable reading independently?
- Consider the steps you are taking in the moment, such as checking connections, recalibrating, or checking patient position if readings were unexpected or equipment malfunctioned.
- How are you feeling in that moment? For instance, are you finding it difficult to troubleshoot the equipment problems? Is it affecting your confidence in getting a reliable reading?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you able to obtain reliable blood pressure measurements, having followed appropriate procedures and working within your scope of practice? Or are you needing support because the technical issues (e.g., persistent damping of the invasive line) cannot be resolved by routine troubleshooting and require specialist technical or medical input?
- What are you learning as a result of the unexpected development? For example, are you mastering a specific troubleshooting technique for BP monitoring or technique refinements from the unexpected event?
On action
What happened?
- Begin by summarising the key steps you took when measuring the specified blood pressures (e.g., setting up the arterial pressure monitor).
- Consider specific events, actions, or interactions which felt important, such as successfully zeroing an invasive line or troubleshooting a dampening issue in the arterial pressure waveform.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately checking the transducer height when the invasive arterial reading was unexpectedly low.
- How did you feel during this experience, e.g., did you feel stressed by a questionable abnormal arterial blood pressure reading or confident in verifying the reading’s accuracy?
How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding applying different blood pressure measurement techniques. What strengths did you demonstrate, e.g., meticulous adherence to zeroing procedures for invasive lines or accurate set up of an arterial pressure monitor?
- What skills and/or knowledge gaps were evident, e.g., difficulty performing bedside troubleshooting of an invasive blood pressure monitoring catheter?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in applying blood pressure measurement techniques?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding resolving a persistent technical fault causing damping in the invasive waveform, and how you reacted to this.
What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to refining your technique for setting up an arterial pressure monitor.
- What will you do differently next time you approach invasive blood pressure measurement, for instance, by proactively checking all connections and flush systems to minimise the risk of dampening?
- Do you need to practise any aspect of the activity further, such as troubleshooting questioned accuracy of abnormal arterial blood pressure or key learning outcomes related to applying blood pressure measurement techniques?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of setting up or troubleshooting invasive blood pressure monitoring since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, encountering severe damping in a subsequent arterial line trace forced you to re-evaluate the diligence of your zeroing and calibration process during your first attempt at this training activity.
- Considering what you understand about measurement principles, troubleshooting techniques, and haemodynamic monitoring now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your techniques for measuring blood pressure (NIBP, arterial, CVP) and recognising artefacts based on further learning and experiences? For example, how you proactively developed a systematic checklist for transducer levelling and dynamic response testing based on further learning and troubleshooting experience.
- Has discussing questioned accuracy of abnormal arterial blood pressure readings or the impact of technical issues on haemodynamic interpretation with colleagues, peers, or supervisors changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior therapist about a severe delay caused by misinterpreting a damp waveform refined your understanding of the critical nature of accurate pressure monitoring.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent haemodynamic monitoring experiences, contributed to your overall confidence and ability in the technical proficiency and troubleshooting of invasive monitoring equipment, particularly in preparing for assessments like DOPS or OCEs? For example, how your accumulated technical proficiency, ability to recognise artefacts, and experience in zeroing invasive lines now enables you to confidently set up an arterial pressure monitor or perform bedside troubleshooting of an invasive blood pressure monitoring catheter during relevant DOPS or OCE assessments.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to blood pressure measurement and waveform troubleshooting? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now routinely seek advice from the Training Officer or Technical Specialist immediately when persistent technical issues (e.g., severe damping or monitor failure) cannot be resolved by routine troubleshooting, recognising this requires specialist technical input.
- Looking holistically at your training journey, how has this initial blood pressure measurement experience, revisited with your current perspective, contributed to your development in meeting the learning outcomes related to applying blood pressure measurement techniques and practising safely? For example, how this foundational experience has supported your development in improving technical proficiency with monitoring equipment and understanding physiological measurements necessary for critical care.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 3 |
Outcome
Apply blood pressure measurement techniques to monitor critically ill patients. |
| # 8 |
Outcome
Practice safely in accordance with guidance and legislation to minimise risk in all elements of patient care. |