How to Take a Blood Pressure using the Two-Step (2-Step) Method

The two-step method for taking a blood pressure is similar to the one-step manual blood pressure method, but requires that you take the blood pressure by feeling the brachial artery and then using a stethoscope. So, in a sense you will be taking the blood pressure twice using the same arm but with two methods.

The 2-step blood pressure method is used to assess for a most accurate blood pressure. Professionals tends to say it is the most reliable method, especially if you are needing the most accruate blood pressure reading on a patient who is having blood pressure issues.

In the previous article, I talked about how to take a manual blood pressure using the one-step method and this included a video demonstration as well.

In this article, I am going to give you step-by-step instructions on how to take a manual blood pressure using the two-step method. In addition, you can watch this video demonstration.

Video on How to Check a Blood Pressure with the 2-Step Method

Steps on How to take a Manual Blood Pressure using the Two-Step Method

1. 1. Have the patient in a sitting or lying position with arm at heart level
   2. Turn patient’s arm so palms are up and expose the upper arm
   3. Palpate brachial pulse and place the blood pressure cuff 1-2 inches above where you found the pulse
   4. Wrap cuff around the upper arm, so it fits appropriately. Tip: you should be able to get 2 fingers snugly underneath it.
   5. Then palpate the brachial pulse with your non-dominant hand and inflate the cuff using the rubber bulb with your dominant hand
   6. As you are inflating the cuff note when you no longer feel the brachial pulse this is the systolic reading
   7. Then slowly deflate the cuff by turning the valve counter-clockwise until you no longer feel the pulse. Note the number where you no longer felt the pulse, this is the diastolic reading.
   8. Then deflate the cuff fully
   9. Wait 30 seconds. Now you are going to use the stethoscope and use the same arm.
   10. Locate the brachial pulse with the diaphragm or bell of your stethoscope
   11. Turn the rubber valve bulb clockwise so you can inflate the cuff again
   12. Inflate the cuff 30 mmhg ABOVE the patient’s systolic pressure that you collected from the first reading
   13. Then deflate the cuff while letting the sphygmomanometer drop at a rate of 2-3 mmhg per second.
   14. The first sound you hear will be the systolic pressure
   15. Then note when the sound disappears this the patient’s diastolic pressure
   16. Then deflate the cuff and tell the patient the reading and document

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