A stethoscope is used to listen for different sounds in the heart, lungs, or intestine, called auscultation. It’s a known fact that doctors and medical professionals know how to use a stethoscope. But if you are a newbie trainer or a nurse-to-be, you need to know how to use a stethoscope properly.
To use a stethoscope, adjust its earpieces and choose whether to use a diaphragm or bell. Then, hold it on the patient’s chest and place it on their skin. Take a full minute to hear the heartbeat. Before you use a stethoscope, make sure you are in a quiet place.
However, using the stethoscope properly may not be as easy as it appears. When used for different parts of the body, the stethoscope is not the easiest instrument to use. Therefore, you must know the proper precautions with a step-by-step guide. Therefore, this article is going to guide you in using a stethoscope like a pro.
How To Use A Stethoscope
- Adjustment of the earpieces:
Before using a stethoscope, ensure that the earpieces are pointing forward and are properly positioned. It won’t be possible to hear the sound if they are facing backward. Also, the earpieces should have a good seal to prevent ambient noise from getting in.
Additionally, keep the earpieces within earshot. You might not need to tighten or loosen them. Otherwise, you won’t be able to hear properly.
- Select a chest piece that fits your body:
There are different sizes of chest pieces for a stethoscope. Some are appropriate for adults, and some are for children. Make sure to select the right size of chest piece according to your patients and your needs.
- Find a quiet spot to use a stethoscope:
Make sure you are in a quiet area to use and hear the sounds clearly from your stethoscope. There should not be a lot of noise in the background while you are hearing. This can make it difficult to hear the tiny sounds. Thus, you will fail to examine your patient.
- Put your patient in the following positions:
To listen to the sound and examine your patient, you may need to position your patient. For example, if you have to listen to his lungs, ask him to sit up straight. If you hear his heartbeat, you may ask him to lay on his back with his face upward. Therefore, you should follow different positions to listen to the sounds properly from the lungs, intestine, heart, etc.
- Determine whether you want to use a diaphragm or a bell:
The small round side is called the bell, while the flat side on the stethoscope is called the diaphragm. The diaphragm is used for hearing high-pitched or medium sounds.
While the bell is good for listening to low-pitched sounds, so before using, decide what side you need to use to hear the sounds.
- Place the chest piece on the Skin:
For hearing the clear and proper sound, you have to place the chest piece on the bare skin of your patient. This will help in avoiding the interruption of fabric rustling.
- Hold the diaphragm on the patient’s heart:
Now to examine the patient’s heartbeat, place the diaphragm of the stethoscope on the patient’s heart up on the left side. In other words, place it under the left side of the breast. Apply sufficient pressure when pressing the diaphragm.
- Ask the patient to take a deep breath:
Hold the diaphragm on the chest for 1 minute and ask the patient to breathe deeply. As you listen, Lub-dub sounds will be audible, which is the normal sound of the heart.
- Count how many heartbeats you heard:
The normal heart rate of young children under 10 years is sixty to a hundred and above heartbeats in one minute. At the same time, older children and people above 11 years old have higher heart rates of 40 to 60 beats per minute.
Check the heart rate of the patient whether it’s normal according to his age or not.
- Listen for unusual heartbeats:
While you are hearing and counting the patient’s heart rate, also take note if you hear any other sound other than the normal sound, which is the Lub dub. Any other sound is not considered normal. If this is the case, more sophisticated tests and treatments may be needed.
Trainers or nurses who are new should listen to the sample sounds of an abnormal heartbeat so that you may know the difference and can refer the patient to see another doctor for further tests.
How to listen to lung sounds with a stethoscope
- Position the Patient in a Straight Posture
For listening to the sound of lungs, ask your patient to sit up and make his posture straight. Next, ask the patient to breathe deeply and normally so that you can hear the sound coming from his lungs.
- Place the diaphragm on the chest:
Now that the patient is all ready, grab your stethoscope and place the diaphragm part on the patient’s chest so that you can hear the sound of the lungs. A pulmonary examination requires listening to the upper and lower lobes.
So place the stethoscope’s diaphragm on the upper part of the chest, then at the bottom of the chest and between the breasts.
Doctors or nurses need to pay attention to both the front and back sides of these regions. You can compare the sounds and check if anything is abnormal after listening and examining all the spots.
- Take note of the patient’s normal breath sound:
The doctor should take note and listen to the patient’s normal breath sound. As far as breathing is concerned, tracheal, bronchial, bronchovesicular, and vesicular sounds are normal.
During normal breathing, air moves through the airways in patterns that are created by body structures. The location of breath sounds is described by:
- A sound’s duration (how long the sound lasts),
- The pitch of a sound (how high or how low it is),
- Loudness (the degree to which the sound is loud), and
- Sound’s Timing (when the sound is emitted at a certain point in the respiratory cycle).
By checking all these things, the doctor can determine whether the normal breath sounds are the same as those in the patient’s lungs.
- Pay attention to abnormal breathing sounds:
If the doctor cannot hear any breath sounds, it means the patient may have something abnormal in his lungs. No breath sound usually means the patient’s lungs are filled with air or fluid.
A patient experiencing abnormal breath sounds or struggling with respiratory issues may also experience thickening of the chest wall, slowed airflow, or inflammation and asthma. Wheezing, rhonchi, striding, etc., are also abnormal breath sounds.
In other words, a patient with abnormal breathing sounds would be wheezing and whistling, and in such a situation, he would not be able to breathe deeply. A breath sound can therefore be normal or abnormal. A problem with your lungs may be indicated by abnormal breath sounds, such as:
- Experiencing inflammation
- An infection
- The flow of air into the lungs
This type of condition should be treated and cured by doctors with more proper treatments as soon as possible.
Don’t Forget to Read the Following Tips.
Nurses and trainers should also keep these tips and advice in mind when using a stethoscope.
Cleaning of the stethoscope:
One should often keep his stethoscope clean after examining each patient to avoid infection and bacteria. Using an alcohol solution or less chemical cleaner may be desirable for cleaning your stethoscope. Every time you use it, wipe it down with a cloth to keep it disinfected.
Don’t overuse cleaners or alcohol when cleaning. You can damage your stethoscope by doing this.
Avoid Noisy Surroundings
Before using your stethoscope, make sure that you are in a quiet open area. This will help you in listening to your patient’s heartbeat sound more clearly. Otherwise, the ambient noise will not let you hear the sound of your patient.
Additionally, some electronic stethoscopes have an ambient noise reduction feature. As long as you also have one to be around people, it would not be a problem.
As a beginner, if you are looking for good and clear sound quality while listening to your patient’s heart or lungs, you may consider buying an electronic stethoscope as it provides clear and amplified sound and reduces the ambient noises, which makes it easier to examine your patient’s heart or lungs.
Your stethoscope needs to be in good working order and quality for you to be able to hear the body parts of the patient. However, one must keep in mind that they are not cheap in price but are generally expensive.
Stethoscopes with a single tube:
For some professionals, stethoscopes with single tubing are better than those with double tubing. A double tube stethoscope makes it difficult to hear heart sounds and lung sounds because the tubes rubbing together.
Moreover, small and thin tubing is preferred except when the stethoscope is worn on the neck, in which case a longer tube is preferable by doctors and trainees.
It is vital to use leak-proof tubing:
Before using your tool, make sure your tubing is free of leaks. Diaphragm tapping can be done to check it. Put the earpieces in your ears while you tap. A leak in the tubing can be determined by not hearing any sound coming from them.
Alignment of the double-head steel tubing:
The alignment of the tubing is the important thing to look at, which most people get confused about. If you pull it slightly apart and align it slightly, you will notice that they are slightly pointing forward.
Now some people want their tubing to be adjustable, so to do that, you need to grip the sprung steel central section and rotate it very gently. You will see they will rotate quite easily. Remember that once the tension on the grips is lost, it is very difficult to reapply the tension.
The pointing forward alignment gives you a far more comfortable fit in the ears and will give you a much more clear and good sound.
Keep it away from hot and cold:
Be careful while using your tool, do not dunk it into something cold or hot. Also, keep it away from water and heat. You may ruin it if you do any of these.
When tapping the drum, keep the stethoscope away:
Keep the stethoscope out of your ears when speaking or tapping the drum. It will hurt badly and can also cause damage to your ears depending on how loudly you talk on it.
Pay attention if you hear odd sounds:
If you heard any odd sounds out from the body of your patient, take note of them. Moreover, the right treatment should be provided as fast as possible.
Keep it away from oils and chemicals:
Keep your stethoscope away from your skin oils or any chemicals. They can damage the tubing. Stethoscopes should not be overcleaned and wiped with alcohol. After cleaning your tool, dry all parts thoroughly before reassembling.
Do not fold and coil the tubing:
Make sure to keep your tubing nice and intact from time to time. You don’t have to bend it up or coil it tightly. Some people place their stethoscopes inside the drawers; by doing that, your tubing may start cracking.
Change your earpieces over time:
Many newer ones come with different sizes of earbuds on them, so you could change that out if you wanted to. But make sure that when you are placing it, it may follow your ear so that the conduction of sound is best.