How to Use a Stethoscope: The Ultimate Guide
Okay, you’re new to the healthcare field and will need to get comfortable with using a stethoscope very quickly!
You’ll learn most of it on the job and throughout your training, but it’s best not to start from Zero…
This guide will go through everything from what a stethoscope even is, it’s parts, and how to use one.
Let’s get to it!
The Importance of Knowing How to Use Your Stethoscope
Although it may sound silly at face value, you should take some time alone to get to know your stethoscope. You’ll be handling it every day and want to get comofortable with your personal stethoscope in your own time first. If you haven’t yet bought your own stethoscope, click here to learn how to pick the right one. (See our recommendations for specific professions such as nurses, doctors, and EMTs)
Make sure you know how to quickly fit it properly, and are used to maneuvering it. Ensure you can hear well through ear pieces before trying to use it in a clinical setting.
Practice at home and get used to tuning the bell and diaphragm on yourself or a willing friend or family member, positioning it in your ears and placing it around your collar.
This will be your most used implement throughout your career, so take learning to use it seriously…
The best approach to learning about how to use a stethoscope is to start with its anatomy.
There are five distinct components of a stethoscope, each of which plays a significant role in how sounds are heard.
Those components and their functions are:
A two sided component comprised of the diaphragm on one side and bell on the other.
The diaphragm is the bigger and flatter side of the chestpiece, a metal disc containing a second disc of plastic.
“Lub-lub” sounds of normal heartbeat and breath are easier to detect using the diaphragm, as are other higher-pitch sounds.
The bell is a hollow cup-shaped metal piece with a little hole on top.
Low pitch sounds, such as the “whoosh” from heart murmurs, are easier to detect using the bell.
The metal piece connect the chestpiece to the tubing.
Running from the chestpiece to the headset, tubing carries sounds picked up by the chestpiece to both ears.
This tubing ranges in length from about 18 to 27 inches.
Sound travels from the chestpiece and through tubing to the headset, which releases the sound to the ears through eartips on each side.
Fitted into each ear, sound from the chestpiece is delivered to the ears through these small buds. Rubber tips on the eartips help create a seal within the ear to keep environmental noise blocked.
Stethoscope Quick Tips
Before starting to use your stethoscope, it is good to understand some of the most common mistakes made by new students and practitioners.
Remember these points and you will be less likely to make the same errors:
- The eartips must be correctly fitted into your ears in order to receive sound well.
- Some stethoscopes are designed with earpieces turned slightly forward.
- This positioning is to help sound travel directly into your ear canal toward the eardrum.
- Avoid using the stethoscope over thick or layered clothing, or dry hair.
These things will produce rustling sounds, possibly leading to confusion of findings.
Some stethoscopes direct sound toward the bell or diaphragm through tunable chest pieces.
To ensure you are using the open side of the stethoscope, tap the chestpiece lightly while the eartips are in your ears.
Simply twist the chestpiece at the stem to switch sides of the stethoscope as needed.
To avoid detecting false sounds, hold the chestpiece between your index and middle fingers.
If you are not hearing sounds through your stethoscope, or the sounds are oddly muffled, check openings for blockages.
Check the eartips to see if items have become embedded during carrying, wear or use.
Lint and dirt can obstruct the sound pathway.
To ensure your stethoscope is always in best working order, maintain it well.
If you experience obstructed sound, it may be a seal issue.
Your stethoscope must be airtight for transmission of sounds to your ears.
If parts have become loose in the chestpiece, tubing is loosened at connections, or the tubing is cracked, that airtight seal is broken and sound will not properly transmit, if it does at all.
Rotate the chestpiece at the the stem to index the bell before using.
This is for double-sided stethoscopes with both a bell and diaphragm, of course.
Only one side of the chestpiece will be open at a time.
If using the bell, ensure the bell side is open. If using the diaphragm, ensure that side is open.
Gently tapping on the chestpiece while your eartips are in your ears can quickly provide clarity regarding which side is open.
The genius of a stethoscope is in its simplicity.
To simplify the explanation of how your stethoscope works, let’s start with the use of the flatter surface of the chestpiece, the diaphragm.
When you use a stethoscope by placing the diaphragm on someone’s chest, sound waves traveling within their body cause vibration of that diaphragm.
Because tubing is directly connected to the vibrating diaphragm, generated sound waves have only one direction to travel.
That is, through the tubes and into your ears.
Sounds are amplified into your ears because the sound waves are given limited space within the stethoscope’s narrow tubes, instead of traveling outward into greater expanse.
In essence, more sound waves reach your eardrums.
This is called multiple reflection.
Using the diaphragm side of the chestpiece is more effective for waves of high pitch sounds.
Such sounds, like breath and heartbeats, cause a greater number of pressure fluctuations in a given time period.
This is because they travel at higher frequency.
These higher pitched sounds create direct vibration on the diaphragm’s larger, flat disc surface.
When you hear the sounds of the opening and closing of an artery, for example, you are hearing the actual sound waves generated by that activity.
The stethoscope’s bell works in a different manner.
The bell is able to pick up lower pitched sounds than the diaphragm.
This is because the bell does not pick up vibrations caused by an artery’s movement.
Instead, the bell picks up vibrations in the skin resulting from that movement by the artery.
Low pitched sounds often cannot vibrate the diaphragm unless pressure is applied.
However, those low pitched sounds still vibrate the skin. That skin in turn vibrates the bell.
How to Wear A Stethoscope
Curios to know how to wear a stethoscope?
Here’s the deal….
Most stethoscopes have headsets designed for wear at a specific angle.
This angle presents the eartips directly toward the ear canals, to improve delivery of sound.
It is important to ensure that the eartips point forward in your ears.
Some people may have some discomfort from the preset positioning of the eartips in their ears.
If you experience this and note that acoustic performance is not at optimum, you can gently adjust the ear tubes for a custom fit.
Not doing so may mean that you are not receiving sound adequately and have a poor acoustical seal.
Eartips must also create a good seal within the ear canal, neither being too large or too small.
It is particularly important to ensure proper fit of soft-seal eartips.
If soft-seal tips are too large for the wearer, compression can cause blocking of sound.
An eartip that is too small can result in environmental noise blocking stethoscope performance.
When not using your stethoscope, ensure it is placed around your neck over clothing.
It is best to drape it around a collar to prevent direct contact with skin.
This is because stethoscope tubing may harden over time, when frequently exposed to human skin oils.
How to Use a Stethoscope to Listen to Heart Sounds
Listening to the heart is part of every physical exam.
Unfortunately, this is not as simple as merely using the chestpiece to hear the heartbeat.
There are different areas of the chest to locate relating to the heart’s position and those of its valves.
Both the bell and the diaphragm are used when properly auscultating the heart.
To hear blood flow through the aortic valve, place the stethoscope in the right space between the second and third ribs.
This will be next to the sternum.
For sounds of the pulmonary valve, move to the left side of the sternum.
This will also be in the second interspace.
For the tricuspid valve, move down to the lower left area of the sternum.
The mitral valve can be heard at the apex of the heart, which you should have already identified through the prior actions.
However, it is commonly located at the left fifth intercostal space.
This will be approximately six centimeters from the border of the sternum. Some people prefer to start heart auscultation at the apex.
Abnormalities should be detected and sound irradiation should be noted, especially for heart murmur.
When listening to higher pitch sounds, such as for S1 and S2, it is best to use the diaphragm of the stethoscope.
The bell works better for lower pitches, such as S3 and S4.
How to Use a Stethoscope to Listen to Lungs
We have all had the shock of a cold stethoscope diaphragm being placed on our bare back during a physical.
While somewhat of a cold shock, this is part of how lungs are heard.
To listen to the lungs, place the diaphragm at the front and back of the thorax.
Because breath sounds are higher frequency, the bell will not prove as effective as the diaphragm.
How to Use a Stethoscope to Listen to Bowel Sounds
Stethoscopes are used to listen to the abdomen to detect signs of obstruction, intestinal mobility issues and other problems.
To listen to the abdomen, first divide it into imaginary quadrants.
Do not palpate or percuss the abdomen until you have first auscultated.
Palpations and percussions can alter the typical sounds of the bowel through tensing of muscles.
Start the abdominal auscultation by placing the stethoscope’s diaphragm on the right lower quadrant.
To progress through the exam, work your way clockwise through the other three sections of your imaginary quadrant.
Follow the path of the large intestine.
Normoactive bowel sounds will be gurgling noises occurring at the rate of about 5 to 34 per minute.
How to Use a Stethoscope to Listen to Bruits
You will use the bell of your stethoscope to listen for these sounds.
This is very important during exams, particularly for patients with atherosclerosis.
Neck length can vary and affects whether you will listen to two or three points along the carotid artery.
Use your best judgment to decide if two is sufficient, or three required.
You may need to ask the patient to hold his or her breath, if those sounds are interfering with your hearing.
How to Use a Stethoscope for Blood Pressure
To screen blood pressure the “old fashioned” way, place the bell of the stethoscope lightly under the lower edge of the sphygmomanometer cuff.
You must use the bell, as low frequency noise is generated as the Korotkoff sounds.
Low Frequency Versus High Frequency Sounds
It has been said repeatedly here, but it is important to remember the simple rules of low frequency versus high frequency during stethoscope use.
Low frequency sounds are heard best by the bell of your stethoscope.
The diaphragm best hears high frequency.
Over a short period of time, switching from diaphragm to bell will become second nature, as will the necessary tuning of the chestpiece, for stethoscopes with a tunable stem.
Storage of Your Stethoscope
When not using your stethoscope, it is important to ensure it is protected from damage and elements which may affect its functioning.
Consider the following tips for its safekeeping:
- Store it away from extreme heat and cold, as tubing of the stethoscope can become damaged or crack after extended exposure.
- Do not store your stethoscope in a handbag, pocket or other location where lint, dirt, dust or other materials can enter or become lodged in the earpieces.
- Do not expose your stethoscope to solvents or oils, as they can also cause damage to tubing, enter into earpieces and otherwise obstruct or damage your stethoscope.
- Keep your stethoscope away from direct sunlight or UV rays. These are highly damaging to the tubing and can cause it to crack.
How to Clean and Maintain Your Stethoscope
Most medical personnel have a favorite or even sentimental stethoscope.
Well cared for, your stethoscope can last for years and still provide optimum acoustic performance.
When buying yours, remember that lighter colored ones tend to show all dirt and markings.
Black or other darker colored ones look cleaner to the patient and others around you, with less external pampering required.
Some care and cleaning you will do for your stethoscope will keep it looking good and serves aesthetic purposes only.
Other care and cleaning extends its life and performance quality.
Finally, some cleaning is necessary to keep germs away, as over 80% of stethoscopes used within hospitals are contaminated with microbes, such as Staphylococcus.
General Care and Infection Control:
- To disinfect, wipe your stethoscope’s parts with a 70% isopropyl alcohol solution.
- Particularly handy are small alcohol wipes.
- Do not immerse your stethoscope in any liquid or sterilization solution.
- Do not use any sterilization process, as tubing can be damaged and crack.
- Remove ear tips for more thorough cleaning.
- Wipe down your stethoscope before, after and during every shift.
- To clean, start at the earpieces, move down the tubing and end at the bell and diaphragm.
- Gently take the diaphragm apart to remove dust, debris and lint. Clean it well before reassembly.
- Abrasive cleaners will ruin the exterior and tubing.
- When cleaning the tubing of your stethoscope, remember that too many applications of alcohol will cause the PVC material it is constructed of to crack and stiffen.
- Disposable covers work well for protecting and preventing infection.
Some hospitals supply these, but others may need to be convinced to order them.
Such covers are made of thin plastic and don’t make crackling sounds.
Tags: how to hold a stethoscope, How to use a stethoscope, how to use a stethoscope for blood pressure, how to use a stethoscope on yourself, how to use a stethoscope to listen to lungs, how to use a stethoscope video
Categorised in: Stethoscope Guides