As a doctor trainer, one of the most important skills you can teach your students is how to wear a stethoscope. This seemingly simple task is actually fraught with potential for error, and if not done correctly, can lead to inaccurate diagnoses and treatment plans. In this guide, I will walk you through the proper way to wear a stethoscope so that you can be confident in your ability to use this vital tool correctly.
What is a stethoscope:
A stethoscope is a medical instrument used to listen to the internal sounds of a patient’s body, usually for the purpose of diagnosing cardiac or pulmonary conditions. The stethoscope consists of two main parts: the chest piece, which is placed against the patient’s skin, and the earpieces, which are inserted into the physician’s ears. The stethoscope is connected to the chest piece by flexible tubing.
There are two types of stethoscopes: acoustic and electronic. Acoustic stethoscopes are the traditional type of stethoscope and consist of a simple set of earpieces connected to a chest piece by tubing. Electronic stethoscopes amplify the sound of the patient’s body, making it easier to hear faint sounds.
Why wear a Stethoscope on the neck all the time?
The reason you see so many doctors and medical students wearing their stethoscopes around their necks is twofold.
- First, it keeps the stethoscope readily available so that it can be used at a moment’s notice.
- Second, wearing the stethoscope around the neck helps to keep the earpieces clean and free of dirt and debris.
- Third, it ensures that the stethoscope is always within easy reach, so that it can be quickly and easily grabbed when needed.
Ways to wear a stethoscope:
There are a few different ways to wear a stethoscope around the neck. The most common method is to simply drape the stethoscope over the back of the neck, with the earpieces hanging down in front.
Another way to wear the stethoscope is to loop it around the back of the neck, so that the earpieces are resting on the shoulders.
Finally, some people prefer to wear the stethoscope over one shoulder, like a necklace.
Regardless of which method you choose, be sure that the stethoscope is positioned in a way that is comfortable for you and that allows you to easily grab the earpieces when needed.
How to wear a stethoscope: Step-by-step process to putting on
Step 1: Place/Position the stethoscope correctly
Before you put on the stethoscope, make sure that the earpieces are properly positioned. The small side of the earpiece should point downwards, and the larger side should point upwards. This will ensure that the stethoscope is positioned correctly in your ear.
Step 2: Earpeace should fit snugly but not too tight
Once the earpieces are in place, put on the stethoscope so that the earpieces fit snugly into your ears. The earpieces should not be so tight that they cause discomfort, but they should also not be so loose that they fall out easily.
Step 3: Properly adjust the earpieces
After the earpieces are in place, you will need to adjust them so that they fit snugly but comfortably. To do this, simply bend the earpieces until they fit snugly around your ears.
Step 4: Connect the tubing to the chest piece
Once the earpieces are properly adjusted, connect the tubing to the chest piece. Make sure that the tubing is securely connected to the chest piece, as this will ensure that the stethoscope does not come apart while you are using it.
Step 5: Place the chest piece against the patient’s skin
After the tubing is securely connected to the chest piece, place the chest piece against the patient’s skin. The chest piece should be placed directly against the skin, and should not be obstructed by clothing.
Step 6: Listen for sounds
Once the chest piece is in place, you can begin listening for sounds. To do this, simply hold the stethoscope up to your ear and listen carefully. You should be able to hear a variety of different sounds, including the sound of the patient’s heartbeat and the sound of their breathing.
If you are having difficulty hearing the sounds, you may need to adjust the earpieces or the chest piece. You can also ask the patient to breathe deeply or cough, as this will help to amplify the sound.
How to hold a Stethoscope for use:
It’s best if you hold the chest piece with your dominant hand’s index and middle fingers. Do not grip it with the tips of your fingers, as this may result in additional noise. Keep the tube under your thumb to prevent it from rubbing against your skin. It’s also important to keep your hand from obstructing the sound.
When you’re ready to listen, hold the stethoscope just below your earlobe with your non-dominant hand and insert the earpiece into your ear. If you’re right-handed, this would be your left ear. Do not push the earpiece too far into your ear canal, as this can result in discomfort. You should be able to hear the sound without having to push the earpiece too far into your ear.
If you’re having difficulty hearing the sound, you can try adjusting the angle of the stethoscope or moving it slightly up or down your earlobe. You can also try holding the stethoscope with your nondominant hand and using your dominant hand to hold the patient’s skin taut. This will help to amplify the sound.
To increase the sound transmission, place the diaphragm directly on the skin while using a stethoscope. It’s best to put it on top of light clothing since doing so may result in loud noise from rubbing against the diaphragm. This might cause you to overlook subtle sounds that are important for diagnosis and evaluation.
Carrying Sa stethoscope when not using it:
Here are some tips for how to handle your stethoscope when you’re not using it, so that it lasts longer and performs better:
- Because you’ll wear it around your neck, place it above your shirt collar to prevent oils from your neck from hardening the tube.
- The movement against your clothing during the day may cause the earpiece and chest piece to loosen; thus, checking on them regularly will ensure they remain tight.
- Be sure not to step on the tubing or leave it kinked, as this can damage the stethoscope and affect its performance.
What you should avoid when wearing a stethoscope:
- The tubing of a stethoscope may be damaged when it comes into contact with the body’s oils, which can cause early failure. To prevent this, avoid letting the tubing rest on your neck or clothing.
- When using the stethoscope, you won’t hear anything because the earpiece faces backwards.
- The best way to protect your food from spoiling is to keep it cool and dry. It’s also important not to allow water into the bag during extreme weather, such as intense heat or cold.
- You should never put your stethoscope into any liquid since this may damage the internal components. If you want to clean it, use propyl alcohol instead.
Components of a stethoscope, with uses and descriptions:
Headset:
The headset of a stethoscope is the part that goes over your head and around your ears. It consists of two earpieces and a yoke that connects them. The yoke helps to distribute the weight of the stethoscope evenly so that it’s more comfortable to wear for long periods of time.
Earpeace:
The earpeacce of a stethoscope go into your ears and help to create a seal so that you can hear the sound more clearly. They come in different sizes, so you can choose the ones that are most comfortable for you.
Tubing:
The tubing of a stethoscope is the part that goes from the earpieces to the chest piece. It’s made of a flexible material so that it can be bent and shaped to fit around your neck.
Chest piece:
The chest piece of a stethoscope is the part that comes into contact with the patient’s skin. It consists of two parts: the diaphragm and the bell. The diaphragm is used to amplify high-pitched sounds, while the bell is used to amplify low-pitched sounds.
Diaphragm:
The diaphragm of a stethoscope is the part that comes into contact with the patient’s skin. It’s used to amplify high-pitched sounds.
Bell:
The bell of a stethoscope is the part that comes into contact with the patient’s skin. It’s used to amplify low-pitched sounds.
Stem:
The stem of a stethoscope is the part that connects the chest piece to the tubing. It’s made of a rigid material so that it can be easily inserted into the patient’s skin.
Binaural:
The binaural of a stethoscope is the part that goes over your head and around your ears. It consists of two earpieces and a yoke that connects them. The yoke helps to distribute the weight of the stethoscope evenly so that it’s more comfortable to wear for long periods of time.
Yoke (also called the frame)
The yoke of a stethoscope is the part that connects the two earpieces. It’s made of a flexible material so that it can be bent and shaped to fit around your head.
How to use a stethoscope:
To use a stethoscope, you’ll need to put the earpieces in your ears and position the chest piece on the patient’s skin. You can then adjust the angle of the stethoscope or move it up or down your earlobe to get the best sound.
When you’re ready to listen, put the diaphragm on the patient’s skin and hold it there firmly. You can then use your other hand to hold the patient’s skin taut. This will help to amplify the sound.
If you’re having difficulty hearing the sound, you can try to increase the sound transmission by placing the diaphragm directly on the skin. You can also try using a stethoscope with a larger chest piece.
When you’re finished listening, remove the earpieces from your ears and put them back in the storage pouch. Then, place the stethoscope around your neck or in a drawer so that it’s out of the way.
It’s important to clean your stethoscope after each use, especially if you’ve been using it on multiple patients. To do this, you can use a disinfectant wipe or spray. Be sure to avoid getting any water on the earpieces or tubing, as this can damage the stethoscope.
Putting your headset on correctly:
Insertion:
To put on your headset, start by holding one earpiece in each hand. Then, place the earpieces over your ears so that the yoke is resting on the top of your head.
Correct positioning:
Once the earpieces are in place, adjust them so that they fit snugly but comfortably over your ears. The earpieces should be pointing inwards and the yoke should be resting on the top of your head.
Below is an image showing the Littmann stethoscope positioned so that the tubing is by the chin and not in front of the neck:
Tightening:
Once you’ve adjusted the earpieces, tighten the yoke so that it’s snug but not too tight. You should be able to fit two fingers between the yoke and your head.
Connecting the tubing:
Once you’ve put on the headset, connect the tubing to the chest piece. To do this, align the two parts so that the tubing is pointing downwards and away from your head. Then, push the tubing onto the chest piece until it snaps into place.
Adjusting the length of the tubing:
The length of the tubing can be adjusted by sliding the earpieces up or down on the yoke. To make the tubing shorter, slide the earpieces down so that they’re closer to your ears. To make the tubing longer, slide the earpieces up so that they’re further away from your ears.
Adjusting headset tension:
The tension of the headset can be adjusted by loosening or tightening the yoke. To loosen the yoke, rotate it clockwise. To tighten the yoke, rotate it counterclockwise.
How to Proper fit and assemble ear tips:
It is important to have a proper fit and assembly of ear tips in order for the stethoscope to function correctly. The ear tips should be positioned so that the small opening is facing outwards and the larger opening is facing inwards.
Then, push the ear tips onto the earpieces until they snap into place.If you’re using a stethoscope with interchangeable ear tips, you can choose the size that fits best for you.
To do this, start by holding an ear tip in each hand. Then, position the ear tips so that the small opening is facing outwards and the larger opening is facing inwards.
Next, push the ear tips onto the earpieces until they snap into place.
Once the ear tips are in place, you can adjust their positioning by gently pushing or pulling on them.
They should fit snugly but comfortably in your ears.If you’re using a stethoscope with non-detachable ear tips, you can still adjust their positioning by gently pushing or pulling on them.
How to use a tunable diaphragm:
The tunable diaphragm is a feature that allows you to adjust the frequency of the sound that you’re hearing. To use it, simply place the chest piece on the patient’s skin and press down lightly with your fingers.
If you want to hear lower frequency sounds, such as heart sounds, use the bell of the stethoscope. To do this, place the bell on the patient’s skin and press down lightly with your fingers.
To hear higher frequency sounds, such as breath sounds, use the diaphragm of the stethoscope. To do this, place the diaphragm on the patient’s skin and press down lightly with your fingers.
You can also use the diaphragm to hear both low and high frequency sounds by pressing down lightly with your fingers in the center of the chest piece.
Littmann is among the pioneers of tunable diagram technology and they have more details here.
Note that a tunable diaphragm is useful in all stethoscope models except Electronic, Pediatric, and Infant models.This is because those models have a built-in filter that eliminates low-frequency sounds, making a tunable diaphragm unnecessary.
How to use a non-chill rim and diaphragm:
The non-chill rim and diaphragm are features that help reduce the risk of patient discomfort. To use them, simply place the chest piece on the patient’s skin and press down lightly with your fingers.
The non-chill rim helps to prevent the patient’s skin from coming into contact with cold metal, while the non-chill diaphragm helps to prevent the patient’s skin from coming into contact with the cold rubber of the diaphragm.
These features are especially useful when examining patients who have sensitive skin or who are very young or very old.
How to Convert Stethoscope chest peace to a traditional open bell:
If you’re using a stethoscope with a tunable diaphragm, you can easily convert it to a traditional open bell by removing the diaphragm and replacing it with the bell. To do this, start by unscrewing the retaining ring from the chest piece.
See the image below of the 3M™ Littmann® dual-head stethoscope chest piece with its tunable diaphragm being removed.
Next, remove the diaphragm and replace it with the bell. Finally, screw the retaining ring back onto the chest piece.
This can be useful if you want to hear lower frequency sounds, such as heart sounds, or if you’re examining a patient who has sensitive skin.
It’s also important to note that you should never use the open bell of the stethoscope on patients who have open wounds, as this could lead to infection.
You should not convert stethoscopes for pediatric, and infant models to open bells because those models have a built-in filter that eliminates low-frequency sounds, making a tunable diaphragm unnecessary.
Attaching a Special Procedures Adaptor to Cardiology Stethoscopes:
The Special Procedures Adaptor is meant to be placed over the stethoscope chest piece’s diaphragm side. Place the adaptor over the diaphragm by pushing it down. To remove it, pull it away from the chest piece.
Whether you have pediatric or thin patients, this adaptor model by Littmann is perfect for you. It creates a complete seal for small site auscultation and prevents bandages from interference.
You’ll also be able to detect both low- and high-frequency sounds more effectively.
Note that the special procedure adaptor is only available for 3M™ Littmann® Master Cardiology stethoscopes. They are essential in cardiology and are also used in pulmonary, critical care, and anesthesiology.
We have reviewed all the top-rated cardiology stethoscopes here.
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