A stethoscope is a medical instrument used to listen to various sounds produced by the body. Just like any other piece of equipment, there is a right way and a wrong way to use a stethoscope.
In this article, we will explain the correct way to wear and hold a stethoscope so that you can effectively provide the best care possible for your patients.
Components of a Stethoscope
In order to understand how to properly use a stethoscope, it is important to know the different parts of the instrument.
A stethoscope typically consists of the following components:
- Ear tips
- Ear tubes
- Tubing
- Chest Piece
- Stem
- Diaphragm
- Bell
Each component plays an important role in amplifying internal body sounds and making them easier for medical professionals to hear.
How to Wear a Stethoscope Correctly
- Position the Patient
- Position the Ear Tips
- Adjust the Ear Tubes
- Position the Chest Piece
- Protect the Tubing
- Re-Position the Diaphragm or Bell
- Disinfecting Your Stethoscope
Each step is essential in order to wear and use a stethoscope correctly and provide the best care possible for your patients.
Position the Patient
The first step for using a stethoscope involves ensuring that the patient is in a position that will allow you to auscultate the target area.
For example, when listening to the lungs, it’s fine for the patient to be standing, sitting upright, or lying down.
The patient should be relaxed as you instruct them to take a deep breath in, followed by a passive exhalation.
Position the Ear Tips
The ear tips are silicone buds at the top of the stethoscope that are placed into your ears. They come in different sizes, and selecting the wrong size can impact the sounds heard with your stethoscope.
A size too small can impair the sound quality, and a size that is too big can irritate your ears.
It’s also important to position the ear tips correctly by making sure that they are pointing forward toward the clavicles. Otherwise, you may not be able to hear the sounds properly through your stethoscope.
Adjust the Ear Tubes
The ear tubes are the metal pieces that connect the ear tips to the tubing of a stethoscope. They provide left and right pathways for sound to travel through.
In order to use a stethoscope properly, you must adjust the ear tubes so that the ear tips fit comfortably in your ears.
They contain springs that allow you to adjust how tight your stethoscope is sitting on your ears by either pulling the ear tubes together or pushing them apart.
You must adjust the tension to make a proper seal, but not too much because you don’t want it to be uncomfortable during use.
Position the Chest Piece
The chest piece is the most important part of a stethoscope and is sometimes referred to as the head. This is the component that is placed on the patient’s body in order to hear sounds during auscultation.
The chest piece is made up of the following:
- Stem
- Diaphragm
- Bell
The stem is the metal piece that connects the diaphragm and bell to the tubing. The diaphragm is larger in diameter and picks up higher frequency noises, such as breath sounds.
The bell, in comparison, is smaller and picks up lower frequency noises, such as heart murmurs. When using a stethoscope, you must know how to properly position the chest piece in order to hear the desired sounds.
Protect the Tubing
The tubing of a stethoscope plays an important role in helping the sound travel from the chest piece to your ears.
During auscultation, it’s important to be careful not to allow things to bump against the tubing. That is because it could as produce inadvertent artifacts that are easily mistaken for abnormal lung sounds.
Therefore, when choosing a stethoscope, it’s best to select one with tubing that is thick enough to block out external sounds. If the tubing is too thin, it can impact the quality of sounds that you hear.
Re-Position the Diaphragm or Bell
When using a stethoscope to listen to the lungs, the practitioner must re-position the chest piece in order to listen to all the different lobes. This includes the following segments:
- Anterior
- Posterior
- Lateral
- Apex
- Bases
By re-positioning the chest piece, you will be able to compare different areas and listen for any abnormal sounds.
For example, if wheezing is heard in only one area, it may indicate that there is an obstruction in that particular lobe of the lungs.
Disinfecting Your Stethoscope
A stethoscope is one of the most-used tools in the hospital setting. Therefore, cross-contamination is always a concern, which is the transmission of microorganisms from one person to another.
That’s why it’s important to clean and disinfect your stethoscope after each use. The most common way to do this is by using an alcohol-based solution.
You can either use wipes or spray the solution onto a clean cloth and then wipe down the entire stethoscope. Be sure to pay close attention to the chest piece or any other part that comes in contact with the patient.
How to Wear a Stethoscope When It’s Not in Use
When you’re not using your stethoscope, it can be worn comfortably around your neck. The chest piece weighs more than the side with the ear tubes; therefore, the tubing must be balanced in order to evenly distribute the weight.
If possible, try to prevent the stethoscope from coming in contact with your skin. That is because skin oils may cause the tubing to become hardened over time.
Another reason to disinfect your stethoscope after each use is to not only protect your patients but also to prevent bacteria and microorganisms from transferring onto your skin or uniform.
How to Hold a Stethoscope
When using a stethoscope for auscultation, it’s important to hold it with a firm grip so that the chest piece remains in contact with the patient’s skin.
This will help ensure that you hear accurate sounds, which lowers the risk of a misdiagnosis.
It’s important not to grip the diaphragm or bell with too much pressure as this could create extra noise. Also, you can prevent the tubing from rubbing against the skin by keeping it under your thumb.
If you are able to hold the chest piece directly on the patient’s skin, it will provide better acoustics and sound transmission.
It usually works fine when placed on top of light clothing; however, this could create unnecessary noise as clothing rubs against the surface. Again, this is usually not an issue, but it is something to consider.
How to Rotate a Stethoscope
The chest piece of a dual-sided stethoscope contains both a diaphragm and a bell. Therefore, you must rotate the head of the stethoscope whenever you want to switch between the two.
This can be done by pulling back on the stem and rotating the chest piece until it locks into the desired position. Then, it can be rotated in the opposite direction if you want to change it back.
As previously mentioned, the diaphragm is used to listen to higher-pitched sounds, while the bell is used for lower-pitched sounds.
How to Hold a Stethoscope When Taking Blood Pressure
When taking a blood pressure reading, the stethoscope should be placed under the patient’s arm so that the bell is resting against the brachial artery.
This is the large artery that’s located on the inside of the arm, and it’s where the blood pressure cuff is placed. If you apply too much pressure with the bell of the stethoscope, it will perform like the diaphragm, and high-pitch sounds will be heard.
The blood pressure cuff and stethoscope bell placement are essential for obtaining an accurate reading.
What is the Best Stethoscope for Healthcare Workers?
If you’re a medical professional looking to purchase a new stethoscope, we recommend the 3M Littmann Classic III Stethoscope.
It’s made of high-quality materials and provides clear sounds that are easy to hear. Not to mention, this stethoscope offers the best bang for your buck in regard to quality and affordability.
To learn more, check out our comprehensive guide that reviews the best stethoscopes for healthcare workers who perform auscultation on their patients.
This is our top-recommended stethoscope for medical professionals.
As an affiliate, we receive compensation if you purchase through this link.
Final Thoughts
A stethoscope is a vital tool for medical professionals, including nurses, doctors, and respiratory therapists. Therefore, they must learn and understand how to properly wear and hold a stethoscope when performing auscultation.
This requires learning about the different parts of the stethoscope and how to rotate and disinfect it properly.
By following these steps, you can ensure that you’re using your stethoscope correctly and protecting both yourself and your patients. Thanks for reading!
Written by:
John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.
References
- Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020.
- “Anatomy of a Stethoscope.” 3M Littman Stethoscope, www.littmann.com/3M/en_US/littmann-stethoscopes/education-center/how-to-choose/anatomy.
- “Proper Use of the Stethoscope.” National Center for Biotechnology Information, 2013, www.ncbi.nlm.nih.gov/pmc/articles/PMC3650582.
- “A New Stethoscope Design with Unique Characteristics and Development in Medical Device.” PubMed Central (PMC), 1 Mar. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC5928306.