Learn the art of proper stethoscope usage, identifying normal and abnormal sounds, and discovering the essential techniques for accurate assessment.

How to Use a Stethoscope: A Step-by-Step Guide

The stethoscope is one of the most important tools in your medical bag, and knowing how to use it effectively is paramount to your success as a medical professional.

You will use your stethoscope to measure blood pressure, listen for heart sounds and bruits, zero in on lung sounds,

From initial auscultation to thorough diagnosis, the proper utilization of your stethoscope will serve you and your patients well. We have gathered some tips to help you get started.

Choosing the Right Stethoscope

There are many types of stethoscopes, and choosing the right one depends on your needs. For example, cardiologists and pediatricians use different types of stethoscopes that work best for their patients.

There are countless brands to consider, each offering different features. Some of the brands we carry even have customization options.

Stethoscope types include:

Classic: a general, multipurpose stethoscope like this one that is designed to meet the needs of most medical professionals.
Cardiology: best used to identify heart sounds and minimize background noise.
Pediatric: specifically made with children in mind, these are perfect for small pediatric patients.
Digital: a newer technology, digital stethoscopes connect to smartphone apps that help with noise cancellation, increased amplification, and easier identification. They are a pricier option with advanced features.
Teaching: these stethoscopes come with two headsets to allow teachers and students to listen together.
Lightweight: perfect for EMTs and nurses, lightweight stethoscopes are a great option for quick auscultation.
Veterinary: animals have varied body shapes that are different to humans, so veterinary stethoscopes are shaped in a way that allows access to the areas a veterinarian needs to reach.

3M Littmann Classic III Stethoscope

Adjusting a Stethoscope

Let’s dive into adjusting your stethoscope. You need a good fit to provide accurate results. To make sure your stethoscope is appropriately adjusted:

Make sure the ear tips are sized and fitted correctly:

The size of your ear tips will make a difference in overall sound quality. With improperly fitted ear tips, the acoustics will be distorted, rendering the stethoscope ineffective for listening. You can purchase ear tips in a large range of sizes to suit your needs.

If you are experiencing pain in your ears after wearing your stethoscope, the ear tips are too big. If you cannot get a proper seal in your ears and can hear a lot of background noise, the ear tips may be too small.

Adjust the headset tension:

We know how uncomfortable a stethoscope can feel when it’s fresh out of the box. With a few minor adjustments, your device will start to feel natural.

If your headset is too tight, you could experience pain in the ears, or even headaches. A headset that is too loose will result in no sound coming through.

Adjusting the tension in the headset is a quick and easy process. Increasing and decreasing the tension is done by pulling apart or pushing together the ear tubes. After adjustment, the tubes will hold their shape, ensuring a proper fit.

How to Wear a Stethoscope Correctly

How you wear your stethoscope matters, too. Depending on what you need to listen for, the patient will need to be positioned accordingly. Ear tip placement is also important.

Positioning the Patient

First, ensure the exam room or area is free from excessive background noise. Then you can prepare your patient for listening based on what you need to hear.

To Hear:	Position the Patient:
Heart and abdominal sounds	Supine position
Lung sounds	Upright position

Positioning the Ear Tips

The ear tips of your stethoscope need to be facing forward to work properly, with the ear tube curve pointed behind you. They need to have a snug fit and tight seal, so if this is not achieved, you will need to purchase a different size.

You will be able to feel the difference and adjust as necessary.

Choosing the Right Chest Piece

You may be able to swap out the chest piece. If your stethoscope has this option, make sure the chest piece is right for your patient.

Chest pieces are available for cardiology, pediatrics, and other specialties that may suit your specific needs.

How to Use a Stethoscope: 5 Ways to Listen to Your Patient

Once you have adjusted your stethoscope and ensured a proper fit, you are ready to start listening to patients.

First, holding your stethoscope correctly will make a big difference in how well it works for you. Using your index and middle fingers on your dominant hand, hold the stethoscope between the bell and diaphragm with a finger on either side.

This grip will help reduce extra noise compared to placing your fingers on the diaphragm.

Next, make sure you are treating the individual patient and adjust your technique to work on each patient.

For example, you might hear outside sounds on a patient with body hair even if the room is quiet. This is from hair rubbing against the diaphragm. Take care to be very still to avoid this issue.

If your patient is overweight, you can ask them to lean forward when listening to their heart. This may help with hearing the heart in patients with a thicker chest wall.

There are five main functions of a stethoscope to be familiar with:

Listening to the Heart

Heart sounds are an important part of your exam. To listen to a patient’s heart, you will need to:

Place the diaphragm on the patient’s chest over their heart. This is on the left side of the chest, just under the breast.
Maintain a tight grip on the chest piece and push down on the patient’s chest. You want to make sure you are well connected so that you do not pick up outside sounds.
For a thorough examination, make sure you listen long enough and identify normal heart sounds. You can also measure their pulse.
Pay attention to anything that sounds abnormal, like a heart murmur or ventricular defect.

Listening to the Lungs

The lungs tell the story of the patient’s breathing quality. You can listen to the lungs to check for things like air or fluid in the lungs.

Like before, you will use the diaphragm side of the chest piece to listen to the lungs. You can listen from the front of the chest or the back.
Make sure to move your stethoscope around to cover the entire body of each lung.
Listen to both lungs and pay attention to any differences between the two.
Listen for wheezing and crackling noises as well as normal breath sounds.

Listening to Abdominal Sounds

When listening to the abdomen, you are checking for abnormal organ activity. This helps identify issues with the bowel and vascular disease.

Use the patient’s navel as a starting point and consider that the center of the abdomen.
Mentally draw a diagram on the belly, separating the area into four quadrants.
Use the diaphragm to carefully listen to each section separately.
Check for normal and abnormal bowel sounds. Ideally, it will sound like the stomach is “growling.” Abnormal sounds include silence (this could indicate a blockage) and fast sounds, which may indicate disease.

Listening for a Bruit

A bruit, or vascular murmur, is “an audible vascular sound associated with turbulent blood flow.” Bruits are often associated with blocked arteries, atherosclerosis, and murmurs. Checking for a bruit is indicated if a murmur has been identified.

To check for a bruit:

Locate a carotid artery in the patient’s neck. Using the diaphragm, apply light pressure.
Listen for a “whooshing” sound, and take care not to confuse the sound with a murmur, as they often sound similar.
Other major arteries can be used to check for bruits.

Checking Blood Pressure

Blood pressure is one of the easiest indicators of a patient’s cardiac health. Checking blood pressure using a stethoscope is a simple process:

Snugly apply a blood pressure cuff to your patient’s arm. Ensure the patient is sitting in a relaxed position and make sure their legs are uncrossed.
Use the diaphragm and place it over the brachial artery below the blood pressure cuff.
Listen for Korotkoff sounds to measure the systolic blood pressure.
Squeeze the bulb on the blood pressure cuff to inflate the cuff. Generally, you will inflate it to 180 mm Hg.
Once the correct pressure is released, listen closely for Korotkoff sounds to determine the diastolic pressure.
The systolic pressure and diastolic pressure together will indicate the patient’s blood pressure.

Maintaining and Cleaning Your Stethoscope

To ensure longevity and functionality, you need to properly clean and maintain your stethoscope. We have seen stethoscopes lose their effectiveness earlier than necessary due to inadequate care, so don’t skip this important step!

Be sure to sterilize the stethoscope between patients. You can use regular soap and water or alcohol wipes and then air dry once cleaned.

Remove the diaphragm (if your model allows) and clean it separately. Remove ear tips and swab those with soapy water or alcohol.

Do not submerge the stethoscope in water, as this can destroy the inner tubes and render it useless.

Conclusion

You will use your stethoscope daily, so proper care and technique will make all the difference in its usefulness. These tips will help you treat patients with confidence and ensure a long life for your stethoscope.

Author: Steven John Cumper, B.App.SC. (Osteo.), M.Ost., is a businessman with a strong foundation in biomedical science and osteopathic medicine, who founded and led Medshop to international success, culminating in its acquisition by the Bunzl Group in September 2021, where he continues to serve as Managing Director (Medshop Group).