BP on dialysis pt

[LogCabinMom]

This is a very basic question, and I feel very stupid for even asking it. I'm a little too embarrassed to ask another nurse at work.

I have a pt at the LTC facility I work at who is on dialysis. She is a small woman. For the life of me, I cannot get her bp on her arm (the one w/o the port, of course) - manually or with a machine. I cannot even find her brachial pulse! I cannot hear any sounds in my ears at all! This is one of my greatest fears, that I can't do something as simple as take a bp. Honestly, it's not just me... aides are frustrated too, and like I said, I'm too embarrassed to ask another nurse.

Is this common in dialysis pts? I've had others, tho, who I haven't had a problem with - I usually have no problem in obtaining a bp measurement in anyone else... Our facility's policy is to take it on the arm... is it ever ok to just "read the gauge" w/o hearing sounds? Any tricks out there to help me?

Thank you!

[UM Review RN, ASN, RN]

What size cuff are you using? What kind of stethoscope? Have you tried to use a doppler?

Sometimes if you get it through doppler, it can clue you in to where exactly you need to listen to hear the systolic BP.

Good luck!

[Rook]

You can try the thigh if you have a big enough cuff. Don't be scared you should ask questions though if you are having trouble. I remember in my interviews that the managers always loved it when I said that I'm not the kind of person who isnt afraid to ask questions. Remember you are learning, plus getting correct BPs on dialysis patients is extremely important because, especially after dialysis they can drop very low.

[Ayvah, RN]

There is an alternate way to take a BP without using a steth, but it will only give you SBP. Pump up the cuff and place your fingers on where the radial pulse will be. Start to deflate the cuff. Once you can feel the radial pulse, that's the approximate systolic blood pressure. Not ideal for dialysis patients though, because I've had some with very low diastolic blood pressures.

[kale39]

taking the SBP is not an option if you can not palpate a radial pulse, I would also ask the other nurses, maybe they also are having the same problem, and like you are too afraid to ask, so is this pt even really having a proper BP measurement? No question is a stupid one, the only stupid question is the one that goes unasked.