[neurorachel]

Originally Posted by swolfe_2

I always check for corelation, if the values are significantly different then I take cuff pressures on other extremities. If my a-line is different then all of these, then I trust cuff. The reason why I check different cuff pressures is because it is fairly common for pts to have left subclavian stenosis that will give you a false low SBP. You can also try a "rose" on your aline if there is a "whip" in the reading. Sometimes that will help.

hey...what do you mean a rose on your aline and a whip in the reading? just curious!

[swolfe_2]

A “whip” is when any kind of invasive line either under or overestimates the actual sbp and underestimates the dbp because there is excessive catheter movement intra-vascularly (aka whip). “Whip” is artifact that under dampens your waveform and will have a steep upstroke on your waveform and sometimes an extra waveform after you flush. It is more often observed in PA catheters but can happen on A-lines as well. A “rose” is a small circular devise that you place between pt and system that attempts to equalize pressure.

[diveRN]

If the patient is sick enough for an Aline, then I follow that after zeroing, square wave testing, and correlation against the NiBP. If they aren't sick enough for one and BP has been stable, then I seek orders to DC it.

We see most emergent A lines in the groin, and non-emergent ones inserted brachially. Groin lines are especially susceptible to infection.

[joeyzstj]

We always use the A-line when possible. The manufacturer of the A-line we use has informed our facility that in the presence of hypertension to double check with and NIBP and go by the cuff. If the BP is normal or is low go with the a-line. With the NIBP you have to account for cuff size, placement, edema, inproper position, extremity position, movement, ect. With an A-line you need to Keep an eye on fluid levels in the pressure bag, wave forms, the level of the transducer, ect. They both have their ups and downs, however I would rely more on the A-line.

[labman]

Well today I had my first super sick patient who required different pressers ended up having an art line that correlated and not correlating but it helped tremendously when I had to switch pressers and just having a constant line. We had our share of not really sick patients who required them and they always went bad like ALWAYS!

[GrnHonu99]

Originally Posted by labman

Hey fellow NICU nurses. I have a quick question for all of you gals and guys. Whenever a patient comes back from OR with a perfectly working A-Line do follow for of the A-line or a BP cuff? We follow the BP cuff I think A line there is less room for error (of course unless wave is dampened) and get a more accurate reading. Tell me what your ICU uses for recording BPs?

I usually hope they correlate! However we all know that hardly ever happens...i usually judge by the waveform and such..if its good then ill go by the aline...however at times we get wierd aline readings and we just know its incorrect then we go by the cuff...

[ccc2066]

Our docs order by cuff for BP parameters even if they have an A-line.

[jbp0529]

Our bedside monitors have the ability to sorta "adjust the calibration" of our Alines, either up or down, w/o any external devices. For example, if our Aline reading is way higher than the NIBP, like > 30 mmHg, and the waveform/fast flush is ok, we can "dial down" the Aline BP through this calibration method. So say my NIBP reads 100/60. Aline is 140/85. All I have to do is turn this dial and adjust it. Now it reads 115/70 on the Aline, which is correlating much better. Its pretty neat. Has allowed us to save many an Aline that we otherwise would have d/c'd or not paid attention to.