BP in arm with PICC?

RN1982 · May 4, 2008

If I can't take the BP on the opposite arm, I take it on the wrist or the leg.

light4j · May 4, 2008

If I can't take the BP on the opposite arm, I take it on the wrist or the leg.

Yeah, the guy has a shunt in his other arm, so I took it in his leg, but his nurse had been taking it in his forearm...I've heard you're not supposed to do it in that arm at all, or below the PICC- I've yet to hear which is the best one.

WSU_Ally_RN, BSN, RN · May 4, 2008

Just last week I had a pt with a PICC in her right arm and a DVT in her left, so we were taking bp's in her right forearm. That is where her PCP told her to take them until the DVT resolved, and it was the only place she would allow us to take them.

Shopgirl1 · May 4, 2008

Alright, another question, not to do with PICC's but arms and BP's, and lab draws. Patient has a bilateral masectomy...where do I do all of the above? And she has EXTREME 3+ BLE edema!! :uhoh21:

WSU_Ally_RN, BSN, RN · May 4, 2008

Alright, another question, not to do with PICC's but arms and BP's, and lab draws. Patient has a bilateral masectomy...where do I do all of the above? And she has EXTREME 3+ BLE edema!! :uhoh21:

Does the patient know? Usually in that case, the patient can tell you where they normally have all this done. Hopefully the doctors will place some more permanent access (TLC, PICC, mediport, etc) for you. Maybe ask them for suggestions or help...

Shopgirl1 · May 4, 2008

Well, she did thankfully have a port, however we needed to get blood cultures....hmmm....tricky. The PCA ended up getting the BP on her forarm since her legs were so swollen, she has cancer through and through..so sad.

Daytonite, BSN, RN · May 4, 2008

alright, another question, not to do with picc's but arms and bp's, and lab draws. patient has a bilateral masectomy...where do i do all of the above? and she has extreme 3+ ble edema!! :uhoh21:

the reason for not doing blood draws in a mastectomy arm is because their protection to invading bacteria has been compromised due to the removal of the lymph nodes during their mastectomy. a bp can be done as long as you don't keep the cuff inflated for a prolonged period of time.

for bilateral mastectomy patients without a central line, we got an order from the doctor to draw or place ivs in the arms and then followed a very strict skin cleansing protocol before any sticking.

edema can be overcome by placing an ace wrap on the arm, elevating it and wrapping it with a warm k-pad to help the circulation along. within 15-30 minutes enough swelling is displaced to find a vein.

if you are still in doubt about any of this (as you should be), ask several surgeons who do mastectomies or oncologists what the pathophysiology is behind why a blood pressure, needlestick or iv can't be done on a mastectomy arm and when there can be exceptions to it.

TX_ICU_RN · May 5, 2008

Considering a PICC is a central line, I would not take a BP in an arm with a PICC. Even taking it in the forearm could increase the pressure above the cuff creating problems for the PICC.

Virgo_RN, BSN, RN · May 5, 2008

Considering a PICC is a central line, I would not take a BP in an arm with a PICC. Even taking it in the forearm could increase the pressure above the cuff creating problems for the PICC.

It might increase arterial pressure, but since a PICC is venous, would it really be an issue?

IVRUS, BSN, RN · May 5, 2008

Hi- I'm currently half way through nursing school and also work as a CNA in hospitals. We're finishing up learning about central lines/PICCs etc., and I know that you're not supposed to use an arm with a PICC to take the BP, or so I was taught and have always though. But, I'm working with a nurse tonight who said you could take the BP in the arm as long as it's below the PICC, so in the forearm- is this allowed? I've heard differing opinions- what's the right answer?

Your nurse that you were working with is correct. You can take a BP out of the arm BELOW the PICC line, but not over the PICC line. If you think of it in terms of what happens when you squeeze a straw and then let go... a reflux of fluid will be drawn into the straw when you release pressure. This also occurs with open-ended or non-valved IV catheters; A reflux of blood is drawn into the IV catheter and this increases the potential for occlusions. In addition, the squeezing of the arm can increase the contact of the IV catheter with the tunica intima which in turn encourages the possibility of phlebitis and thromus.

DD

cjcerrn · May 5, 2008

I just called the nurse on the IV team here that is certified to insert and work with PICC's. She states that it is not recommended, but not contraindicated if that is the last alternative. The fear is in fracturing the PICC line, but this is a moot point in case of emergency.