BP question....

[Kiringat]

This has me stumped...

When taken in upper extremities, this Pt's BP is insanely low - think 51/30-ish.

The doc thinks this is inacurate, so there are orders to take BPs in the lower extremities, where they read completly WNL.

My question: What would cause such a vast difference? There is no circulation impairment or anything else (far as I can tell) that would cause such a low read in the UE's. Help!

[nrsang97, BSN, RN]

Is the pt female? Have they had a bilat mastectomy? That will affect the BP readings.

[Kiringat]

No surgery, a/v fistulas, nothing.

[blondy2061h, MSN, RN]

What position was the patient in? Having a position where the extremity is above the heart will create a falsely low bp, such as when a patient is laying on their side.

[Virgo_RN, BSN, RN]

Has the patient had a duplex ultrasound of the upper extremity arteries done?

[Flightline, BSN, RN]

Try again tomorrow on the upper extremities; it will probably work just fine. But if not, there's only two possibilities: 1. the equipment isn't working properly. Try a different machine. 2. The equipment can't hear the pulse. Is the patient obese in the arms? If not, it's just a quirk of his/her brachial vasculature in his/her upper extremites. Nothing to do about it really, except take it in the lower extremities or use a pediatric cuff and take it radially. Of course, you could try to take it manually, but why bother if you're getting good readings in the lower extremities?

Oh, by the way, the pt does have decent pulses radially, right? I mean I would hate to think you weren't getting a reading and their hand was rotting off from no circulation or something.

[tvccrn, ASN, RN]

Another off the wall thing: the patient could have coarction. I know that with the kiddos if we get differing readings fro top to bottom that is one of the things they look at.

[PICNICRN, BSN, RN]

With a Coarc your BP are higher in the uppers usually..............

Could it be the cuff?? If it reads accurate in the lowers is the cuff too big for the uppers? This could give you a false low.

[tvccrn, ASN, RN]

With a Coarc your BP are higher in the uppers usually..............

Could it be the cuff?? If it reads accurate in the lowers is the cuff too big for the uppers? This could give you a false low.

Doh!! You're right, it's been so long I got mixed up. :nuke:

[jenrn6282]

is the person in afib sometimes our automatic bp cuffs dont read a persons bp well if they are in afib secondary to the irregular pulse. and will give falso low or high or get no reading at all....anyway i would always do a manual to be sure

[nerdtonurse?, BSN, RN]

I had one where the BP was insanely low (like 40's over 30's) and so I go in, pt is sitting up, reading a magazine, completely A/O, no SOB, no signs and symptoms of anything except boredom (had a lap chole, going home the next morning). I was worried about bleeding (hx of blood thinners), but pulse was okay, and the manual bp was ok. This pt popped in and out of afib, and had for years, and I think she must have had an "afib moment" and the machine couldn't figure it out.

I also had one where the arms were low, manual or auto, and the legs were okay. Pulses palp, but weak. Called the doc, he ordered dopplers, and the pt had DVTs everywhere....

[nursej22, MSN, RN]

A duplex sounds like a good idea. A number of things can impede arterial flow: aneurysm, stenosis, and steal syndrome. Also the proper size cuff and the Afib thing are good points.

As much as are cuffs get banged around I wonder how accurate they are.