Other ways to get BP?

  1. Does anyone know any other ways to assess a BP when it can't be heard anywhere or palpated? This pt BP has been done in the thigh for a while now. Now, it can't be heard or palpated. It disappears by doppler at around 60 mmhg as the cuff is inflated. We've tried all pulses and with a machine. The pt is oriented and has pedal pulses. Any ideas?????? :imbar
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  2. 9 Comments

  3. by   steve0123
    Invasive? A lot of work to insert and maintain the arterial line... Not really worth it if you're just doing routine BP's. I'm stumped... Sorry...
  4. by   suzanne4
    First, what are the reasons that the pressure is being done on a thigh to begin with? If you can't easily palpate a radial pulse, then your BP is low, and your patient is hypotensive, of course, unless you have some type of arterial damage in that arm.

    What type of unit are you working on? I remember working on the Navajo Rservation many years ago and having a patient with a systolic BP in the 40s over the weekend, then she died on the Monday. But she was alert and talking the entire weekend.

    Have you tried putting the BP cuff around the patient's calf, and checking for a BP in their foot with the pedal pulse. If there is a pedal pulse, then they are perfusing okay.
    Last edit by suzanne4 on Jul 9, '04
  5. by   Mags4711
    suzanne4, she did mention the patient does have pedal pulses, so he is likely not as hypotensive as the old rule of thumb would say he should be.

    bbq, have you tried putting a cuff on the ankle or wrist and using a machine like a dynamap?

    Other than that? Nope, no ideas beyond an indwelling line...

    Faith
  6. by   longforseaair
    This pt. is a frequent flier and usually exacerbation of CHF.
  7. by   longforseaair
    Yes, tried doppler and also dynamap.
  8. by   Mags4711
    Suzanne4,


    I just re-read your post. Really really good point about being alert and oriented but still having a low BP. Certainly is something to keep in mind!
  9. by   suzanne4
    Quote from faithmd
    suzanne4, she did mention the patient does have pedal pulses, so he is likely not as hypotensive as the old rule of thumb would say he should be.

    bbq, have you tried putting a cuff on the ankle or wrist and using a machine like a dynamap?

    Other than that? Nope, no ideas beyond an indwelling line...

    Faith
    I already suggested that they put the cuff around the calf, and use the pedal pulse. If the patient has a pedal pulse that is of good quality, then yes, they are not hypotensive.

    But why isn't the cuff being used on an arm? Is she too small and you don't have one in the right size?

    What other history does she have besides CHF?
    Last edit by suzanne4 on Jul 9, '04
  10. by   Farkinott
    Could it be a better (privately purchased) stehoscope is needed?
  11. by   suzanne4
    If you are able to easily palpate a pedal pulse, then it means that there is a popliteal pulse there. Farinkott makes an excellent suggestion, what type of stethescope are you using? Is the cuff being properly positioned, with the trinagle or whatever marking that yours has, over the actual pulse? Just sounds quite odd that you have a pedal but can't get a BP even with a doppler.

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