NIBP monitoring on same arm as the a-line?

  1. 0
    I've worked in a MICU for 1.5 years now. Some nurses do not monitor the NIBP when an a- line is in place. Citing discomfort of squeezing the arm hourly as their reason. Some nurses use the opposite arm of the a-line. Some opt to use the same arm as the a-line.

    What is the best practice?
  2. 10 Comments so far...

  3. 0
    I always measure with a cuff even with a A-Line.. I personally don't care which arm its on, the A-line will only be disturbed for a few minutes each hour either way. I feel safer when the cuff and A- line are close in readings because the A-line is not always correct.
  4. 1
    I check a cuff or manual pressure once per shift, or more frequently if I feel something's going on with the a-line that I can't immediately troubleshoot.
    lilredrn likes this.
  5. 0
    Quote from Sun0408
    I always measure with a cuff even with a A-Line.. I personally don't care which arm its on, the A-line will only be disturbed for a few minutes each hour either way. I feel safer when the cuff and A- line are close in readings because the A-line is not always correct.
    Thank you both for your reply.

    I also prefer to monitor cuff pressure. I prefer to do it qh. I prefer the same arm. We don't always know if there is an impediment to flow through one arm, which would cause different readings in both arms. I certainly don't routinely check the b/p in both arms. IDK, maybe I should check a cuff pressure in both arms, at some point during my care.

    In my short time as an ICU nurse, I've encountered insufficient pressure on the bag. An empty bag. A transducer that is visibly not level. I definitely prefer to use the cuff pressure w/ the a- line. As you've mentioned, they don't always work right.
  6. 0
    If their line correlates well/is not positional I'll usually go with just an arterial reading unless you're titrating pressors or something, then a backup NIBP is a good idea to make sure your a-line isn't pooping out.

    I always do NIBP in the opposite arm. I've only seen a handful of patients who had drastic differences between arms for NIBP. Main reason is it's annoying to listen to the A-line alarm every time the NIBP cuff is inflated. Same reason I don't put my pulse ox on the same arm as a cuff.
  7. 1
    In an ICU setting I think we develop the habit of being overly particular to every detail.... which is a positive thing. In a critically ill patient it is important to ensure that the readings you are documenting are accurate. An a-line has so many factors such as positioning, zeroing, obtaining a proper wave form, etc. that can cause erroneous results. Most ICU patients are sedated and vented, so concurrent monitoring of both NIBP and A-line won't hurt the patient. If both are correlating well then the a-line gives you a real-time view to accurately titrate pressors, but if nothing else, monitor NIBP q30min.... then if there is a difference in the two readings, you can further investigate whether or not the a-line is accurate.
    zcoq72mehs likes this.
  8. 2
    some good answers.

    it is of my opinion that the aline should be verified against a second source with some regularity, and this should be documenting in your protocols. some places, it is q2hrs, some q4hrs

    i am a proponent for using the opposite arm, but not just for my convenience.

    when we occlude the artery on the side of the a-line, in theory we could promote thrombus formation as the stagnant blood allows for the platelets to begin their thing

    second, the radial/ulnar flow is already partially compromised (thus, the infamous, inaccurate allen test), and we are furthering that compromise for awhile longer with same arm nibp

    thirdly, there is can be a transient change in flow dynamics causing shearing force pulsations that may compromise the site further, ntm dampening issues with the monitoring system itself

    fourth, excessive nibp measurements on same side may increase interstitial spacing near the site and affected extremity, ntm interfering with lymphatics--something we dont want to do cause possibly affecting immunity and possibly changing infectious statistics

    all in all, it just seems more prudent, esp. with q15minute checks, to use an unaffected extremity when possible.

    my 2 cents
    lilredrn and Nccity2002 like this.
  9. 0
    I agree with ZCOQ72MEHS.
  10. 1
    Have to be honest, I may only check a cuff pressure once a shift. If I've got a good, functioning A-line, that is the gold standard for monitoring. Continuing to use a NIBP seems just silly to me as well as putting an extremity's perfusion at risk, especially with a critical patient.

    Interesting article:
    http://www.medscape.com/viewarticle/563819_5
    Altra likes this.
  11. 0
    I typically just check a NIBP once a shift, if it's correlating with the a-line then i'm fine but if my a-line starts to go wonky i'll cycle the cuff, usually not on the same arm as the a-line. And being that I work peds cardiac ICU, for certain defects I may cycle my cuff on the upper/lower extremity opposite the a-line (on a leg for example if my a line is radial) to make sure i'm getting equal upper and lower ext blood flow which can be an issue in certain cardiac defects


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