what?...q 15 NIBPs with an art line???

NIBPs q 15 may cause nerve compression and nerve damage, skin-pressure lesions due to repetitive, prolonged cuff inflations, among other things....not to mention just plain annoying to the patient and totally unnecessary with an art line which measures the true blood pressure. NIBP's and art lines don't really "correlate" because they measure two different things - blood flow (NIBP) versus actual blood pressure (art line). As stated by the previous poster, the art line reading is the gold standard and is the true blood pressure if properly calibrated.

why not chart on q 15 of the art line and q 1 hr of the NIBP? get an order and state your case...you're being a patient advocate!

Chisca states, "Correlates? Measurement of the blood pressure by art line is the gold standard".


I only have to say that no system is fool proof. Hopefully you are not trusting your aline every time it tells you the pressure is low or high... There are many factors that affect this reading just as there many factors that can affect an NIBP reading or even a manual pressure. If you read my post above, I talk about trouble shooting when you have questionable pressure readings or questionalbe waveforms. If you have worked critical care for any lenght of time you must know this is common. Square wave test it actually the "gold standard" to determine if your aline is accurate. However, even that does not account for the postional aline dampening...


I am trying so very hard to stay positive in this profession, but I get so frustrated when cocky people want to show thier umfff and try to make themselves look better by talking down to others when it is not even necessary. We were just having a discussion trying to better our practice here....

Yes, probably over-reacting... but I am so tired of that interpersonal dynamic that seems to prevail in this profession. So tired of it.

I agree with you dorimar. If I have a positional a-line, I too use a NIBP to correlate to the A-line. Yes they will correlate if the a-line is not positional and has a lovely waveform. How can one trust an a-line if the wave form is dampened?

Is that what you get out of my post? I was trying to express my frustration with the practice of accepting NIBP pressures over direct arterial measurements in critically ill patients. There is no evidence published to support this practice no matter how common this ritual has become. If you are aware of any studies that support this practice I would appreciate your sharing them.

But if a "direct arterial measurement" is either overdampened or underdampened (which happens often), then it is not accurrate. If your square wave test indicates overdampening or underdampening, then your aline is not the number to guide your treatement. Then you need to trouble shoot, and yes you should be comparing cuff to aline, especially in these situations....

I never see anyone document square wave. Every time I teach it even experienced nurses tell me they've never heard of it. Underdampened waveforms are very common. I have seen descrepencies by as much as 50 mmHG due to hyperresonnance of underdampening. Scary that we sometiems titrate nipride based on an underdampened waveform... Most people now days never even heard of a ROSE...

What I'm sensing is that nurses are using NIBP correalation as an independent criteria as whether or not an arterial line is accurate. Again, no published evidence to support this practice.

Our policy is to zero the A-line and check a square wave form q shift, check the waveform with each pressure check, and level the transducer PRN. If everything checks out ok, we leave the peripheral cuff off and only check a peripheral pressure q4h. I've heard people talk about "correlating" before and I don't get it. Why even bother if your A-line is functioning properly?
Now the other day, I had a pt with an A-line that had a dampened waveform and inadequate square wave form test. I tinkered a bit with the lines/positioning/equipment, etc. but couldn't fix it. We left the line in for gases but monitored peripheral pressures. I just don't see why you would ever do both? Then your stuck trying to figure out which one to treat if they're significantly different.
I work in a 17 bed mixed ICU in a somewhat rural location so I'm always interested to hear what other people are doing...

I should clarify: I don't "correlate" to see if the art line is functioning, but to see if there's a perfusion mismatch. It's also helpful, IMO, when the art line is extremely postional. Just my $0.02.