blood pressure on four extremities

BittyBabyGrower, MSN, RN · Jun 6, 2005

We don't do 4 limb BP unless we think there is a cardiac problem. Did they say why they do this?

Gompers, BSN, RN · Jun 6, 2005

We do it as well. They say it's to rule out cardiac issues, but I've never seen anything funky leading to a STAT ECHO or anything! I can't see changing it just to kids who "might" have a heart defect because you never really know who has what.

So we do it, and we really don't mind because it doesn't take long and it's a way to ensure the kids have frequent BP monitoring during admission.

kaibigan · Jun 6, 2005

we do things/cares differently in various places, at least, now i know am not the only one performing in some unique ways. thanks to all for your input, it help me think am not wrong and become more confident. the same with gompers, they said they do the four-limbs test to rule out cardiac problems.

BabyNurse513 · Jun 6, 2005

at the last 2 hospitals I worked at, we were required to do 4 extremity BP's on all new admissions.

NICURN40 · Jun 7, 2005

hi again!
i need ur opinion, when u have an admission, is it a routine care that u check all the four extremities for blood pressure? when is it only indicated?
in my previous hospital we check on;y the bp on one extremity either the left or right leg. am quite confused here in my new hospital, upon admission nurses check all the bp's for the four limbs.
any IPP that i can use to start a new protocol in my new unit, thanks! ples. provide me a copy .
In my hospital we do not do routine 4 point B/P's on admission. The purpose of doing a 4 point B/P is to rule out
coarctation of the aorta. By doing 4 point pulses ( bilat brachial and bilat femoral) you can determine if the pulses in the legs are lower, therefore indicating a need for a cardiac U/S. The reason for checking the upper vs lower extremity pulses or B/P is that in a coarct,there is less pressure in the legs as compared to the arms. Doing 4 point B/P can be time consuming because the baby needs to quiet down for each B/P, otherwise w an agitated/ upset baby the B/P's are invalid. I have seen babies who were normal newborns, and on admission by the mother-baby RN
were identified to have weaker femoral pulses than brachial, had a cardiac u/s done and were transferred out for a coarct.
Hope this helps.

prmenrs, RN · Jun 7, 2005

We did for a while a few (>10) years ago--very poor return on effort! [JMO] I don't think that hospital does it any more.

My current hosp does it if a murmur is heard, plus checks pulse oxy check. Still not a great return on effort. I'm very unimpressed w/this make-work test.

kaibigan · Jun 7, 2005

i'd like to make a correction in regards to my last statement, i meant that in my previous hospital, NICU nurses don't do the four-limb test unless the baby is heard to have a murmur on ausculation. this is the reason why i have found myself unique among the other nurses in the hospital i presently work with 'coz i don't do the four-test limb unless the baby is positive for heart murmur

my current hospital has been practicing four-limb test whether or not the baby has murmur. in short, even if i don't i still have to follow 'coz it's a part of their protocol.

sparkyRN · Jun 8, 2005

Certainly there's nothing wrong with doing BP x 4 ext. and kaibigan, you need to follow your hospital's protocol. But as prmenrs said, as a standard admission protocol I agree that there is poor return on time invested. If there is indication of desaturation, PPHN, murmur or irregular rhythm, then those circumstances would indicate a need for further BP monitoring. The results of 4 point BP with varying pulse pressure are not always indicative of a problem and conversely, the difficulty in obtaining consistent measurements on all 4 ext.will not always give accurate data. (in other words the BP data may indicate a problem exists when it really doesn't OR there may be a problem that won't be reflected in the BPs because in the difficulty in obtaining them.)

If the pulse pressures vary on these BPs but there is no other indication of a cardiac issue, what do you do with this info? In my experience, you tell the doc and they say "yeah, ok, well just watch him" which is what you are going to be doing anyway.

AllyIII · Jun 17, 2005

We do 4 BP's but we get lots of PPHN's, and potential ECMO's so it's just easier to do it on everyone

Certainly there's nothing wrong with doing BP x 4 ext. and kaibigan, you need to follow your hospital's protocol. But as prmenrs said, as a standard admission protocol I agree that there is poor return on time invested. If there is indication of desaturation, PPHN, murmur or irregular rhythm, then those circumstances would indicate a need for further BP monitoring. The results of 4 point BP with varying pulse pressure are not always indicative of a problem and conversely, the difficulty in obtaining consistent measurements on all 4 ext.will not always give accurate data. (in other words the BP data may indicate a problem exists when it really doesn't OR there may be a problem that won't be reflected in the BPs because in the difficulty in obtaining them.)
If the pulse pressures vary on these BPs but there is no other indication of a cardiac issue, what do you do with this info? In my experience, you tell the doc and they say "yeah, ok, well just watch him" which is what you are going to be doing anyway.

NickieLea · Jun 25, 2005

This is the third NICU I've worked in since I became an RN. I also worked L&D for a couple of years and ER for a couple of years. (DH is active duty Air Force, hence all the freaking movign around!)

Some NICUs do it, some don't.

Any cardiac kids we weren't expecting before delivery to be cardiacs, we didn't discover based on 4 point BPs.

It seems as soon as I grow comfortable doing it the way the particular place I'm working in does it, we move!