Quote from janfrn
My comment is anecdotal and definitely not evidence-based (in the purest sense
) but I'll share it anyway. With infants and small children (under 3 years old and developmentally normal) with no cardiac history who are not sedated or soundly asleep, it's a waste of effort to get a cuff BP. The second the cuff starts to inflate, the child gets agitated, starts to cry, squirm and flail. The movement causes the cuff to continually reinflate in a futile attempt to sense a pulse and that only agitates the child more. The numbers eventually obtained are not very valuable, with artificially high systolic and artificially low diastolic pressures. BP in children is a (very) late sign of deterioration and usually signals impending collapse, something that should be identifiable by other means - but by that point they're usually in no shape to fight the measurement. So for these little people assessment of HR, colour, capillary refill and urine output are the best way of determining cardiac output, NOT BP. If their HR is within normal range for age, they're pink and warm with brisk cap refill and are sitting in a wet diaper, they're good. If BP measurement is absolutely required then putting a cuff on and leaving it on, waiting for the child to fall asleep or to be snuggly cuddled or having a nurse who is extremely good at distraction and comfort measures are essential elements! As I said, this is not research-based, but the result of 18 years worth of peds nursing and observation. Maybe your director would like to do a few shifts in your shoes and see how well she manages with the BP part.
As OP and Jan have said. It totally depends on the kid--specifically.
Little kids and babies hate, say, something like axillary temps enough. What is the point in obtaining a BP on a child unless there is some clear indication for it?? Throughout the night is not necessary UNLESS
there is some specific and individual indication for it. To take it just to take in general peds, without some specific indication, is a waste of time and an irritation to the kid
, who is already less than thrilled to be there. Kids don't adapt to stress as well as adults. Their coping is different. Some kids do better than others, but in general, it's added irritation and stress to the kid unless there is some reason for it. Better to even spot check as SPO2, unless the kid needs continuous.
I have seen newborns fight cuff pressures all to hell, and it can take some time to get a decent (reliable) BP on them. In cardiac, say they have procedure or surgery, they have art lines. And even if you check the art line against a cuff BP on the monitor, unless there is a problem with the line, we go with the art line numbers over all.
With kids, you don't just do things to do things
b/c it's someone's arbitrary idea of a standard protocol. I think it would be difficult to show evidence of the benefits of doing this, w/o certain or special indication, for general peds, just for the hell of it. You assess a kid as a whole. Sure you do this with adults, but kids can change so quickly, you really learn to look at the big picture with them quickly in addition to any monitored data. You may well have to act quickly with a child, but at the same time, you can't, necessarily,
just react without sound rationale and specific insight, b/c what you do to them can affect them quite severely
--just as much as potentially what you do not for them--say for example, with airway and breathing--that requires very quick and correct intervention--but, if they perhaps need suctioning as opposed to bagging and albuterol or epi, then obviously you don't jump to epi. The tolerance in homeostatic response is more narrow to extreme reactions with children.
See how adults get pizzed off when you go in the middle of the night for a BP? Well, you may well have to do this, depending on their meds and other conditions and situations with them. (And this may well be the case with your pediatric patient.) Well, kids can become supper pizzy. And once that reaction is started, now you will have to invest a whole lot of time on not only hopefully getting a reliable BP, but also in calming them down. In other words, is the benefit of the preventive monitoring worth the risk of a reaction, which could end up causing the kids a whole lot of needless stress and waste a lot of time that could be more wisely allocated?
Is it worth making him cry so much now you have to N&P suction the day lights out of him--severely elevating his HR and BP
? Is it worth him forgoing a decent period of sleep and rest, which is vital to children, especially sick ones? Will the BP data even be close to anything accurate or usable, and to what end?
I mean evidence based practice is good, but this is a question more along the lines of common sense in terms of working/experience in pediatrics.
Now, of course, if there is clear indication for around the clock BPs, for example, that's a different story, and that child would probably be in a unit bed anyway.
To do them more than once a day BP w/o good indication in a child is as Jan said. It's a waste, and it's a needless extra stress to children who will often not response with the same level of tolerance an adult generally might.
Does that make sense?