arterial lines vs noninvasive cuff

Pediatric Critical Care Columnist · Sep 1, 2004

I'd say: good waveform, go with the art line. Cuff BPs are fraught with potential inaccuracy, especially in someone with a very large upper arm, certain heart conditions, and even restlessness. If that cuff slips down over the antecub, your reading is gonna be wacky. It's easier to titrate your nipride than it is to explain and evacuate a major bleed.

zambezi, BSN, RN · Sep 1, 2004

I agree, if the waveform is good, the line has been zeroed, it is properly dampened etc...it should be the more accurate of the two... I would think that running a bit of a lower pressure with an active head bleed would be beneficial to the patient anyway...

If you have a question...you can always call the doc, give him the scenario and ask him which pressure he wants you to run by (but if he took the time to come in at 3 am, I'm thinking he probably wants you to use the A-Line)

ernest68 · Sep 1, 2004

Assuming that the transducer is in level with the heart after flushing any air bubbles in the tubing then rezeroed, plus a properly inflated pressure bag with a nice waveform...Art line sounds like a winner.

TREBORICUNURSE · Sep 1, 2004

A-line vs NIBP? If A-line is properly zeroed and the waveform is good I think result from art. line is a true BP.

imnmk_rn · Sep 1, 2004

Just agreeing with everyone else... go with the art line. As long as the waveform is decent, and properly leveled/zeroed. One of our intensivists once asked me when we were asking which BP to use (art line vs NIBP), "why are you guys so bent on checking cuff pressures when you have no reason to believe the art line is wrong?" Plus, generally cuff pressures are a little lower than art line pressures.

Elenaster · Sep 3, 2004

I agree, if the waveform is good, the line has been zeroed, it is properly dampened etc...it should be the more accurate of the two... I would think that running a bit of a lower pressure with an active head bleed would be beneficial to the patient anyway...
I agree with the info about the A-line. You are correct in keeping the lower pressure with an active (unrepaired) bleed, but with one that has been clipped, we generally like to keep much higher pressures to help prevent vasospasm. I've seen them let pressures ride all the way up to 200 systolic as long as the patient doesn't have cardiac issues. We will actually start pressors if we can't keep it greater than 140 for very high risk patients.

ajithpaul · Oct 16, 2004

i do agree wit this point as far as the arterial waveform is good and the line is patent arterial bp is more reliable than cuff bp .

Just agreeing with everyone else... go with the art line. As long as the waveform is decent, and properly leveled/zeroed. One of our intensivists once asked me when we were asking which BP to use (art line vs NIBP), "why are you guys so bent on checking cuff pressures when you have no reason to believe the art line is wrong?" Plus, generally cuff pressures are a little lower than art line pressures.

RNBEAUTY2003 · Oct 25, 2004

Hi! I had a head bleed patient and needed to keep bp 120-160 systolic. Upon arrival to unit we were using a noninvasive cuff which was giving me blood pressures within this parameter. At 3am we finally got in a radial a line but my pressure from the a line was reading 180s to 190s and my cuff was reading 150's. my patient was in aflutter so my waveform on my aline was correlating with that. I could not tell if there was a whip in the line. But now what blood pressure do I treat. If his bp is really 180's I need to crank up the nipride, but if the cuff is correct I am okay. What do you guys do. It always seems that you open a can of worms the more monitoring you add..... Thanks for your help!
Don't mean to sound ignorant- fairly new to ICU.
What is the whip in an a line? Appreciate all input.

heartICU · Oct 26, 2004

Don't mean to sound ignorant- fairly new to ICU. What is the whip in an a line? Appreciate all input.

Catheter whip is the movement of the catheter as the blood pressure changes from diastole to systole (kind of like the end of the catheter 'whipping' back and forth in the vessel). In the example of the arterial line, the presence of whip will sort of look like a scribble at the end of the waveform. It looks like an exaggerated response (overestimated systolic & underestimated diastolic), kind of like spiking at the end of the waveform. It usually signals an underdampened system. People sometimes call it artifact. Hope that helps!