Blood pressure and PICC's

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Specializes in Med-Surg.

quick question while I'm at work. I have a patient who is a double aka amputee and right arm is totally injured with an external fixator. He has a picc in the left arm and his wife who is a nurse won't let us take a bp...at all. He's on meds that I'm very uncomfortable giving without knowing his bp. The picc is in the a/c. Can I take a bp in the wrist on the side with the PICC???

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cant help really but whats a PICC?

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Specializes in Trauma ICU, MICU/SICU.

Yes as long as your below the PICC. We have lots of multi-traumas and burns and do it all the time.

Maybe you talk ABC's with her.

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Specializes in Trauma ICU, MICU/SICU.
cant help really but whats a PICC?

Periphally Inserted Central Catheter.

It's an IV that goes in a large vessel in the arm to the the Vena Cava. Help me out guys if my description is too rough or slightly off vessel wise.

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Specializes in Nephrology, Cardiology, ER, ICU.

I've done the BP BELOW the PICC line before and haven't had any issues. Good luck.

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Specializes in Emergency & Trauma/Adult ICU.

You could also try to track down a thigh cuff.

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Specializes in Education, Acute, Med/Surg, Tele, etc.

Also I learned a little trick early on...if you can palpate a pulse in the radius...you are at LEAST 90 systolic...can't get diastolic though.

Use your other assessments as well...alert? Cap refill (for fingers they do have)? Pulse ox? Resp rate? Pulse rate? Talking? Moving? Headache? Dizziness? Skin color (red/pink/flushed/bluish)? and so on. AND continue these assessments after the med is given to make sure all is well. All these have to do with BP :) so use those as well...

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Specializes in ER/Trauma.
You could also try to track down a thigh cuff.
I was going to ask the same thing - why not take on on the thigh :)

Atleast with young kids it's somewhat easier - don't really need an adult thigh cuff.

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Specializes in Med-Surg.
You could also try to track down a thigh cuff.

His AKA's are very high up and he is very obese.

I appreciate the input from everyone. I wound up taking his BP below the PICC and the wife agreed. There was no documentation of a BP for three days. We're giving his albumin, lasix and other meds.

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Specializes in Emergency & Trauma/Adult ICU.
There was no documentation of a BP for three days. We're giving his albumin, lasix and other meds.

Yikes Tweety, sounds like a tough situation. I'm sure you appropriately documented the heck out of this one, and/or took it up the line to your manager ... giving meds affecting volume without knowing the BP. Just curious, did the pt.'s MD not question why there was no BP documented for 3 days?

As for the pt.'s wife ... knowing enough to know that a PICC calls for some reasonable precautions so as not to blow the line, but thinking that the correct approach was to simply not check BP ... not gonna go there.

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Specializes in Med-Surg.
Yikes Tweety, sounds like a tough situation. I'm sure you appropriately documented the heck out of this one, and/or took it up the line to your manager ... giving meds affecting volume without knowing the BP. Just curious, did the pt.'s MD not question why there was no BP documented for 3 days?

As for the pt.'s wife ... knowing enough to know that a PICC calls for some reasonable precautions so as not to blow the line, but thinking that the correct approach was to simply not check BP ... not gonna go there.

When I approached the MD, I asked if she knew and she said yes the wife was refusing, I told her I wasn't comfortable with that, and the doc said "I definately am not either and I will talk to her." I'd better not say too much more in case she or someone else I work with reads this. :lol2:

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Refusing a BP is scary. Have you thought about having an AMA form signed?

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