Blood Pressure Question

[CNA0681]

Some of my co-workers insist on using an arm cuff to check blood pressure at the wrist. I am sure the reading will be off as an arm cuff is not meant for the wrist.

Are there any safety concerns with this practice? Thoughts welcome on the accuracy of this method.

I checked with our Director of Staff Development and she said it was ok.

I work in a SNF.

Thanks! This forum is the best.:heartbeat

[seanpdent, ADN, BSN, MSN, APRN, NP]

The closer to the heart the measurement is taken ,the more accurate. So taking at the wrist and say the ankle are going to be 'off' compared to the brachial.

As for using the arm cuff on a wrist, sounds like their would be a sizing difference which can be an issue. If the cuff is too large you'll get a falsely low BP and too small of a cuff gives you a falsely high BP.

Good luck.

[mom2michael, MSN, RN, NP]

I actually tried this out on a patient when I first started as a tech in the ER. I took her arm pressure and then her wrist and it was almost identical but I also adjusted the cuff size accordingly.

The docs in the ER don't mind wrist pressures IF you can't get an arm pressure or you can't get a cuff big enough to go around the upper arm. But they really stress for trending purposes that however you start taking the BP you continue to take the BP that same way until D/C.

[NotReady4PrimeTime, RN]

Here are some references for you to use to back up your argument:

http://www.ncbi.nlm.nih.gov/pubmed/11939439

http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijanp/vol9n1/bp.xml

http://www.bpmonitoring.com/pt/re/bpm/abstract.00126097-200702000-00003.htm;jsessionid=LF7JhKvLLhGz0VfQM7gN5LpGnhZJJWC3s54J7n6dVhT2X8Rbwpvl!446770951!181195629!8091!-1

http://www.bmj.com/cgi/content/full/322/7285/531

There are oscillometric blood pressure monitoring devices specifically designed to measure wrist pressures and they are reasonably accurate if used correctly. They're for at-home trend monitoring, not for hospital measurements where life and death decisions may be made based on the results. The person should be seated, with both feet on the floor and their wrist at the level of their heart. They should not speak, cough, laugh or sneeze while the cuff is working because it may interpret that noise as a Korotkoff sound. And as I indicated, these monitors are strictly for trend monitoring in a home setting. I think the references I've cited above will explain why it's not a good idea to use the same cuff around a wrist as one would use around the upper arm.

[inthesky]

A tech came to me with a patient's blood pressure of 220/120 (something ridiculously scary like that). I panicked for a second and then the tech told me it was an ankle BP. He had an IV in one arm and a hemophiliac elbow bleed in another. This is a psych floor, so I called an ICU nurse who said to go ahead on the IV arm BP and it was about 135/80.