Blood pressure question

[crawlyberry]

Hi...Can someone tell me the correct way to take bp on these patients?

1) The patient has had a left masectomy and has a picc line in her right arm. If you were to use a manual cuff and place it on her right forearm, where do you place the stethoscope? Would it be at the brachial artery or do you put it on the radial artery?

2) Bp taking on the leg. If cuff is on the thigh, does the stethoscope go by the popliteal artery?

3) If the cuff is placed on the calf, where does the stethoscope go?

We have been using the electronic machines, but I would like to be sure of these placements for manual cuffs. Never had these situations pop up in clinical, but would like to know. Thanks.

[Daytonite, BSN, RN]

1) the patient has had a left mastectomy and has a picc line in her right arm. if you were to use a manual cuff and place it on her right forearm, where do you place the stethoscope? would it be at the brachial artery or do you put it on the radial artery?

on the inner side of the forearm at the wrist over where you would place your fingers to palpate for the radial pulse.

2) bp taking on the leg. if cuff is on the thigh, does the stethoscope go by the popliteal artery?

yes.

3) if the cuff is placed on the calf, where does the stethoscope go?

there are only two major arteries in the foot: the dorsalis pedis which is on the top of the foot and the posterior tibial which lies on the medial side above the ankle. i'd try for the posterial tibial, i think, because it lies near the fibula. if its too deep and you can't hear it, then try for the dorsalis pedis which is closer to the skin.

[mlblmt]

I'm confused about the first scenario. Wouldn't the the left mastectomy and right picc line exclude either arm or forearm being used for bp?

[Daytonite, BSN, RN]

Not necessarily.

[locolorenzo22, BSN, RN]

no, if the PICC is in the right, that means that you could use the BP below the antecube where it is inserted....I generally use the legs...just because of ease.

[queen_mimi]

You can use the arm where the picc line is inserted... as long as it is below where it is inserted and you dont do frequent blood pressures. Had a patient that had two shattered legs, one shattered arm... and a picc line in the other... IV therapy informed us that it was ok to use the picc line arm, but to make sure it was below the point of insertion.

[crawlyberry]

Thanks for the input...I appreciate it!:wink2:

[stephmj]

Now I have a hard time trying to listen to the popliteal and foot pulses. Is it easier to use the bell or diaphragm? How hard do you push down?

[murphyle, BSN, RN]

Popliteal, use the diaphragm. Pedal, use the bell. (You won't be able to get a good acoustic coupling with the diaphragm unless your patient has size 14 feet.) Use light to moderate pressure - enough so you're hearing clearly, but no so much that you occlude the vessel.

Hope this helps!