BP cuff or A line

A-line for major op patient, critical ill pt those who on inotrops (so that we can titrate).. if patients' BP is known to be stable, we would follow NIBP

don't know about NICU but in adult critical care the a line is the gold standard unless there is a reason to doubt it.

Unless the A-line result is suspect, we use it. I have a personal policy of verifying results with a cuff if I start trending in a bad direction.

May

Just noticed you were asking about NICU...I'm speaking strictly about adult ICU.

Sorry I forgot to write I work in a NSICU. Neuro surgical ICU sorry for the confusion.

I ALWAYS check a NIBP at the beginning of my shift or immediately when they return from OR. If it correlates to my a-line, I go with the a-line. If there is quite a discrepancy, I notify the provider and ask which do they prefer to follow. THEN DOCUMENT THEIR PREFERENCE. Also, if I have changes in BP at any time during my shift, I recheck a cuff pressure to make sure it is still correlating.

I personally verify the A-line pressure with a cuff pressure frequently because there are a lot of things that can alter your a-line reading. Most of the time the doc gives us an order to follow the cuff pressure if the A-line and cuff readings differ by more than 30mm Hg.

I've been in units that want both recordings, so I set my auto to hourly. I will go along with it until the bruising and edema starts, and by then the a line should have been D/C'd anyway.

Most units want to check for correlation every 4 hours, or every time you zero.

I always check for corelation, if the values are significantly different then I take cuff pressures on other extremities. If my a-line is different then all of these, then I trust cuff. The reason why I check different cuff pressures is because it is fairly common for pts to have left subclavian stenosis that will give you a false low SBP. You can also try a "rose" on your aline if there is a "whip" in the reading. Sometimes that will help.

I use both. If the art line & cuff correlate then I am constantly checking the art line reading. I still cycle the cuff q30-60 minutes if they are correlating.

If not correlating, or if say a 20 point difference. I cycle the cuff every 15 minutes.

I like having both readings.

I always check for corelation, if the values are significantly different then I take cuff pressures on other extremities. If my a-line is different then all of these, then I trust cuff. The reason why I check different cuff pressures is because it is fairly common for pts to have left subclavian stenosis that will give you a false low SBP. You can also try a "rose" on your aline if there is a "whip" in the reading. Sometimes that will help.

hey...what do you mean a rose on your aline and a whip in the reading? just curious!

A “whip” is when any kind of invasive line either under or overestimates the actual sbp and underestimates the dbp because there is excessive catheter movement intra-vascularly (aka whip). “Whip” is artifact that under dampens your waveform and will have a steep upstroke on your waveform and sometimes an extra waveform after you flush. It is more often observed in PA catheters but can happen on A-lines as well. A “rose” is a small circular devise that you place between pt and system that attempts to equalize pressure.

If the patient is sick enough for an Aline, then I follow that after zeroing, square wave testing, and correlation against the NiBP. If they aren't sick enough for one and BP has been stable, then I seek orders to DC it.

We see most emergent A lines in the groin, and non-emergent ones inserted brachially. Groin lines are especially susceptible to infection.