BP cuff or A line

[labman]

Hey fellow NICU nurses. I have a quick question for all of you gals and guys. Whenever a patient comes back from OR with a perfectly working A-Line do follow for of the A-line or a BP cuff? We follow the BP cuff I think A line there is less room for error (of course unless wave is dampened) and get a more accurate reading. Tell me what your ICU uses for recording BPs?

[sarahrain]

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

[suanna]

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.

[MayisontheWay]

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.

[labman]

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

[registeredin06]

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.

[Christie RN2006]

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.

[IckuRN, RN]

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.

[swolfe_2]

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.

[wanderlust99]

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.

[wanderlust99]

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!

[swolfe_2]

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.