BP Cuff Readings vs. Arterial BP

[Zee_RN]

Disagreement at work yesterday. Which do you use:

Left radial artery SBP reading: 70 (I don't remember diastolic)

Right brachial non-invasive cuff SBP reading: 109

Which one do YOU use to base therapy on? This was repeated several times, using the cuff on both arms, and the same range of differences was obtained (~30 mmHg each time).

Pt. was on neo at 200 and dopamine at 20. 82-year-old female, s/p cardiac arrest. Sinus tachycardia on monitor, heart rate ~110. Blood pressure cuff used was the appropriate size for the patient's arm.

[Morguein]

At my facility, if its working properly, we treat the A-Line BPs over the cuff BPs.

[Gompers, BSN, RN]

Don't know if this matters much...

But in neonatal we basically take the higher pressure of the two when deciding treatment, because if given a choice, we'd rather have a low BP than a sky high one. We do a cuff pressure at least once a shift to see how it correlates with the arterial line reading. It's rare that I've seen the arterial line to be reading significantly higher than the cuff, usually less than 10 difference even with a spectacular line. I have seen lines that are starting to go bad and in those cases, the cuff BP is higher so we go by that. You can never know exactly how well your arterial line is working - in my experience, sometimes you can still get great blood return and peaked wave forms on the monitor, but the line isn't as "strong" as it was the day it was inserted. It's like it slowly goes bad over time.

I do agree that if you are having major discrepencies, or any question at all about the pressure, a good old fashioned manual BP is the way to go. I know that hearing it with my own ears gives me the most confidence in my reading and therefore in my treatment.

[rkealy, BSN]

Not to dig up an old discussion...but I also have wondered....just tonight we had (as I find in many of our vascular patients carotids, fempops etc) a AAA Stent that had a 180 SBP ABP and 140 SBP NIBP. MAP 84 and 72 respectivley. My experience is that especially in the patients that have alot of Plaque (stiff cruchy stuff) this tends to be the case. My theory (although unfounded and unproven :) ) is that thier arteries have lost alot of thier stretch in places depending on where the artline is placed especially in the distal peripheries. No doctors have ever given me a reason why, and most say treat for the average of the two between ABP and NIBP. Some don't care for the NIBP as it measures through "resistance" I.E. tissue etc. but that is the pressure that they will be treating when on meds at home right? So..the muddy waters continue to be stirred :)

[MegNeoNurse]

Art line. It should be a WORKING art line if you have a pt on pressors. I am glad to work in a teaching hospital with residents available (although not always helpful) 24/7 if the attending is not in house. I'm pretty sure any attending who was accepting this patient as an admission would get their butt on up to the unit to see them sooner than later.

And, norepi + dobutamine please :)

[sockov, ADN, ASN, BSN, CNA, LVN]

I'd go by cuff. There could be a small fibrinous clot at the end of the tip of the A-line catheter. Pts. baseline B/P is taking with a cuff pre-op. When the pt. gets out of the ICU to the floor, or going to the doctors office, they will be using a cuff. So, I'd go by the cuff!

[Sockeye]

I go by artline. Giving the artline a couple of aggressive flushes using 2-5 cc syringe would take care of a possible fibrin clot.

The last thing that you want is picking/choosing the pressure that you like most. You want to go by non invasive and you have a reason for it - fine; but then stick to it until you resolve your lines or health crisis.

[sockov, ADN, ASN, BSN, CNA, LVN]

Most institutions have policies NOT to flush an invasive line.

[Sockeye]

Really? Why not? Not the last three I worked in. Flushin CVLs has always been part of the capping policies. And for artlines, Edwards Lifesience makes a product called Vamp. Precisely for reflashing the sample discard back into the vessel. The Vamp or similar products are in use all around the world. So again, why not to flush the lines?

[umcRN, BSN, RN]

Most institutions have policies NOT to flush an invasive line.

we flush our arts, RA's, LA's. CVL's, UVC/UAC's whatever you got. How else are you supposed to know it's patent? Even our intra-cardiac lines we have a policy to draw back every morning to make sure we get blood return to be sure it's in good position. The only central lines we don't draw off of are those on our tiny kids (I work peds) where the french size is too small for blood draws. Other wise we check it. And if we ever have a waveform issue the first thing the doc will ask us is if we flushed it/got blood return

[KBICU]

Id look at the art line wave form, if it looked like a good wave i would try flushing the line. Many times I would have an art line that was slightly dislodged or had a whip and it made the ABP off by alot. In those scenarios where the cuff pressure was still okay id go with the cuff. Also look at the pt - does the pt look like their SBP is in the toilet? How do they feel? Good question

[sockov, ADN, ASN, BSN, CNA, LVN]

I meant, "manual" flush like with a syringe. Sometimes you have to flush gently with a 3cc to get it unstuck from the vessel wall. Sorry for confusion.

[Sockeye]

Sometimes you have to flush rather aggressively (or vigorously, as they like to call it in formal policies). There is no harm in that.