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.

[nyrn5125]

A difference in the aline sbp 70 to cuff of 109 would lead me to believe she had subclavian stenosis. The aline measures pressure and the cuff measures flow. So the flow isn't there because of the stenosis. Our vascluar surgeons have us follow the aline. When once questioning a surgeon about the accuracy of aline vs cuff he said "I put a catheter in the aorta myself and I know it's correct". On a few occasions the doc has given orders when someone had bad stenosis to take the reading and add 50 to the SBP.

[MommyandRN]

I have been in that situation. What I do is, I make sure the A-line is at the phlebostatic axis, I flush the line, move the wrise around to see if it is positional. Sometimes you need to roll up a washcloth and tape an armboard to keep it in a position to get a good reading. If all of those are done and they are still not the same, then I document BOTH. I let the physician know that they are measuring far apart. Let them decide. Usually, the doc says to go with whichever is highest. But still document both, because if you are measuring something on the patient and getting these readings, it should be documented. Protect yourself by stating that the BP cuff and a-line readings are 30mm apart and that the MD is aware.