BP in pregnancy... semi-fowler or left lateral??

[JoC,RN]

In the past we were always told that accurate BP readings in pregnant women was left lateral. I've recently gone back to work after 17 years and are now being told that the left lateral gives a false low reading and should be taken in semi-fowlers. I'm having trouble finding the research to support this. What is your hospitals policy and does anyone know of any literature I could read to confirm this?

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

Back to basics! The BP cuff should be at the level of the patients heart. If the cuff is higher you'll get a false low. If the cuff is lower, you'll get a false high. Try it on a co-worker in differant positions. Of course I would never do such a thing, but trying to get a hypertensive patient out of the ER, a nurse might take the BP on the higher arm with the patient on his side. Usually drops about 15 points.

[Jolie, BSN]

Common sense seems to indicate that taking a patient's B/P in the position in which they are actually resting provides the most accurate results.

On a well patient during a pre-natal visit, take it in a sitting position.

On a hospitalized patient, take it in the position in which they are currently resting in bed and note that position in the record.

I was a frequent flier high-risk OB patient with both of my pregnancies. It drove me nuts to have a nurse come into my room and have me change positions 2 or 3 times in order to get a B/P that "looked good." How about accurately recording what is actually found?

[JoC,RN]

Makes perfect sense. Thanks!

[dthfytr, ADN, LPN, RN, EMT-B, EMT-I]

Besides position, the hearing of the person taking the BP is a factor, and those people who pump up then let the pressure down rapidly will also get a inaccurate reading. But there I go nit picking.

[klone, MSN, RN]

Besides position, the hearing of the person taking the BP is a factor, and those people who pump up then let the pressure down rapidly will also get a inaccurate reading. But there I go nit picking.

On a labor pt, it's usually done by the automatic cuff attached to the EFM machine.

[ragingmomster, BSN, MSN, RN]

In order to diagnose gestational hypertension the blood pressure must be an elevated reading two times so many minutes apart in a sitting position.

While providing care, it is better to keep a patient off her back, either left or right sidelying, to decrease pressure on the vena cava.