BPs on an infant

[A&OxNone]

I've been wondering about a situation that happened the other day, so I just wanted some feedback. Be gentle, I'm new to almost anything pediatrics! Just started in a pediatric floor this week! (I've been in a mostly adult ER for most of my career, so we don't see many peds bc we don't have a peds unit.)

Long story short, 2 week old with pyloric stenosis, scheduled for surgery later in the day. Had been NPO all day, however he hadnt been really eating for a few days due to the condition. He had a wet diaper at 0800, but when I checked him at 1230, he was bone dry. Got vitals, and the first time the BP looked low, so I rechecked it, and the second reading was high. This is with the automated cuff.

So, I know in the ER and with adults, at that point I would just get a good old fashioned manual reading so I could trust it. But how/where would u do that on an infant? Same way, just a smaller cuff? Can u actually hear anything with those tiny arteries?

Preceptor ended up calling the doc and baby got a bolus anyways, so the BP wasn't really an issue, but for the future, what do I do to know its accurate?

[albsRN]

I've been wondering about a situation that happened the other day, so I just wanted some feedback. Be gentle, I'm new to almost anything pediatrics! Just started in a pediatric floor this week! (I've been in a mostly adult ER for most of my career, so we don't see many peds bc we don't have a peds unit.)

Long story short, 2 week old with pyloric stenosis, scheduled for surgery later in the day. Had been NPO all day, however he hadnt been really eating for a few days due to the condition. He had a wet diaper at 0800, but when I checked him at 1230, he was bone dry. Got vitals, and the first time the BP looked low, so I rechecked it, and the second reading was high. This is with the automated cuff.

So, I know in the ER and with adults, at that point I would just get a good old fashioned manual reading so I could trust it. But how/where would u do that on an infant? Same way, just a smaller cuff? Can u actually hear anything with those tiny arteries?

Preceptor ended up calling the doc and baby got a bolus anyways, so the BP wasn't really an issue, but for the future, what do I do to know its accurate?

Hi! I work in pediatric cardiology and it is possible to get an infants blood pressure manually. The first step is to make sure you have the right size cuff. Also, the stethoscope I use is shaped in a way that I've found fits underneath the cuff a bit. I always palpate for the brachial pulse first so I can put my stethoscope right over it. If you find you can't hear it at all, you can do a palpated blood pressure: Feel for the brachial pulse, pump up the cuff until it goes away, release, and feel for when the pulse returns. You will only get the systolic pressure but it's very accurate! If you can't even feel the pulse, this is when a doppler is needed. I always go for the doppler last because it requires two people (one to hold the doppler in place and one to pump the cuff).

And of course, all this can be challenging with a fussy baby! With a little practice you'll be able to get them on almost any baby. :)