CHF and weights

[psugarland]

As a Home Health nurse, we have many patients who have CHF. And many of those are so edematous in their lower extremities that they will not or find it very difficult to stand on a scale. Does anyone know of some other ways to monitor fluid changes. My DON suggested measuring their calves...thank you in advance

Psugarland in Texas

[KBICU]

Urine output/fluid intake? BNP levels? Could there be any other ways to get accurate weights other than a standing scale?

[amoLucia]

In a home situation, I & O may be difficult to manage for pts who have ambulation/balance problems assoc with lower limb edema. And my guess there is there may be weight issues too. These pts have a wide stance when walking & standing and they probably need balance & support when doing so. I speak from experience when I say that you need an accommodating scale that has a wide base to step up on while having steadying support.

They DO sell floor scales with a wide base to step up on and the step-up is usually low enough for pts to manage. The scale needs to be on a flat floor with something VERY sturdy/stable to grab on to. My own personal wide scale is on my bathroom's linoleum floor right in from of my sink vanity. (You could do this in a kitchen in front of a counter-top.) I can step up easily enough but I hold on to the counter until I feel steady. Then I can just let go of the counter, but I'm only fingertips away from regrabbing it for support. I FEEL SAFE, and I'll bet that's the issue with your pts. The scale weighs me, steadily with good support.

You can improvise with a walker or 2 canes, as nec. Last week, I HAD TO use the scale in my MD's office, altho I had just weighed myself that morning. With the exam table right there and with my cane, I was able to step-up on the scale (altho it was a bit narrower than it could have been).

You just may need to drag along a wide-base scale in a protective diaper-bag that your agency bought for these kinds of situations.

----just from my personal perspective.

[paradiseboundRN]

You can measure calves/ankles/feet as long as the nurses all agree on how to measure. For example, if you are going to measure calves, how many centimeters from the knee or the foot? If you can agree on it, then all the nurses can compare measurements and monitor the edema correctly. CMS (Medicare) likes to see measurements for edema.

[Isabelle49]

If you can believe this, and I am almost embarrassed to type it, if a CHF patient is unable to stand on a scale we must measure upper arm circumference. For a patient who sits most of the day, I would think that by the time arm circumference increased they would already by drowning in fluids. I have discussed this with managers to no avail whatsoever. I am in favor of calf measurements for those who are out of bed. I even called the board of nursing to discuss this, because I felt competence could be an issue if we were measuring upper arm circumference, since gravity would definitely have an effect on the lower legs. The board of nursing missed the point completely and said we should just go ahead and measure upper arm circumference, since it couldn't hurt anyway. Now on a bedbound patient upper arm circumference may make sense, but normally I check for sacral/scapular edema. Unfortunately I am in Louisiana and the city I currently work in seems to be lacking smarts!