to cuff or not to cuff

Hmm

Well, CRNAs do not need an order to decide the course or tx or how to get there.

As for the question, well... simply put there isnt one. Research has clearly shown that cuff pressures can be off upward of 20 points actual BP. ABPs are the only true measurement of BP. Tx should always be guided by the ABP and, in fact, there is no need for a cuff when one us present.

alright mmac.. obviously u have no clue.. and i guess this is gonna get ugly.. read ur literature. aside from what is the more accurate or "preferred" .. sometimes u just don't have the choice.. and to tell me what is right or not? u can't tell me that u will use the abp when it is dampened or positional or clotting or whatever.. there are times when u just don't have a choice.. and i was merely telling people to just make sure to have an order if u have both and there's a difference.. i guess it is what it is... until next...

DFK.......

If you have an art line that is "not working", clotting, damping, etc....... don't use it and go with the cuff. It' s not that hard of a decision. Just document that it is flawed. If you have been educated properly on monitoring BP with an art line then you know how to test for over/underdampening, proper waveform, zeroing, at what level to place it, etc. If you recognize a good waveform and all of the above checks out then you HAVE to go with the Art line pressure whether you like what it is reading or not. There is no better measure of blood pressure than art line. Just make sure you don't get caught up with the folks who just decide their art line sucks for no other reason than it is different from the cuff and they like the cuff reading better. If you can prove that the art line is off and you can't fix it then there is no problem as long as you document

Uh huh

Would you like me to post journal articles?

Oh i might as well since you are such an arrogant fool. Ill just go ahead and add those below for you. BTW, i dont just read journals, i publish in them. SO dont partonize me with "read your research".

Lets recap shall we?

- You post started with "getting an order" which isnt relevant in the CRNA forum (which your posting in).

- It is assumed that anyone who is a SRNA/CRNA (again u posting in the CRNA forum) will be able to recognize the difference between depressed waveforms and clots.

- Ive taken care of more art lines than you have seen in your whole career. Dont insult me with BS like "u can't tell me that u will use the abp when it is dampened or positional or clotting or whatever". Thats IRREVEVANT. You post asks which one would be what you treat from. All things being equal the ABP IS THE GOLD STANDARD. NOT a sphygmomanometer.

When taking care of sick patients, I rely on MAPs second only to ABPs. Attitude check there fella, you have no idea the level of expertise of those you randomly call "clueless".

References

T. Nicholls and W.C. Shoemaker. (1998). Recent advances in hemodynamic monitoring and management of the emergency critically ill patient Curr Opinion Crit Care 4: 168-176.

Clark JA, Lieh-Lai MW, Sarnaik A, Mattoo TK.

Discrepancies between direct and indirect blood pressure measurements using various recommendations for arm cuff selection.

Pediatrics. 2002 Nov;110(5):920-3.

Vardan S, Mookherjee S, Warner R, Smulyan H.

Systolic hypertension. Direct and indirect BP measurements.

Arch Intern Med. 1983 May;143(5):935-8.

Ochiai H, Miyazaki N, Miyata T, Mitake A, Tochikubo O, Ishii M.

Assessment of the accuracy of indirect blood pressure measurements.

Jpn Heart J. 1997 May;38(3):393-407.

Bridges EJ, Bond EF, Ahrens T, Daly E, Woods SL Direct arterial vs oscillometric monitoring of blood pressure: stop comparing and pick one. Crit Care Nurse. December 1997:17:96-97, 101-102.

Hoover L. Comparison of blood pressure readings between cuff pressures and radial arterial catheters with changes in transducer level and patient position [abstract]. Am J Crit Care. 2000:9:220-221.

Bridges EJ, Middleton R. Direct arterial vs oscillometric monitoring of blood pressure: stop comparing and pick one (a decision-making algorithm). Crit Care Nurse. June 1997:17:58-68, 68-72.

Topol E, ed. Textbook of Cardiovascular Medicine. Philadelphia, Pa: Lippincott-Raven Publishers; 1998.

Venus B, Mathru M, Smith BA, Pham CG. Direct versus indirect blood pressure measurements in critically ill patients. Heart Lung. 1985:14:228-231.

Loubser PG. Comparison of intra-arterial and automated oscillometric blood pressure measurement methods in postoperative hypertensive patients. Med Instrum. 1986:20:255-259.

Gardner RM. Direct blood pressure measurement: dynamic response requirements. Anesthesiology. 1981:54:227-236.

Gibbs N, Gardner RM. Dynamics of invasive pressure monitoring systems: clinical and laboratory evaluation. Heart Lung. 1988:17:43-51.

McGhee BH, Woods SL Critical care nurses' knowledge of arterial pressure monitoring. Am J Crit Care. 2001;10:43-51.

alright mmac.. obviously u have no clue.. and i guess this is gonna get ugly.. read ur literature. aside from what is the more accurate or "preferred" .. sometimes u just don't have the choice.. and to tell me what is right or not? u can't tell me that u will use the abp when it is dampened or positional or clotting or whatever.. there are times when u just don't have a choice.. and i was merely telling people to just make sure to have an order if u have both and there's a difference.. i guess it is what it is... until next...

alright mmac.. obviously u have no clue.. and i guess this is gonna get ugly.. read ur literature. aside from what is the more accurate or "preferred" .. sometimes u just don't have the choice.. and to tell me what is right or not? u can't tell me that u will use the abp when it is dampened or positional or clotting or whatever.. there are times when u just don't have a choice.. and i was merely telling people to just make sure to have an order if u have both and there's a difference.. i guess it is what it is... until next...

A lot of times in the ICU, the SBP or DBP isnt as important as the MAP, and even though the actual systolic and diastolic numbers are off, the MAPs consistently correlate between NIBP and ABP (even a dampened one, I've noticed that to a point, when ABP lines become dampened the SBP and DBP converge on the MAP). So if you have an a-line that says 90/40 and a NIBP that says 100/35, it doesnt matter which one you "go with" your actions should be the same.

Uh huh

Would you like me to post journal articles?

Oh i might as well since you are such an arrogant fool. Ill just go ahead and add those below for you. BTW, i dont just read journals, i publish in them. SO dont partonize me with "read your research".

Lets recap shall we?

- You post started with "getting an order" which isnt relevant in the CRNA forum (which your posting in).

- It is assumed that anyone who is a SRNA/CRNA (again u posting in the CRNA forum) will be able to recognize the difference between depressed waveforms and clots.

- Ive taken care of more art lines than you have seen in your whole career. Dont insult me with BS like "u can't tell me that u will use the abp when it is dampened or positional or clotting or whatever". Thats IRREVEVANT. You post asks which one would be what you treat from. All things being equal the ABP IS THE GOLD STANDARD. NOT a sphygmomanometer.

When taking care of sick patients, the brachial artery pressure is of little interest to me in comparison to the aortic pressure. Attitude check there fella, you have no idea the level of expertise of those you randomly call "clueless".

References

T. Nicholls and W.C. Shoemaker. (1998). Recent advances in hemodynamic monitoring and management of the emergency critically ill patient Curr Opinion Crit Care 4: 168-176.

Clark JA, Lieh-Lai MW, Sarnaik A, Mattoo TK.

Discrepancies between direct and indirect blood pressure measurements using various recommendations for arm cuff selection.

Pediatrics. 2002 Nov;110(5):920-3.

Vardan S, Mookherjee S, Warner R, Smulyan H.

Systolic hypertension. Direct and indirect BP measurements.

Arch Intern Med. 1983 May;143(5):935-8.

Ochiai H, Miyazaki N, Miyata T, Mitake A, Tochikubo O, Ishii M.

Assessment of the accuracy of indirect blood pressure measurements.

Jpn Heart J. 1997 May;38(3):393-407.

Bridges EJ, Bond EF, Ahrens T, Daly E, Woods SL Direct arterial vs oscillometric monitoring of blood pressure: stop comparing and pick one. Crit Care Nurse. December 1997:17:96-97, 101-102.

Hoover L. Comparison of blood pressure readings between cuff pressures and radial arterial catheters with changes in transducer level and patient position [abstract]. Am J Crit Care. 2000:9:220-221.

Bridges EJ, Middleton R. Direct arterial vs oscillometric monitoring of blood pressure: stop comparing and pick one (a decision-making algorithm). Crit Care Nurse. June 1997:17:58-68, 68-72.

Topol E, ed. Textbook of Cardiovascular Medicine. Philadelphia, Pa: Lippincott-Raven Publishers; 1998.

Venus B, Mathru M, Smith BA, Pham CG. Direct versus indirect blood pressure measurements in critically ill patients. Heart Lung. 1985:14:228-231.

Loubser PG. Comparison of intra-arterial and automated oscillometric blood pressure measurement methods in postoperative hypertensive patients. Med Instrum. 1986:20:255-259.

Gardner RM. Direct blood pressure measurement: dynamic response requirements. Anesthesiology. 1981:54:227-236.

Gibbs N, Gardner RM. Dynamics of invasive pressure monitoring systems: clinical and laboratory evaluation. Heart Lung. 1988:17:43-51.

McGhee BH, Woods SL Critical care nurses' knowledge of arterial pressure monitoring. Am J Crit Care. 2001;10:43-51.

mike,

correct u are.. i made a mistake in posting this into this thread.. i was caught up with the micu/sicu thread..

sorry to all ..

i was merely telling people to just cover their asses when it comes to charting and the like, assuming good abp waveform and a good amount of point differential...

no problem

We all make mistakes and with the numbers of forums on this board (tuns) it sure is easy to click the wrong one.

Have a good one!

mike,

correct u are.. i made a mistake in posting this into this thread.. i was caught up with the micu/sicu thread..

sorry to all ..

i was merely telling people to just cover their asses when it comes to charting and the like, assuming good abp waveform and a good amount of point differential...

Everyone makes mistakes, Cant we all just get along. So MMAC Yoiu have h=been published as a SRNA. Where?? i am interested in trying to publish.

Brian

Hey Brian :)

Not as an SRNA :)

I have been published as a flight RN on 3 occasions now (all peer reviewed) with 2 more in editors hands.

One on Permissive Hypotension in blunt and penetrating trauma

One on Brugada Syndrome

One on Men in Nursing

In editors hands now

-Tricks of the Trade, Intubation techniques and bag techniques in the difficult airway

- The Brain Book (a hand held air medical crew resource guide for my program)

- Air medical Crew and pilot communications (title not solidified yet)

It is alot of work but VERY cool. The best thing to do is decide on a topic you find interesting. Then you have to pick the type of journal you want to publish in an review what they seem to like.

From there its all about writing, rewriting and sending it in only to have it send back for further rewriting!

If i can help let me know