forearm bp

[megster]

This is a silly question, but I'm a new nurse. I know it's important to use the right size cuff, but if you have an obese patient, is it okay to take their bp on their forearm? Is it accurate? I can't say that I've had to take one there before. Do you just put the scope right below the cuff as usual?

[deeDawntee, RN]

Yes, we do it all the time. If there is a way you can correlate the reading with an upper arm blood pressure, that would be good. Sometimes we even do ankle pressures. You do what you gotta do!!

(I wouldn't recommend around the neck!! hehehe just kidding!!:lol2:)

[MrsMommaRN]

working on a joint replacement floor we have a lot of patients that have gone through the bariatric sx and are in the process of losing wt so we often need to do bp on the forearm. (why not just have the larger cuff available i say). this is my suggestion. put the cuff below the bend in the arm, palpate the bracial pulse and place your stethoscope there. you should be able to hear and get an accurate reading. good luck.

[rn/writer, RN]

working on a joint replacement floor we have a lot of patients that have gone through the bariatric sx and are in the process of losing wt so we often need to do bp on the forearm. (why not just have the larger cuff available i say). this is my suggestion. put the cuff below the bend in the arm, palpate the bracial pulse and place your stethoscope there. you should be able to hear and get an accurate reading. good luck.

this is a good suggestion, however, there are many larger patients with whom we still have a problem. if the upper arm is comparatively short, it can be kind of cone shaped. that means the cuff fits fine at the top but it bunches at the bottom and the fit is anything but secure. i much prefer to use the more uniformly-shaped forearm in these cases.

on very slender patients, if we don't have a small cuff available, i will use a regular one on the thigh. doesn't happen often but it does work. the most important consideration appears to be the proportion of the cuff to the site. it should wrap around approximately one and half times wherever it is placed.

[TazziRN, RN]

Palp the brachial pulse with the cuff below the bed? Do you mean wrap the cuff around the elbow with the lower edge below the bend? Otherwise, with a FA pressure the radial pulse is used.

I do FA pressures all the time, both in ER and HH. Even the larger cuffs aren't a good choice for short people or the morbidly obese.

[Hoozdo, ADN]

I have had to do them on the thigh and the calf. If I am titrating any drips to BP I will insist getting an Aline in them. Sometimes getting an Aline in is impossible.........in that case I will go with whatever BP seems plausible anwyhere I can get one.

[MrsMommaRN]

to clarify wrap the cuff below the bend in the arm palpate radial pulse place stethoscope at pulse site and take reading.

sorry if it sounded confusing

[sharann, BSN, RN]

We use the forearm alor lately. The lower leg we use often in patients with AV grafts, PICC lines, post mastectomies and unusually shaped upper arms(obese). We use the lower leg for babies and toddlers as well because they tend to move the arms more vigorously than the legs(until they figure out what we are up to!)