The American Association of Critical Care Nurses (AACN) has recently published a new guideline regarding the importance of obtaining accurate non-invasive blood pressure (NIBP) readings and problems that can ensue. How to obtain accurate NIBP readings: 1. Measure BP in the upper arm (between the shoulder and the elbow) using the oscillatory or auscultatory method. 2. Use appropriate-size BP cuff and follow instructions for fit and placement per manufacturer's guidelines. a. If upper arms cannot be used for BP measurement or if the maximum size BP cuff does not fit the upper arm, BP may be measured in the forearm. b. Consider use of thigh and calf for BP measurement if the upper arms and forearms cannot be used. 3. Measure baseline BP in both upper arms. For clinically significant differences in BP (>10 mm Hg), use the arm with the higher pressure. 4. Positioning of patient: The appropriate reference level for NIBP measurement is the heart. a. Patient should be seated with back and arms supported, feet on floor, and legs uncrossed with upper arm at heart level (phlebostatic axis: 4th intercostal space, halfway between the anterior and posterior diameter of the chest. b. If patient cannot be seated, position patient supine or with head of bed at a comfortable level and with upper arm supported at heart level. 5. The patient and the caregiver should not speak while BP is being measured. 6. Minimize complications by using the maximum (least frequent) NIBP cycle time for the shortest time period and by ensuring proper cuff placement. Patient conditions that affect NIBP readings: Stiffness of the arteries, particularly in older patients can nfluence amplitude of the oscillations and may cause underestimation of mean arterial pressure. Accuracy of the automated device may also be limited if patients are hypertensive, hypotensive, and/or have cardiac dysrhythmia. Some precautions: Do not place BP cuff over a bony prominence Do not allow BP cuff to over-inflate - set the parameters of the BP cuff machine no higher than 200mm hg unless patient with known BP higher than this. Set the BP machine interval to what is required by patient condition. If patient is stable, do they need a BP reading every 15 minutes or is every 30 minutes adequate. Remove the BP cuff when not needed for serial readings. Do not take BPs in the arm of a patient with a dialysis access or in the affected arm of a mastectomy patient. Correlate the BP to the patient... If you get a measurement of 60/30 and the patient is awake, alert and talking to you and the last BP was 130/80, consider repositioning the BP cuff and obtaining another reading. For patients with known high BP, a reading of 220/110 is still cause for concern - again always assess your patient. Complications of NIBP... Skin irritation and possible skin breakdown due to frequent NIBP cuff inflation Artificially inflated BP readings if cuff inflates, deflates and reinflates repeatedly Patient discomfort if cuff inflates too high Importance of accurate readings... Hypertension is one of the leading causes of heart disease in the US. The American Heart Association recommends home blood pressure monitoring for patients with known hypertension. It is equally important that the nurse know how to teach patients to do home BP monitoring. Remind patients to take their BP at approximately the same time each day and take all their meds as prescribed. Also, keep a log of BPs and bring it with them to their next appointment. Maintaining accurate BP readings allows providers to have knowledge that will guide them to prescribe the correct medications in order to control your patient's blood pressure. Maintaining good BP control decreases the risk of end-organ damage caused by hypertension and increases the likelihood of excellent BP control. References: AACN Practice Alert, 2016 American Heart Association, Home Blood Pressure Monitoring, 2015