Measuring blood pressure

Nurses General Nursing

Published

I had something very bizarre happen today at a clinic but I wanted to check with others on AN in case I might be incorrect on this.

A CNA checked my blood pressure. I was wearing a long-sleeved shirt that was a bit tight in the sleeves so I could not easily roll up my sleeves. The CNA said not to bother trying to roll up my sleeves and, instead, she took my BP on the LOWER part of my arm. The reading was way off and she used one of those d*mned automatic cuffs so it inflated very high and actually HURT when she was doing it.

WTH? I've been an RN (first ADN, then BSN) for nearly thirty years. I've done blood pressure checks as a parish nurse. I've been a clinical instructor and taught skills lab. Never, ever, EVER have I seen or taught ANYONE that it's appropriate to check BP on the forearm. Always, always, ALWAYS have used the upper arm and cannot imagine why this CNA would have done this---unless she either had no idea what the heck she was doing or if there's been some changes in acceptable practice of checking BP of which I am unaware.

Is there a new procedure of which I am unaware? A new way that is acceptable for people to check BP? I am thinking not, that this CNA clearly has no clue of what she is doing, but I wanted to check with the folks here on AN to make sure. I am very polite to people and don't believe in going off on a stranger---so I generally don't say anything about mediocre or poor customer service unless there is REALLY a problem. I was also taken aback that I was actually speechless! I mean, yes I would have said something to a student or an orientee who made a similar mistake but I didn't feel like trying to correct this total stranger. I also don't believe in being a PITA patient and telling everyone that I'm an RN, yadda yadda, so as to intimidate someone or make them feel nervous around me.

Good grief---and to make it worse, she asked me how my drive was and when I told her that I got stuck behind some farmers doing harvest, she prattled on and ON about having been in an auto accident with a tractor years ago. Yeah, that story was enough to make my pressure go up, too. Of course her story got me upset. Duh!

So---unless there is something that I don't know and this CNA was doing it right, I am going to call tomorrow to speak with her nursing supervisor. Oh, and she had the guts to say that maybe she should check it again before I left. NO THANK YOU!

Dang---my arm is still a little sore. She really hurt me. :angryfire

Input welcome. Thanks!

Specializes in OB, ER.

I do this fairly often. Usually on obese pts especially the ones with short upper arms. At triage I do it for patients with huge sweaters or whatever because they can't get undressed or roll high enough. In the back I do it for patients with trauma, iv sites in the way, ect. There are several reasons to do it and it works wonderfully! Don't tattle she did nothing wrong!

Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
Wrist/forearm cuffs are very popular in home health and certain other settings. I used one when I worked at a jail, too, for my own safety. I take my own BP at least 2 times/day with a wrist cuff, best readings are when the cuff is near the level of the heart. The key here is consistency.

Agree with consistency....

but...

I take a cuff pressure wherever I can.. and adjust...

There are soooooo many variables that can affect it...the shirt roll..and yes the lower arm..

the size of the arm.

the size of the cuff

the way the bp cuff is placed

whether the patient as pvd

whether the patient is diabetic

whether the patient has an undiagnosed aortic aneurysm

whether the patient is clamped down

whether the patient has no lymph nodes

whether the patient has a dialyses access

so many factors.

the most accurate?

An arterial line with an excellent dicrotic notch with no overshoot.

I'm not sure you want that to happen in that setting.......

Specializes in Occupational health, Corrections, PACU.

Yes, especially automatic cuffs because they have microphones and are sensitive enough to take good pressures on forearms or legs, and often through clothing, if it is not too thick. We often have to do it in recovery room. The upper part of the arm may not be available due to dressings, etc., as other have mentioned. I believe the automated cuffs IF calibrated correctly, are probably superior to manual checks, since there is great variance in what different nurses can hear. I've taken manual pressures before when I had a doubt about the accuracy of another nurse's reading, and found their readings to sometimes be FAR off of mine. And 3-4 points variance in a BP in a forearm is not going to dramatically change your treatment strategy.

Specializes in Gerontology, nursing education.

Thank you all for your responses. I am glad I held my tongue because I didn't want to be a jerk. I also know that I certainly don't know everything about nursing and it's better to ask a question, even if one feels foolish, than make an assumption.

However, I still think she did something wrong. There was no real indication for her to do it on the forearm. I could stand to lose a few pounds but a large size cuff would have fit around my upper arm, even with the shirt I was wearing. She used a regular-sized cuff but she had a large size cuff in her hand. I think when she got an abnormal reading and I told her it was abnormally high, she should have checked it again but used the larger cuff on the upper arm. I will never let anyone do this to me again unless there is a pretty good medical reason.

This was not my PCP but a specialist that I probably will not need to see again for a long time so I am not going to say anything.

Learn something every day! Again, thank you!

Specializes in Medical ICU.

Ditto Chaya

I work in a setting where it may be contraindicated to take a pressure in the upper arm. Such patient may have arms too large for the thigh cuff, or have PICC lines in both arms, or have fistulas in both arms. Usually I will have an art line and I will take a manual pressure once a shift to make sure the pressures correlate. The most ideal position for a cuff is at heart level. Though, I have taken pressures on a patients' arm, wrist, and thigh and all have the same numbers. I have noticed that if a pressure is taken over clothing it will rarely be accurate. Always use the upper arm if indicated!

Specializes in Acute Care Cardiac, Education, Prof Practice.

I had a patient s/p chest debridement making the BP on her upper arm extremely painful as well as previous left sided mastectomy so I did do her BP on the R forearm. I made sure I used an appropriate cuff, which happened to be the large child size, and positioned it carefully on the meatiest part of the forearm. Consistent use, as someone stated earlier, can yield consistent results.

I think the issue here isn't where the tech did the BP but that the techniques are often sloppy and thus inaccurate. I once had a tech fly at me telling me my patient's BP was 62/55 (not the previous patient but a different one). When I saw the positioning of the cuff was almost to her wrist, I repositioned it, rechecked and got 110/65.

Tait

Specializes in Gerontology, nursing education.
I had a patient s/p chest debridement making the BP on her upper arm extremely painful as well as previous left sided mastectomy so I did do her BP on the R forearm. I made sure I used an appropriate cuff, which happened to be the large child size, and positioned it carefully on the meatiest part of the forearm. Consistent use, as someone stated earlier, can yield consistent results.

I think the issue here isn't where the tech did the BP but that the techniques are often sloppy and thus inaccurate. I once had a tech fly at me telling me my patient's BP was 62/55 (not the previous patient but a different one). When I saw the positioning of the cuff was almost to her wrist, I repositioned it, rechecked and got 110/65.

Tait

Thanks, Tait! In my situation yesterday, the CNA's technique was clearly sloppy. The BP would have been inaccurate had she taken it over my shirt on the upper arm with a large size cuff---but it was worse when she took it over my shirt on the lower arm. And it hurt! I have fibromyalgia and stimuli that don't bother other people can be pretty painful for me. She should have requested that I remove my shirt to allow her to take my BP directly on the upper arm, not only for my comfort but also to ensure accuracy.

On the other hand, why was a blood pressure check even necessary when I was seeing a dermatologist? I had just seen a gyno at that system the week earlier, had not come in with c/o of anything except wrinkles and zits. :confused:

Specializes in LTC/Rehab, Med Surg, Home Care.

I have had to take it on the lower arm of morbidly obese pts. Our largest cuff would not fit on the upper arm, and the pt. knew this. I had also gotten it in report to use the lower arm. If you use a manual cuff, listen at the AC, this does work.

We were taught that this is an acceptable alternative. Just like a lower limb may be used for a biltateral mastectomy pt. It's never a first choice.

It does not make sense why the CNA would have done it this way. I'm sure you have a pretty good idea of what your BP normally is, was her number even close? Usually the automatic cuffs won't work on the lower arm.

Anybody have details on the expected variances? I think I am remembering that the popliteal is possibly gonna be 10-15 off.

Specializes in HIV, Transplant.

I'm a nursing student and I wasn't taught to do this but I have seen a nurse on my clinical unit take bp using the forearm. I was supposed to do it but I was having trouble finding a cuff to fit the patients arm and when I told the nurse she just did it on the patient's forearm. I assumed it was okay because she was the RN and I'm just a student even though I had never heard of that being done before.

Specializes in Gerontology, nursing education.

Well, I ended up talking to the nursing supervisor about this. There were no medical indications for the CNA to do this and she ended up getting an inaccurate reading. The thing is, if I wasn't an RN and cognizant of my own normal BP, I might be getting hypertensive over worrying about having high BP. I am sure someone with no medical knowledge would be scared out of his/her mind!

The nursing supervisor was very apologetic---which was not my intention---and said she would go over proper procedure with the CNA. I don't believe in getting someone in trouble but this woman made a mistake that should not be repeated.

Again, thank you all for your input on this!

Specializes in Occupational health, Corrections, PACU.
Thanks,

On the other hand, why was a blood pressure check even necessary when I was seeing a dermatologist? I had just seen a gyno at that system the week earlier, had not come in with c/o of anything except wrinkles and zits. :confused:[/quote]

Because it is a standard of care for any physician's office.....?

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