need tips how to measure BP on really obese patients

Nurses General Nursing

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I noticed that I cant hear BP on obese patients, does anyone have any tips to share? Thansk

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The right size cuff, and if a last resort, a wrist pressure.

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Specializes in Chemo.

There is no real tip, just like it is very difficult to do lung assessments there is a lot of fat mass to hear through. Make sure the cuff is the right size and have a good stethoscope. You can also try using the lower arm and or us a vital sign monitor. I have had patients whose arms were so fat that no IV could be started in the AC let alone anywhere else. This included an U.S. IV.

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The right size cuff, and if a last resort, a wrist pressure.

that is what I have been using-a wrist pressure as my last resort:)))

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There is no real tip, just like it is very difficult to do lung assessments there is a lot of fat mass to hear through. Make sure the cuff is the right size and have a good stethoscope. You can also try using the lower arm and or us a vital sign monitor. I have had patients whose arms were so fat that no IV could be started in the AC let alone anywhere else. This included an U.S. IV.

Oh my God, this week I have to draw INR level on very obese patient, I'm so anxious I wont be able to find a good vein.

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What did nursing school tell you about this? Or is it just more fun to ask here? :)

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Specializes in Anesthesia.
Oh my God, this week I have to draw INR level on very obese patient, I'm so anxious I wont be able to find a good vein.

Look on the inner wrist for a vein.....there is usually one there if you can't find one in the AC.

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I think this is a lot more anti-obese "joking" than anything serious. This is first week of nursing school stuff... BP 101....

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Specializes in Public Health, TB.

Sure, the correct size cuff is important, but I have trouble finding one on our cardiovascular unit and I believe the OP works in home health, so she probably doesn't have a lot of options or an extra set of ears to help her out.

I agree with using the best stethoscope possible, and palpate for a brachial pulse so you know exactly where to place your scope. If you have access to a doppler, it can help locate a pulse as well.

If the wrist cuff works, I'd go with it, but let the MD know that is what you are using.

As to the "nursing school" comment, I don't remember learning much about care for the super obese (yes, that is a medical term). Much of our equipment is just not suited for them and facilities/agencies just aren't willing to invest in the proper equipment.

I used to think 300 pounds was big, but 500 has become the new 300.

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No reference about correct cuff size with obese patients (super or not- and yes, I'm aware of the 'super obese' label). ??? Just asking. Even in 1985 we got taught about cuffs for obese patients.....:)

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Specializes in Oncology/Haemetology/HIV.

While, I have taken issue with the OP on a number of occasions, and I myself, am overweight, I consider a question like this quite valid. While the OP does have history of focusing on "appearance" issues, I feel like cutting her some slack.

Sure, nursing school said plenty about the right size cuff. But cuff size is a very small part of getting a manual BP. No BP cuff is going to suddenly allow to hear easily through a significantly thicker amount of tissue.

I personally recommend getting a very good quality stethoscope that allows one to hear better.

And I question why it is that whenever issues with difficulty treating people with weight issues comes, suddenly posters jump on "fat bias/making fun of the maligned overweight pt" bandwagon. It is a very valid issue to discuss, whether it hits a few sore spots or not. And obesity is creating more and more issues with care.

And, like it or not, human biology has not changed that much over the last several centuries, yet weight issues have increased astronomically. This points to some really unpleasant truths we may not like (me very definitely included).

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What did nursing school tell you about this? Or is it just more fun to ask here? :)

We didnt learn about this either, or even learn how to draw blood! With a BSN! Even. Good question

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