need tips how to measure BP on really obese patients

[Blackheartednurse]

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

[wldcard]

@ESME: Thanks for all that info... that is a very constructive and helpful response.

@OP: I work in EMS too and encounter the obese, morbidly obese, and super morbidly obese all the time out in the field. (And don't flame; a year and a half ago I was in the super morbidly obese category; now I'm just morbidly obese :)) ESME's post covered what I was going to bring up on cuff sizes; there are large (or extra large) and thigh cuffs. I regularly use the large adult and have on a number of occasions used the thigh cuff on people's arms. Use what is the right size. Palpate for the brachial BEFORE you start your BP and make sure your scope is over that point. It is amazing how much artery and vein location can differ from the norm and from person to person. I have found asucultation points at almost the elbow for some people. As mentioned by others, a good scope helps too.

[jbluehorseh]

I been in the medical field for most my life and the morbidly obese has always presented many challenges even on the simple of task; everything becomes more difficult in relation to how sick and the patients mobility. Such as toileting a patient to the bed side commode or having to clean a patient in bed. I remember in nursing school leaning their way taking a blood pressure; it was not useful nor did we study any one-way taking it on an obese patient. So I find the put down a little offensive this I a real issue that I deal with every day on my unit.

[xtxrn, ASN, RN]

I been in the medical field for most my life and the morbidly obese has always presented many challenges even on the simple of task; everything becomes more difficult in relation to how sick and the patients mobility. Such as toileting a patient to the bed side commode or having to clean a patient in bed. I remember in nursing school leaning their way taking a blood pressure; it was not useful nor did we study any one-way taking it on an obese patient. So I find the put down a little offensive this I a real issue that I deal with every day on my unit.

I'm sorry- what put down? :)

[jbluehorseh]

i was taught that as an emt; the idea or theory is that it is a mid-way point. however if i know my patients’ blood pressures run low i will go to 120 or 150 whatever the case might be, having to re-inflate the cuff can give you false readings.

[xtxrn, ASN, RN]

i was taught that as an emt; the idea or theory is that it is a mid-way point. however if i know my patients' blood pressures run low i will go to 120 or 150 whatever the case might be, having to re-inflate the cuff can give you false readings.

i still don't know what you mean by a put down and it being offensive- trying to understand your pov- :)

[kelleann]

We were able to get pressure using a calf on a patient with a restricted limb access and very questionable IV in the other arm. Worked like a charm. This was at the suggestion of her cardiologist.

[xtxrn, ASN, RN]

We were able to get pressure using a calf on a patient with a restricted limb access and very questionable IV in the other arm. Worked like a charm. This was at the suggestion of her cardiologist.

On someone of normal or below normal weight, this may work.... but on an obese (or super obese) person, their calf will probably be even bigger than their arm:)

[rn/writer, RN]

On someone of normal or below normal weight, this may work.... but on an obese (or super obese) person, their calf will probably be even bigger than their arm:)

The problem with arms, especially in those of short stature, is that the upper arm can be sort of cone shaped--wide at the shoulder and much narrower at the elbow. No BP cuff, no matter how large or long, is made to fit a cone-shaped arm. The calf might not be much smaller, but there is usually less variation in the diameter from top to bottom.

[xtxrn, ASN, RN]

The problem with arms, especially in those of short stature, is that the upper arm can be sort of cone shaped--wide at the top and much narrower at the bottom. The calf might not be much smaller, but there might be less variation in the diameter from top to bottom.

Point taken :)