Position for taking BP in preecclamptics

RaeT,RN · Oct 5, 2005

What are you guys doing these days as far as what position you take the BP in for your preecclamptic patients. I think AWHONN states that diagnosis should made with patient sitting up. I attended a conference recently and the perinatologist that was speaking said it was "cheating" to use the BP from left side. One doc I work with has an absolute fit if you take a pt's BP in semi fowler or sitting, she only wants to hear about it if it's high on her side. Another doc I work with agrees with me that the sitting or semi fowler BP can be a very important piece of information.
What do you guys think?

I actually can contribute on this one! I am currently in the AWHONN sponsored Perinatal Orientation program at my hospital and we talked about hypertensive disorders of pregnancy today. The current standard of practice (according to what I heard today) is that the BP be taken in the LEFT arm, with the pt in the LEFT LATERAL DECUBITUS position. You just pull her arm out from underneath her body. Our CNS said that it is unacceptable to take it in the right arm while she is on her left side because the better number makes us feel better.

Hope that helps!

SmilingBluEyes · Oct 5, 2005

You are right; the current literature has stated taking B/P's while sitting up/semi-fowler's is the correct way to assess for PIH pressures, not side-lying. Personally, I take several b/p's, sitting up, laying down, even standing, but never on their backs. Taking several b/p's in differing positions will be the way to get around the doctor's issues w/how you are doing things where you are. Just make sure you are documenting pt positions as you take b/p's.

mugwump · Oct 5, 2005

You are right; the current literature has stated taking B/P's while sitting up/semi-fowler's is the correct way to assess for PIH pressures, not side-lying. Personally, I take several b/p's, sitting up, laying down, even standing, but never on their backs. Taking several b/p's in differing positions will be the way to get around the doctor's issues w/how you are doing things where you are. Just make sure you are documenting pt positions as you take b/p's.

Actually the position of the arm related to the heart is as important. The arm should be level to the heart. If the arm is positioned lower than the heart you get an incorrect high reading and if it is higher than the heart an incorrect lower reading. (hope this helps)

SmilingBluEyes · Oct 5, 2005

good point, mugwump!

midwife2b · Oct 5, 2005

At our facility, if a woman comes to triage for a "PIH workup", initial BP's are taken in both arms, sitting. The rationale is that she has had all her BP's taken in the office while sitting. After that we do serial BP's with the woman in L lateral position to see if rest helps reduce the BP.

That helps the docs decide whether or not the pt. can continue with the pregnancy with bedrest, or if she needs imminent intervention to deliver.

Not all women are admitted, but for those that are, the diagnosis has already been made, so the BP's are taken with the woman in left lateral position, same arm (left). Along with other info (labs, I&O, protein dips, ultrasounds, NST) the day to day decisions of management are made.

It took a LONG time to get to this point, as many docs and nurses had their own ways of assessing BP's and managing women with PIH/preeclampsia.

fourbirds4me · Oct 7, 2005

Both arms... sitting. Lateral positioning is an intervention to lower BP. I agree however that if while lateral if the BP is still elevated... it is more of an indication for delivery.