Positioning for bp

[Heather OB RN]

Hello all, I would realy appreciate your input on this one. How do you poaition your pts when taking BPs? I know that for our hypertensive or preeclamptic pts left side is best, but if you are taking the bp in the upper arm, you are taking a false reading (because the level of the cuff is higher than the heart). This is a debate on my unit, please weigh in!

[cnm in progress]

The most accurate way would be for them to sit upright or in a semi-fowler's position. You're correct that if she's on her left side and you take it in her right arm then it is slightly lowered. If she's on her left side and you take it in her left arm, then it can be significantly falsely elevated. I'll have to look through references, but I know that I read somewhere that the slightly lowered reading in the elevated arm is a minor difference, while the falsely elevated reading on the dependent arm can be more significant.

I think the bottom line is... if she's truly hypertensive, the reading you get on her elevated arm is not going to all of a sudden make her look like she's normotensive, at least from my experience.

One important thing to keep in mind though... you've got to compare apple to apples, not apples to oranges. If someone's been taking her BP on her elevated arm all day and she was normotensive... and now at shift change someone puts the cuff on her dependent arm and gets really high BP's... that's not an accurate assessment.

[mamamerlee, LPN]

The important issue here is consistency, especially if there is a dramatic change.