Pulse ox reading on same hand during mechnical BP reading??

[kukukajoo, LPN]

My gram is in the hospital d/t a small stroke and has been in there about 2.5 weeks. I try to be there and do a lot myself to give staff one less pt to have to hover over constantly. I am pretty tolerant of nurses and aides but this one reall irked me like you would not believe! I had to do all I could not to tell her to get out and then some!

The LNA came in to do vitals on grammy while I was there. Auto BP cuff goes on left arm and is activated. Next instant, LNA is putting the pulse ox on the LEFT middle finger!! I corrected her politely and explained she would not get an accurate reading while circulation was cut off from BP machine. She gave me a blank stare and I explained the whole oxygen/blood thing to her in a quick way. Well she thought for a sec and STILL put the darned thing on anyways!!

I also explained she had a pacemaker and last I knew the right arm should always be used for BP according to cardiologist. Didn't stop her. Hmmmm no wonder her O2 was only 94.....

ON a TELE Unit no less!!

I bit my cheek HARD to not speak. I did not report her, rather I spoke to a nurse on floor who is a good friend and she said she would watch her and correct/teach her if necessary. I will be working there soon so I did not want to make an adversary before I even started and thought this was the best way to handle without making a big fuss.

Did I do the right thing in correcting her? In not reporting her? In stating that left arm should not be used d/t pacemaker leads?

[Okami_CCRN, BSN, RN]

I think you overreacted a tab bit. If your grandmother was on Left Arm Precautions and it was posted above the bed then yeah I would have complained but if no precautions were given that means that the doctor does not see why there should be a difference.

About the Pulse Ox... I leave it on the same arm as the BP but I wait a couple of minutes after the BP is finished before writing down the number. And a pulse ox of 94 is not bad at all... if it was 90 or 88 then I would have said something.

[Bill E. Rubin]

On our unit, someone usually puts a sign up on the wall behind the HOB stating if a particular arm should not be used for BP's IV's, phlebotomy or whatever.... for whatever reason, for example mastectomy or dialysis fistula or pacemaker etc. Sometimes a sign isn't put up, but I always ask a patient before putting on a BP cuff if it's ok to use one arm or the other. Of course, if the patient isn't alert or oriented, that could be a problem.

As to the same hand for the pulse ox, I've done that too, but always get the pulse ox reading before inflating the BP cuff. Inflating the cuff first is... well, it defies logic.

[loriangel14, RN]

I usually use the same arm for both but leave the oximeter on after I remove the cuff. Sat of 94 isn't that bad for an elderly woman. I think you overreacted.

[Bill E. Rubin]

Inflating the cuff first is... well, it defies logic.

Unless you wait for a bit as HappyLoser said. :wink2:

[Nrsstudent09]

As both an EMT and a nursing student I have been told to not take pulse ox on arm that I am taking the Blood Pressure in, unless they are being done at separate times. People always seem to forget that the pulse ox is only as accurate as that finger. Pulse ox measures the pulse ox of that finger not the entire body, hence treat the pt not the machine. Her pulse ox may have been 94, but no shortness of breath or anything could mean she felt fine.

[ohmeowzer RN, RN]

I think you overreacted a tab bit. If your grandmother was on Left Arm Precautions and it was posted above the bed then yeah I would have complained but if no precautions were given that means that the doctor does not see why there should be a difference.

About the Pulse Ox... I leave it on the same arm as the BP but I wait a couple of minutes after the BP is finished before writing down the number. And a pulse ox of 94 is not bad at all... if it was 90 or 88 then I would have said something.

i agree w/ happy looser... i do hope yor gramma geels better soon , take care

[La Quokka]

As to the same hand for the pulse ox, I've done that too, but always get the pulse ox reading before inflating the BP cuff. Inflating the cuff first is... well, it defies logic.

I always do it on the same arm, but obviously I wait to get a sat before inflating. I don't have time (or space) to run around the bed to put the clip on their other hand. Besides, after the cuff deflates and the sat returns, the reading is never different.

[k3immigrant]

I think so too that you overreacted. when we use these machines like bp, pulse ox etc, we should not solely rely on that, we should also look at the pt.as long as they are not in distress, no significant increase in heart rate from baseline.checking the pulse oximetry in the same arm where bp is taken is okay as long as you wait a while to check reading after the bp cuff is deflated.

[leslie :-D]

yeah...i think you may have overreacted.

94% is perfectly acceptable.

you will come to understand these actions, when you begin your profession as a nurse.

hope grandma is doing well and soon to be discharged.

leslie

[Spidey's mom, ADN, BSN, RN]

I actually use opposite arms. But I see no problem with getting a pulse ox first on the same arm that you then inflate the bp cuff.

steph

[CaptGaston]

I use same arm also. But at different times of course. As far as the pacer, BPs are fine. Wouldn't want her to use a shotgun on that side though... I hope she recovers soon.