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

Virgo_RN, BSN, RN · Mar 7, 2008

Yep, it's just fine to take the sat on the same side as the BP. You'll get an accurate reading either before inflating the cuff, or after deflation. I only avoid the left arm in a fresh pacer implant. After it's been there a while, it's not contraindicated.

Peri · Mar 7, 2008

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.....

I suspect that this is one of those instances where we hate to be told we are wrong. Like telling the Doctor what we have wrong with us instead of just giving him the symptoms so that he can work it out.

It may have been seen as the patient's relative telling the nurse her job. Did she wait for a short space for the O2 sats to come up to speed after the BP had been taken? If she did 94% wasn't too bad, but if she didn't it would have been interesting to see what they really were.

I think that your point is a valid one. I don't put the oximeter on the same side as the BP cuff for the reason that you have mentioned. I find that either the patient is able to move their free hand to within reach of the oximeter or that the other arm isn't that far away.

There are circumstances where it is not possible to use both arms/hands, then I wait a couple of minutes as I do the temp, then do the O2 sats on the cuff side.

Good luck for the future.

SDS_RN, RN · Mar 7, 2008

Was her right side impaired by the stroke? From what I was taught is you take the BP on the unaffected extremity unless of course mastectomy ect. then you go to the leg. Please let me know if I'm incorrect.

I think that you did overreact. I do this all the time and all of the other nurses I work w/ do the same. 94% is a good sat and no reason for concern. As long as you check the sat and then start the BP or check the BP, wait a little bit, then check the sat it's okay.

kukukajoo, LPN · Mar 7, 2008

I suspect that this is one of those instances where we hate to be told we are wrong. Like telling the Doctor what we have wrong with us instead of just giving him the symptoms so that he can work it out.
It may have been seen as the patient's relative telling the nurse her job. Did she wait for a short space for the O2 sats to come up to speed after the BP had been taken? If she did 94% wasn't too bad, but if she didn't it would have been interesting to see what they really were.
I think that your point is a valid one. I don't put the oximeter on the same side as the BP cuff for the reason that you have mentioned. I find that either the patient is able to move their free hand to within reach of the oximeter or that the other arm isn't that far away.
There are circumstances where it is not possible to use both arms/hands, then I wait a couple of minutes as I do the temp, then do the O2 sats on the cuff side.
Good luck for the future.

Thanks. I think you are right on the attitude a bit, she was young.

How is explaining to someone how to do something correct overreacting? I was very careful how I worded things and did not say "Hey you are wrong" rather I explained that the read would not be accurate unless she did it before or waited after. We had been talking earlier about nursing school.

The sat read 94 but I am certain was higher, because she did not wait and did it while the cuff was inflated. I should have been more clear on that. I know a 94 is a decent read, but my point was it was not accurate. Imagine the other patients on the tele unit getting a read of 89 and put on O2 when indeed their actual stats are higher.

I did detect some flippancy from the LNA and I think that is why she did not change arms.

It is a medical order from doc NOT to use BP on the left or to lift her using that arm as there were some probs before.

SDS_RN, RN · Mar 7, 2008

Was the order currently on her chart on that floor? :idea: If it was then a sign should have been posted NO BP ON L ARM. If she was not told by your grams nurse which arm to take a BP on then she was not in the wrong however she could have done it on the right side to pacify you. We take BP's on the L arm all time even if a pacer is present unless it was just implanted or we have an order not to. Did the nurse you spoke to then recheck the BP on the R arm to detect if their was a difference? As for her sat it was fine whether it was 94% or 100% she was adequatly oxygenated.

You may not have overreacted when you spoke to her but you made it clear here that you are upset about it. If everything checked out okay then yes I would say you are overreacting. If her sat and BP were WNL then there should be no reason for concern.

When you get into practice you will develope your own way of doing things and others may do it different. Taking a BP and sat on the same arm is not uncommon practice and if things don't pan out then you recheck.

I hope your gram is doing better.

kukukajoo, LPN · Mar 7, 2008

Was the order currently on her chart on that floor? If it was then a sign should have been posted NO BP ON L ARM. If she was not told by your grams nurse which arm to take a BP on then she was not in the wrong however she could have done it on the right side to pacify you. We take BP's on the L arm all time even if a pacer is present unless it was just implanted or we have an order not to. Did the nurse you spoke to then recheck the BP on the R arm to detect if their was a difference? As for her sat it was fine whether it was 94% or 100% she was adequatly oxygenated.
You may not have overreacted when you spoke to her but you made it clear here that you are upset about it. If everything checked out okay then yes I would say you are overreacting. If her sat and BP were WNL then there should be no reason for concern.
When you get into practice you will develope your own way of doing things and others may do it different. Taking a BP and sat on the same arm is not uncommon practice and if things don't pan out then you recheck.
I hope your gram is doing better.

Yes, it was noted on her chart AND on the whiteboard in large letters above her bed. So yes, that :idea: was thought of by all.

I understand everyone has their own ways of doing things but when it is wrong, that is when it is unacceptable. I have taken BP and Ox same arm but do O2 then inflate the cuff. Just easier usually.

Virgo_RN, BSN, RN · Mar 7, 2008

Yes, it was noted on her chart AND on the whiteboard in large letters above her bed.

That would have been good information to include in your original post.

La Quokka · Mar 7, 2008

I can't help but to reiterate this point. I put the pulse oximeter on the patients finger, get a reading, inflate the cuff, and when it deflates it is ALWAYS the same number. It's not an "unnacceptable" way of doing vitals, it's not wrong at all. I defy anyone to tell me that after they have deflated the cuff that their reading was lower than it should have been. It doesn't make sense. Blood pumps through our bodies so fast, that even if there was a deficit of oxygenated blood in the arm, it wouldn't matter, 1 second later there's fresh blood there.

Hell, a pulso oximeter doesn't even measure oxygen, it just measures whatever gas happens to be attached to hemoglobin. Could be CO2 for all we know.

I think the question I want to have answered is what does usually sat at? Was this reading abnormal?

roni221 · Mar 8, 2008

I can't help but to reiterate this point. I put the pulse oximeter on the patients finger, get a reading, inflate the cuff, and when it deflates it is ALWAYS the same number. It's not an "unnacceptable" way of doing vitals, it's not wrong at all. I defy anyone to tell me that after they have deflated the cuff that their reading was lower than it should have been. It doesn't make sense. Blood pumps through our bodies so fast, that even if there was a deficit of oxygenated blood in the arm, it wouldn't matter, 1 second later there's fresh blood there.
Hell, a pulso oximeter doesn't even measure oxygen, it just measures whatever gas happens to be attached to hemoglobin. Could be CO2 for all we know.
I think the question I want to have answered is what does usually sat at? Was this reading abnormal?

:yeah:

Thank you! I do this all the time. I do leave the pulse ox on the finger for awhile so I'm sure I get an accurate reading but I've never noticed much of a difference. I've never had any problems or anyone tell me to do it differently. A couple of weeks ago I had a family member mention something like that and lo and behold her mother satted just fine (like 97 or so) and proved the family member wrong.

I would probably get annoyed if someone tried to tell me how to do my job when they didn't have experience doing it day in and day out. Especially if they started trying to talk about anatomy like you say you did. it just sounds condescending to me.

I can understand about the BP thing, it should be done on the correct arm. Apparently it didn't make too much of a difference or the nurse would have came in and redid it.

I've been a CNA for just over a year and am a 1st semester nursing student so i don't think I know it all, just from my experience it haven't seen it make any difference. If a person is satting low I may switch fingers hands or even have them take some deep breaths. I will be watching to see if there is ANY changes in pulse ox during cuff inflation the weekend for sure though. I just can understand the aide getting annoyed, depending on how you approached her. And you may think you said it nicely but she may have taken it differently.

On the pulse ox thing I would have to agree you overreacted. to say you had to bite your cheek and try hard not to throw her out was a bit much. Now if she had not washed her hands or done something wrong after not listening that had hurt your gram then I could definitely see that reaction but a sat of 94 would change nothing.

Altra, BSN, RN · Mar 8, 2008

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!
...
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.

These comments say more about the episode than whether or not Gram's SpO2 may or may not have been higher than 94%.

Here's hoping you find your new job enjoyable and fulfilling.

BittyBabyGrower, MSN, RN · Mar 8, 2008

We leave the pulseox on the extremity we are using all the time...sometimes that is the ONLY extremity we have....you should just write down the PO reading before you inflate the cuff. And a sat of 94% is fine, so yeah, you jumped the gun a bit!

Hope your gram feels better!

kimmie518 · Mar 9, 2008

If you're going to get that upset over which hand the O2 sat is on, I can only imagine how angry you will get over things that are actually important.

As everyone has stated prior, it's okay to put the censor on the same hand. You stated that you "corrected her", but in reality you were wrong. Maybe she was the one belong polite by not correcting you. And from my experience and knowledge, its okay to take a pacemaker client's bp in their right arm (as long as they are not in the post-op/weeks after time frame).

You should apologize to her the next time you visit your grandmother.

And I take offense to the comment about her having an attitude being r/t her being young. As nurses, we need to step away from generalizations.