what?...q 15 NIBPs with an art line???

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Specializes in MICU, SICU, CCU.

I have worked in many different ICUs and never seen this before...checking cuff pressures q 15 when you have an A line that correlates perfectly. (and documenting BOTH!) I just started working in a very large metropolitan hosp MICU/SICU and that's the standard. Every patient with an A line and on pressors-- no matter what. This seems completely ridiculous and i am just wondering if any other ICUs do the same. If the pressures correlate why would you even think of torturing the pt with q 15 NIBPS???? :banghead:

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Specializes in PICU/NICU.

Sounds like a little much to me! Our policy is Q 4 hours if the cuff/Aline correlates and honestly I think it could be Q shift. I mean if you have a dampened wave or if you are not correlating that is another story. I will put the cuff back on and check a pressure if I have some big change in the BP norm for the pt. I will also put it on and cycle the cuff if my pt becomes hypotensive and I'm going up up up on pressors, or if we're coding the pt. Other that that- give their poor arm a rest.

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Specializes in Trauma ICU, Surgical ICU, Medical ICU.

I know people who do this, we have no policy on it and I have better things to do with my time so I don't do it, plus why have a BP cuff going off q15 on a poor persons arm? Unless you're having problems with the art line, then sure.

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I don't chart NIBP q15 when I have an a-line, but I do chart a cuff pressure on the hour.

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Specializes in Cardiology.

Could you explain your rationale for taking a cuff pressure every hour? I'm curious to the benefit for the patient if your Aline is correlating.

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Specializes in MICU/SICU/CVICU.

I correlate during my initial shift assessment; if it's good I reassess every 4 hours. We don't have a specific policy either for correlation or charting. I only chart the art line in the flowsheet, but I always make sure to document the cuff correlation in my q4hours narrative notes.

To be perfectly honest, q15 sounds like overkill to me unless they're very hemodynamically unstable.

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Specializes in Critical Care.

I'm thinking about the ecchymosis that might result from such a ridiculous regimen, especially in coagulopathic patients.

It's just dumb, IMHO.

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Our policy is to check cuff pressures q12h when an art line is present. But we use our nursing judgement and recheck if pressor requirements go up or the waveform dampens. Doesn't seem to be fair to the pt. to do cuff pressures so frequently when an art. line is present.

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Specializes in ICU, Education.

I always check a cuff pressure at the beginning of my shift to ensure the aline correlates closely. If it does, I don't check again unless I have a questionable pressure by aline, or a questionable waveform. The only time I will do cuff pressures Q15 min with an aline is if my patient is hemodynamically unstable &/or I am titrating pressors, the aline waveform is known to be dampened and cannot be fixed but is still good to draw frequent required ABGs, and patient is a difficult stick. Then I will leave the line in, lower my alarm parameters on the aline to the dampened lower level (never turn them off), make sure my NIBP alarms are set appropriately, and go by teh NIBP.

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Specializes in Dialysis.

Correlates? Measurement of the blood pressure by art line is the gold standard, if there was a difference between NIBP and an art line that has a proper wave form, correctly calibrated, and zeroed then the art line is the real BP. NIBP measures systolic and diastolic by calculation after it finds the strongest signal. Ever notice how the NIBP MAP is different than the standard formula to determine MAP? If you really are interested in correlation use your stethoscope and a manometer but the A line is the most accurate measurement of BP.

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NIBPs q 15 may cause nerve compression and nerve damage, skin-pressure lesions due to repetitive, prolonged cuff inflations, among other things....not to mention just plain annoying to the patient and totally unnecessary with an art line which measures the true blood pressure. NIBP's and art lines don't really "correlate" because they measure two different things - blood flow (NIBP) versus actual blood pressure (art line). As stated by the previous poster, the art line reading is the gold standard and is the true blood pressure if properly calibrated.:nurse:

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why not chart on q 15 of the art line and q 1 hr of the NIBP? get an order and state your case...you're being a patient advocate!

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