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

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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:

Specializes in ICU,CCU, MICU, SICU, CVICU, CTSICU,ER.

only reason I can think of to do both is if there is a difference from left to right arms--but even then you'd only need to do it once to determine the difference. Art line is the gold standard--why risk blowing the line for q15min NIBP's- and what are you double charting for....that is a lawyers dream!

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Specializes in ICU, cardiac, CV, GI, transplan.

Current nursing research does not support this. If you have an arterial line with a good wave form, properly zeroed and calibrated, then you have an accurate directly measured pressure. Who cares what the cuff says in that case? If they don't correlate, then which one are you going to use? I only chart the one I'm using for titration of my drips. As soon as the patient is stable off drips, we try to get rid of the a-line as soon as possible so that we can eliminate that pathway for infection.

Again, there have been studies into this practice and really it's an unnecessary step for the most part. If you have a good art line, then you have a good pressure. The cuff only becomes a relevant measurement if your arterial line is over/under dampened (in which case your cuff and line won't correlate) or if you're going to get rid of the line or cap it for patient ambulation. For legal reasons, only chart one or the other. I was taught this by a nurse who was involved as a witness in a lawsuit against a hospital, and the staff were thoroughly interrogated on why they were charting two blood pressures that didn't necessarily correlate. You might have a cuff of 137/58, and an ABP of 72/66. Which one are you trusting? If the ABP is dampened and inaccurate, why are you even charting it? How do you pick and choose which one is good? In a word, don't chart bad data. It can only hurt you later.

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Specializes in ICU, Education.

But surely, whether or not you charted it, if you were monitoring it, the information is available to those who go looking. In that case, better to explain why you chose one over the other. The monitor will not state that it was overdampened or underdampened, but we can.

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Specializes in ICU, cardiac, CV, GI, transplan.

Somewhere in your assessment notes it should state that your a-line is giving a dampened wave form, so there is no reason to chart bad data. As another poster stated, lawyers adore charting discrepencies and having two different pressures in the same set of vitals is a heck of a discrepency.

If your art line is no good then you should talk to your doctor about either getting a new one (if you still need it) or discontinuing it.

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Specializes in CTICU.

Is this where I should throw in whether people use their IABP pressures to titrate inotropes....? Pet peeve of mine that SO MANY PEOPLE write the balloon numbers down and then treat according to NIBP or even IAL.

In my old age I am getting less militant though... I guess as long as you get a trend, the specifics can get lost.

There's no way in hades I am doing q15min NIBPs if I have a properly functioning arterial line. Otherwise you may as well take it out. The person who said don't look after you? Well, at least you'll leave the ICU with 2 arms.

I work on EBP - I have seen no EB clinical practice guidelines stating that q15min NIBP affects outcomes either way. It all comes down to nursing judgement in that case.

OP - you are right to question. "Because that's what we do" is never a good rationale. Doing something is fine, but make sure you have a reason.

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Specializes in MICU, SICU, CCU.
The person who said don't look after you? Well, at least you'll leave the ICU with 2 arms.

LOL!!! Couldn't have said it better myself. I'm amazed at how heated a topic this has become! And, as I stated in the OP, I am talking about A lines that correlate perfectly. Good square wave, no over/underdampening, good waveform, etc etc. I just assumed that was a given.

Seems we pretty much have a consensus. Of course you don't just automatically trust the art line. You troubleshoot, use good clinical judgement, level and zero prn. I agree with those that argue that documenting two pressures is just asking for a lawsuit!

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Specializes in Anesthesia.

We check q shift for correlation but even that is loosely enforced. It also depends on the quality of the arterial line.

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Specializes in CCRN, MICU, CCU.

Hmm, I think it's time to double check your protocol. That sounds ridiculous and painful.

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