Question about post CVA and blood pressure

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Specializes in Med-Surg/Tele, ER.

Ok, this may be a stupid question, but I had a patient the other day that was post CVA and had right sided weakness. The patient's family member started freaking out when the CNA started to take a blood pressure on the right arm, telling her "you can't take blood pressures or do blood draws on a patient that's had a stroke on their effected side!!!" I asked the Doctor, and she said she didn't know of any reason to not do this, (but if I found one to let her know lol), so, does anyone know any reason why we should not take a blood pressure or start IV's, blood draws on the effected side? Preferably someplace where I can do research on it? I tried googling and can't find any literature on this......

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Specializes in Cardiac/ED.

I have taken care of several individuals with stroke symptoms and I can see no reason why you can't draw blood or start IV's on the weak side. In fact, a good argument could be made that starting the IV on the weak side would be the better choice as that would keep the strong side free as that is the arm they will be using for everything from eating to personal hygiene.

The stroke is a brain injury not an injury of the body...

I hope this helps.

P2

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Specializes in Med-Surg/Tele, ER.

That's what I thought too, but she was so adament about this, I thought I missed something. I will see her tonight, and wanted to explain the reasons why it was ok, as I'm sure she has been freaking out on the CNA again today.

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Specializes in Hospice/Mental Health/LTC/Home Health.

I think it pertains more to the fact that they can't move the affected side as well therefore maybe contributing to increase instance of blood clot? I'm not sure but I know you shouldn't do any of those things on a post mastectomy patient for the rest of their life, so maybe its the same premise of that? I'm not sure just going out on a limb and making a guess :)

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Specializes in Med-Surg/Tele, ER.

Well, I thought about a blood clot too, but the MD dismissed that and said even though you aren't supposed to take BP on a patient with a mastectomy (because of the chance of lymphedema) you have to take it on double mastectomy patients somewhere.....and then said if I found any reason not to take it on a stroke pt to tell her

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Specializes in Cardiac/ED.

I would remind the family member that the injury is of the brain not the arm itself. I have seen some edema in the affected arm but this is usually after a long time following the stroke. Not all strokes are the same...with my grandmother she feels pain/sensation in her weak arm but has no muscle control. If the family insists that they don't want the BP or blood draws on the weak arm then I guess you will have to comply.

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I agree with Psqrd. The family may not realize the arm paralysis is from the brain. I would see where they are coming from with that thinking. Education of patient and family is a huge part of stroke care and rehab. It is amazing what some people think and what is really true.

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Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.

I believe using the affected extremity can lead to falsely elevated readings. It is best to take the BP using the unaffected side.

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Specializes in LTC Rehab Med/Surg.

I have found there can be a big difference between b/p on the weak side vs the unaffected side. CIrculation on the affected side may not be as good.

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I work on a stroke floor and we are not limited to the non-affected side. In fact, sometimes you get stroke patients that had a breast removed or have a fistula in the unaffected arm, so you can only use the affected limb.

On a side note... the stroke docs like to have BPs a little on the high side to allow for perfusion.

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Specializes in Med-Surg/Tele, ER.

Thank you all for the responses! So, the general consensus is that there is no medical contraindication to taking BP on the effected side, just that it may not be an accurate reading? (good to note!) I will try educating the family about this although I'm not sure it will do any good because they already know everything lol!

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I found the following which may be helpful, and it shows the rationale for taking BP in the nonaffected arm of stroke patints. http://www.anesthesia-analgesia.org/content/82/2/437.2.full.pdf

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