Question about taking BP in lower extremities and forearms

[Bumashes]

Hey everybody. When I was giving report to the oncoming nurse the other day, I was telling her how the BP's have been taken in the pt's forearm b/c her upper arms are way too large for the size cuffs we have. We were taking the pressures Q2hrs b/c the pt was having 80's/50's sometimes, and she is quite a large lady. So I mentioned how much more worried I was that we were getting that low of a pressure that far away from the heart (forearms instead of biceps.) My A&P instructor and a nursing instructor once taught me that the further away from the heart you go, the higher the pressure will be in the vessels due to the vessels being smaller/narrower the further you get from the heart. The oncoming nurse had never heard of that, so it made me question what I was taught. I have seen that there is a difference. I've taken a BP in a friend's arms and then calves and had the pressure turn up higher in the calves, but that was only one incident. My teacher had said that the difference in pressure from the upper arms to the lower legs can be as much as 10-20 systolic and 5-10 diastolic, with the lower extremity being the higher resulting pressure. Okay, now I'm rambling. I've not even been a nurse for a year yet, so I don't have much experience to draw from. Please someone enlighten me?

:bowingpur

[malaski]

Yes, you are supposed to put the stethescope in the antecubital/brachial area

[malaski]

oh I see what your saying - you put the cuff on her forearm, so you used the radial pulse. Hmmm I'm not sure

[bigmona]

The literature shows that taking BP via a lower extremity does run higher than when you take it in an upper extremity. I have certainly found this to be the case in my own practice. Came in once to work and had a patient on a nicardipine gtt that was being titrated for BPs taken in the legs- when I took the pressure in the arm it was much lower and I actually had to shut the drip off. Something to be careful with.

[LuLu2008]

I wanted to discuss: (1) placing the cuff on the forearm and (2) putting the stethoscope on the wrist versus the antecubital space. I think it should be on the wrist.

[dionnedillon]

with the 17 lb wt. gain, i am thinking chf, have you all drawn a bnp on her?

[stephmj]

So do you listen on the ac area or the radial area???? Any updates on this question?

[amberghenie]

I wanted to discuss: (1) placing the cuff on the forearm and (2) putting the stethoscope on the wrist versus the antecubital space. I think it should be on the wrist.

When you place the cuff on the forearm you would use the wrist to auscultate the BP. The Cuff acts as a tournicate on the arteries and prevents the blood from flowing to the lower portion of the arm. When its released blood starts flowing back into the hand and fingers and that is when you begin to hear Karotkoff's sounds. It wouldnt make sense to listen to the antecubital area because the blood would not be restricted there.

[stephmj]

What if you placed the end of the cuff at the brachial area?

[jeckrn, BSN, RN]

Do you have access to a large and or/a thigh sphygmomanometer? If not, I'd suggest getting one to your boss.

Larger is not always the answer because of the shape of the arm (extra large at top and somewhat skinny at the bottom) and length of forearm. With patients like described in the 1st post you just have to learn what works best on that patient. This comes only with experince.

[amberghenie]

If the cuff is placed above the brachial area then by all means use the antecubital space to take your blood pressure. Basically the cuff cuts off circulation from anything below it, so you want your stethescope placed on an artery below the cuff. Think of a water hose... when the faucet is turned on the water goes out the open end of the hose. When there is a kink in it it prevents water from exiting and builds up pressure. As you slowly release the kink the water starts dribbling through with force until it starts flowing free again.... Blood circulates away from the heart through the arteries towards your fingers and toes like a water hose. When it has a kink ( from the cuff) it builds up pressure and as you deflate the cuff it slowly allows the blood to dribble back through and these are the sounds you hear. So as long as you place the stethescope on an artery below the cuff you should get a reading. Just remember to always document the spot because the BP may differ depending on where you place the cuff. I hope this helps you...