Manual BP w/ Radial Artery?

[OrgoCoop]

Hi all,

I'm an MS-1 student who worked in a free clinic today. As are most free clinics, we were a bit short on supplies. One of the patients was obese and the cuffs we had did not work for the patient.

One of the nurses suggested taking a radial BP. She put the cuff over the forearm and auscultated the radial artery (122/72). I am having trouble finding more information on this online. Is this a reliable method?

I would guess the "normal" BP ranges are different for this type of measurement (?) compared to brachial measurement. Anyone have any good resources to read up on this?

Sorry for any ignorance on this - just trying to learn more!

Cheers

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[mehc012]

Interesting question! This is one discussion I found on it...

What about taking a forearm blood pressure on an obese patient? Nurses often find that it is faster and easier to take a forearm blood pressure than to search for a larger cuff. Studies have shown that forearm blood pressures generally run 3.6/2.1 mm Hg higher than upper arm blood pressures. The experience in KPSC has been that once clinicians and MAs are taught how to obtain forearm blood pressures, inappropriate usage of forearm pressures becomes commonplace. Therefore, we no longer teach this technique. Instead, the regional mandate is to have both standard and large blood pressure cuffs in every primary care examination room. Using a standard blood pressure arm cuff on an obese patient falsely raises systolic blood pressure by approximately 10 mm Hg. “Miscuffing” should be strongly discouraged.

And the studies it references:
http://www.ncbi.nlm.nih.gov/pubmed/15199302
http://www.ncbi.nlm.nih.gov/pubmed/10225644

 

[HelpPleaseMD]

Hi all,

I'm an MS-1 student who worked in a free clinic today. As are most free clinics, we were a bit short on supplies. One of the patients was obese and the cuffs we had did not work for the patient.

One of the nurses suggested taking a radial BP. She put the cuff over the forearm and auscultated the radial artery (122/72). I am having trouble finding more information on this online. Is this a reliable method?

I would guess the "normal" BP ranges are different for this type of measurement (?) compared to brachial measurement. Anyone have any good resources to read up on this?

Sorry for any ignorance on this - just trying to learn more!

Cheers

ive never heard of this before and do not believe is accurate unless someone else knows more. We do insert an arterial line to measure the blood pressure in patients that need more precise hemodynamic measurements

 

[mehc012]

ive never heard of this before and do not believe is accurate unless someone else knows more. We do insert an arterial line to measure the blood pressure in patients that need more precise hemodynamic measurements

Plenty of the home BP monitors are forearm monitors. Typically they are known to be a bit offset from the standard upper arm ones, but are often cheaper or easier for patients to use themselves on a daily basis, and still give an idea of daily trends.

You're not going to be dropping an art line in the free clinic just because you can't find the large BP cuff...

 

[WheezyBaby]

It's fine to use a forearm cuff if you don't have a size appropriate upper arm cuff. The pulse pressure tends to be wider iirc. In general I wonder how accurately we track bp's though because I think clinics rarely adhere to proper protocol

Subject Preparation

A number of factors related to the subject can cause significant deviations in measured blood pressure. These include room temperature, exercise, alcohol or nicotine consumption, positioning of the arm, muscle tension, bladder distension, talking, and background noise.28 The patient should be asked to remove all clothing that covers the location of cuff placement. The individual should be comfortably seated, with the legs uncrossed, and the back and arm supported, such that the middle of the cuff on the upper arm is at the level of the right atrium (the mid-point of the sternum). Measurements made while the patient is on an examining table do not fulfill these criteria and should preferably be made while the patient is seated in a chair. At the initial visit, blood pressure should be measured in both arms. The patient should be instructed to relax as much as possible and to not talk during the measurement procedure; ideally, 5 minutes should elapse before the first reading is taken.

There's more I've read elsewhere, like no chewing gum 15 minutes prior.

 

[OrgoCoop]

Ok, thanks for all your responses!

I imagine in most situations I will have larger cuffs available to me. It was more a curiosity than anything. Retrospectively, I should have just palpated the radial artery for the systolic pressure - which is better than nothing. I've tried auscultating my gf's BP in the same way the nurse did at the clinic and have had no luck hearing anything at all, but I'm definitely no where close in clinical experience as the nurse was!

Cheers