# Pulse Ox on BP Arm



## Drax (Apr 28, 2014)

This may be a stupid question, but for purposes of accurate readings...

If you place a blood pressure cuff on one arm, can you then place a pulse ox on the same appendage and receive accurate results if you're performing the BP test at the same time?

The automatic BP machines, like WelchAllyn are the press of a button. I am a bit of a stickler for putting the pulse ox on the opposite arm (when possible) because I believe that in some small way the slight deprivation of blood flow to the arm while obtaining a blood pressure may reflect (adversely) on the pulse or oxygen saturation reading.

Is this something worth bothering with or have I just developed an unnecessary (ignorant) habit?

Thanks for your response!


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## Carlos Danger (Apr 28, 2014)

You will very likely get an errant Sp02 reading distal to an inflated NIBP cuff, if any reading at all. 

If you are only taking a BP every 5 or 10 minutes though, it's probably not an issue to simply ignore the errant value, poor waveform, and Sp02 alarm for the 10 seconds that the BP cuff is inflated above arterial pressure.


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## Drax (Apr 28, 2014)

Halothane said:


> You will very likely get an errant Sp02 reading distal to an inflated NIBP cuff, if any reading at all.
> 
> If you are only taking a BP every 5 or 10 minutes though, it's probably not an issue to simply ignore the errant value, poor waveform, and Sp02 alarm for the 10 seconds that the BP cuff is inflated above arterial pressure.



I haven't had difficulty obtaining readings for both at the same time via the same arm (though it isn't desirable by me) with those machines. There is usually a 'beep', I look up, and then begin inputting data into my charting system.

I believe you have answered my question though, I prefer to do opposite arms.


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## Medic Tim (Apr 28, 2014)

It usually sets off a desat or no pulse detected alarm until the cuff deflates.


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## OnceAnEMT (Apr 28, 2014)

My mobile pulse ox just blanks while it is inflated. Tested this out of the same curiosity for in the field. Personally, I use separate arms for the same reason. Just makes sense.


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## Handsome Robb (Apr 28, 2014)

Since SpO2 reads saturation of blood circulating through the venous system and a BP cuff inflates past both arterial and venous pressure, yes, your SpO2 values will be wrong or non existent while the cuff is inflated. Like Halothane said if you're not doing BPs stacked on top of eachother like q2-3 it's not a huge deal. I use the other arm because monitor alarms annoy me though.


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## Drax (Apr 28, 2014)

Appreicate the feedback guys!


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## broken stretcher (Apr 28, 2014)

in my experience with the phillips monitors the pulse ox is accurate except for the 30 seconds the cuff inflates every 5 minutes.


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## Tigger (Apr 28, 2014)

Every monitor I've ever used gives a low perfusion alarm or equivalent when the cuff inflates. Oh well, when you print vitals on the LP12 it doesn't include the discrepancies anyway. Not a big deal.


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## Drax (Apr 28, 2014)

Yeah, I wasn't thinking this was a big deal, just wanted to provide the best possible patient care. If someone were maybe already borderline hypoxic or bradycardic/tachycardic it would be relevant and possibly easier to see visually, but I just wanted to be accurate in recording my results.

With machines, you never can tell, it might give an opposite end reading which could be very bad.


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## Rin (Apr 28, 2014)

If I do both on the same arm, I just wait a minute until I have my bp, resp, & pulse before checking the pulse ox reading to give it a chance to normalize.


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## Angel (Apr 28, 2014)

Rin said:


> If I do both on the same arm, I just wait a minute until I have my bp, resp, & pulse before checking the pulse ox reading to give it a chance to normalize.



I expect it to drop a little so I don't freak out, some times it does, sometimes it doesn't. but >94% im not concerned, especially if the patient is having no resp distress or signs of.


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## ZombieEMT (May 4, 2014)

I think its a problem when only doing them both at the same time. Once you cut off the blood flow to the arm, a pulse ox will not be accurate. If you take a BP and then do a pulse ox after return of blood flow, you should be fine. When I work on a critical care truck we have pulse ox on the patient constantly and BP runs every 15 (or 5 in real critical). We generally put the pulse ox on seperate arms if possible.


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## Akulahawk (May 4, 2014)

When I was doing my hospital clinical, I would normally want to put the BP cuff and the SpO2 sensor on opposite limbs. Sometimes that wasn't an option so i would simply use whatever I could get. If I had to use the same arm for both, I'd just let the SpO2 reading stabilize for a bit before inflating the cuff. When I looked at the "history" of the readings, it would show the SpO2 that it had before inflating the cuff and not a low perfusion SpO2 reading during the times the cuff was inflated. It was probably part of the logic to "understand" that if the SpO2 disappears during a cuff cycle, then it's most likely on the same limb.

If I'm manually doing the data entry, I just look at the SpO2 level right before I inflate the cuff.


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## chriscemt (May 5, 2014)

Drax said:


> With machines, you never can tell...



This is why I prefer to use the same appendage for BP and SPO2/HR.  When taking the BP, when the SPO2/HR fall off, I know the cuff is inflating properly, or at least, I'm more certain that it is, than before.  

No, you shouldn't get an "accurate" reading while taking the BP, but to me, that's a benefit.  Our monitors all seem to work in varying degrees of accuracy and precision.  I tend to make HR and BP manually when there's time to do so.


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## rails (May 6, 2014)

chriscemt said:


> This is why I prefer to use the same appendage for BP and SPO2/HR.  When taking the BP, when the SPO2/HR fall off, I know the cuff is inflating properly, or at least, I'm more certain that it is, than before.



Can anyone else comment on this? Is this a strategy others are using?

I've always used separate arms for the BP vs SpO2.


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## STXmedic (May 6, 2014)

I think people are looking _way_ too far into this.

It really doesn't matter if the pulse ox is on the same arm of the BP cuff or not.

If it's the same arm, then get your pulse ox reading either before or after the cuff inflates. 

I'm not sure what trust issues are required to need to intentionally put them on the same arm to make sure the cuff inflates fully.

If cuff/pulse ox synchronization is regularly on your concern list, you need to reevaluate your priorities I think.

Unless you have a Zoll X and are using its rapid BP mode, it makes no difference. Just don't get a pulse ox reading while the cuff is inflated. That's it. Simple.


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