# BP Cuff on forearm--experience/thoughts?



## reidnez (Mar 23, 2010)

Hey there!

The other day I was visiting my cousin in the hospital. Her RN came in to take vitals and I noticed that she put the BP cuff on my cousin's forearm. It was a disposable cuff connected to the automated monitor that hospitals typically use. The nurse looked pretty busy so I didn't want to hold her up with questions, but it made me curious.

I was wondering if anyone has seen or used this technique prehospital. My thought was that if you had a bariatric patient and none of your cuffs were large enough for their upper arm, you could probably get a regular-size cuff over the forearm and then either palpate or auscultate the radial. I'll try it on my girlfriend when she gets home, though she is nowhere near bariatric .

Thoughts? Experience? Thanks!


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## TransportJockey (Mar 23, 2010)

I've used it prehospital and in hospital both with automated machines and with a steth doing it manually. Works pretty good.


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## Shishkabob (Mar 23, 2010)

There are studies on this, some stating minimal changes in mmHg between upper arm and forearm, and other studies stating as much as 20mmhG difference.


Honestly if it's a choice between no bp, and one that would be a bit off, I'd go with the one that would be a bit off.


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## reidnez (Mar 23, 2010)

Linuss said:


> There are studies on this, some stating minimal changes in mmHg between upper arm and forearm, and other studies stating as much as 20mmhG difference.
> 
> 
> Honestly if it's a choice between no bp, and one that would be a bit off, I'd go with the one that would be a bit off.



That is interesting. My minimally-educated hunch is that pressure would decline to some degree as you go distal, just as palpable pulses do. 20mm/Hg could make a difference in some cases, e.g. the decision to give nitro. But as you say, an inaccurate BP reading is better than none at all.


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## LucidResq (Mar 23, 2010)

I have yet to have a patient so large a bariatric cuff wouldn't work. I'm sure they're out there, but they're very few and far between.


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## reidnez (Mar 23, 2010)

LucidResq said:


> I have yet to have a patient so large a bariatric cuff wouldn't work. I'm sure they're out there, but they're very few and far between.



True, on the ambulance or in hospital you will usually have big cuffs so it's not an issue. I was thinking more of standby/event/first-responder situations where you just have your bag, and probably only have an adult and maybe pediatric cuff since those will cover 90% of patients.


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## reaper (Mar 23, 2010)

I have used in on a NIBP. It will work and is fairly accurate.

Even large cuffs will not give you accurate BP on a lot of obese pt's. If their arms are large at the top and skinnier towards the bottom, the cuffs will not be able to inflate evenly. This is the normal pt's where a forearm BP will be more accurate!


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## LondonMedic (Mar 24, 2010)

Linuss said:


> Honestly if it's a choice between no bp, and one that would be a bit off, I'd go with the one that would be a bit off.


I agree in principle, but I would suggest adding the caveat that it's only acceptable if everyone involved knows what that 'bit off' means and what it could be.


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## MS Medic (Mar 24, 2010)

I have had to do it with an auto BP (and yes the pt was so big that the large adult cuff the LP12 comes with would not fit around the upper arm). I found the readings very unreliable and I would rather use a manual cuff and palpate a pressure in this situation.


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## eveningsky339 (Mar 24, 2010)

I've seen the forearm used even in patients who are far from bariatric, though this occurred in a clinical setting.  I'm not entirely sure why the forearm would be selected on a non-bariatric patient, though.


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## 8jimi8 (Mar 24, 2010)

MS Medic said:


> I have had to do it with an auto BP (and yes the pt was so big that the large adult cuff the LP12 comes with would not fit around the upper arm). I found the readings very unreliable and I would rather use a manual cuff and palpate a pressure in this situation.



how are you using a manual cuff and palpating if it doesn't fit?


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## 8jimi8 (Mar 24, 2010)

reidnez said:


> Hey there!
> 
> The other day I was visiting my cousin in the hospital. Her RN came in to take vitals and I noticed that she put the BP cuff on my cousin's forearm. It was a disposable cuff connected to the automated monitor that hospitals typically use. The nurse looked pretty busy so I didn't want to hold her up with questions, but it made me curious.
> 
> ...



When we do this in the hospital, we always document where the blood pressure was taken on the patient and what tools we used.

Sure accuracy is off, but you can get a partial picture from the trend... and hey if you have pulses... then you have some minimal palpated pressures too, right?


forgot to add... we also do them on the legs.  And  a great reason not to do blood pressures on someone's arm is a contraindication such as an AV Fistula


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## wwwguest (Mar 24, 2010)

*forearm b/p*

I use this technique and it is fine. Sometimes when someone is boarded, clothing is a problem. You can usually slide sleeve up enough to get b/p on forearm. It wont move your immobilized pt enough to risk more injury. Plus dont have to cut clothing if not needed!


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## spinnakr (Mar 24, 2010)

reidnez said:


> That is interesting. My minimally-educated hunch is that pressure would decline to some degree as you go distal, just as palpable pulses do. 20mm/Hg could make a difference in some cases, e.g. the decision to give nitro. But as you say, an inaccurate BP reading is better than none at all.


That's going to depend on a lot - if, for example, the patient is standing (or the arm is just vertical), then the pressure closer to the ground should be _higher_ - albeit marginally so.  However, particularly in patients with a low blood volume, you can see a huge difference between standing, sitting, and supine anyways - so it's very tough to say.  Best just note where the BP was taken.



wwwtraumamedic said:


> I use this technique and it is fine. Sometimes when someone is boarded, clothing is a problem. You can usually slide sleeve up enough to get b/p on forearm. It wont move your immobilized pt enough to risk more injury. Plus dont have to cut clothing if not needed!


Erm, just cut the clothing, seriously.  If the patient is boarded and comes in to the hospital on the board with an intact shirt, then the ER staff will cut it.  Particularly if it's blocking the upper arm.


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## Radioactive (Mar 24, 2010)

Along the lines of this thread:

I had a nurse say to me the other day that in the near future everyone will be taking BP's at the wrist with automated cuffs.  My instructor doesn't even like the normal upper arm type of automated cuffs that are in fairly common use, but he's pretty old-school.  So what's that about with the wrist?


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## mikie (Mar 24, 2010)

*It was probably cancer...*

Check out this thread: 

BP - Auscultation over Radial


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## MS Medic (Mar 27, 2010)

8jimi8 said:


> how are you using a manual cuff and palpating if it doesn't fit?



Putting a manual cuff on the forearm and palpating.

Looked at that other thread. Never thought of ausculatating the radial pulse will look into that some more. Thanks Mike.


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## MS Medic (Mar 27, 2010)

Radioactive said:


> Along the lines of this thread:
> 
> I had a nurse say to me the other day that in the near future everyone will be taking BP's at the wrist with automated cuffs.  My instructor doesn't even like the normal upper arm type of automated cuffs that are in fairly common use, but he's pretty old-school.  So what's that about with the wrist?



My understanding about the auto BP is that it only measures the map and then runs an algorith to "determin a BP". I could be wrong on this. But if that is correct then you never actually get the systolic or diastolic BP.


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## Turner (Apr 21, 2010)

They do this a lot in dialysis centers.


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## Aidey (Apr 22, 2010)

In dialysis centers things are a little different because they have to avoid any fistulas/grafts the pt has. 

I've done them on the wrist and seen them done on the wrist at hospitals/SNFs. Like someone said above, sometimes the shape of the persons upper arm makes it impossible for the cuff to inflate evenly, so the wrist is a better option.


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## adamjh3 (Apr 22, 2010)

So is auscultating over the radial site "a better option" that is accurate, or better than no BP at all? I've seen that thrown around, and I'm not quite understanding how getting an inaccurate BP could be beneficial to the Pt, and I could definitely see a few ways it could be detrimental. 

I'll try this at class tonight, I'll get someone's BP in the upper arm, and then the wrist, I'll report my findings.


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## Shishkabob (Apr 22, 2010)

It's better than no bp at all, but like the link I posted, BP from the upper arm can vary from the BP of the forearm from no mmHg to 20mmHg.

Granted, most of the time a few mmHg won't make much a difference, but it's clinical judgement.


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## adamjh3 (Apr 22, 2010)

Okay, thanks, Linuss :beerchug:


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