# How to get B/P's in places besides arms?



## RMApok (Aug 19, 2006)

We had a pt today I had no clue how to get a B/P on. They had their left arm amputated and their right arm had a dialysis shunt in it. It was a transfer pt, so in the hospital we wrapped the electronic vital machine around their calf and got a BP that way. But in the box (we have no lifepacks) how would you get one? I just wrote "Unable to obtain B/P" on my run form and describe the procedure, but is their a place to listen to that will yield accurate results? I was never trained of one.


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## MMiz (Aug 19, 2006)

Their neck of course.  I kid I kid. Is there any reason why you wouldn't be able to obtain a calf BP in the field?  We have calf-sized cuffs on our rigs.


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## RMApok (Aug 19, 2006)

Well, I never learned to take a BP anywhere but the arm. Where exactly do you place the steth on a leg BP, and is it accurate?


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## MariaCatEMT (Aug 20, 2006)

RMApok said:
			
		

> Well, I never learned to take a BP anywhere but the arm. Where exactly do you place the steth on a leg BP, and is it accurate?



*Posterior tibial pulse behind the inner ankle*


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## Ridryder911 (Aug 22, 2006)

Actually, the most accurate place would be the popliteal (behind the knee) when using thigh cuffs, since it is the largest and most accessible. Dorsal pulses are hard to auscultate, if using a "calf" reading. Remember the reading will and should be interpreted different because of the distance. 

R/r 911


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## Chimpie (Aug 22, 2006)

Ridryder911 said:
			
		

> Actually, the most accurate place would be the popliteal (behind the knee)


Flash back to Ally McBeal.


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## ResTech (Sep 2, 2006)

If it were me personally I wouldnt have worried with a B/P in that situation. There are other perfusion parameters that can be assessed to gauge overall perfusion status (ie heart rate, resp status, pulse strength, skin quality, SpO2, mental status) in the stable pt. such as yours. And if a B/P was just obtained prior to departing the originating facility and was good, then document that. I would have documented pt's. one arm and shunt and been done with it.

But, yeah what everyone else said if you really need to obtain a B/P.


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## fyrdog (Sep 7, 2006)

You should be able to take a BP anywhere youcan compress an artery. I've seen some place the automatic cuff on the forearm because the patient had so many clothes on. Turned out accurate. Of course the the larger tha artery the better you will hear it with your scope. The corotid artery is not recommended however.


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## Jon (Sep 7, 2006)

Serious Question - Why can't we take a BP in an arm that has a dialysis shunt, or on the side someone had a masectomy on?

I've heard different reasons for both. RidRyder?


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## emtbuff (Sep 7, 2006)

For the masectomy I'm not sure but for the dialysis shunt I believe it is for risk of clotting off the shunt and that it in turn not being able to use it again.  Or something along that line.


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## Ridryder911 (Sep 7, 2006)

It has to do with lymphatic system, impedance or circumferential around can cause increase edema and thus damage (remember thoracic duct, etc). As well, the impedance in the A/v shunt can be damaged with changes in pressure. 

R/r 911


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## Airwaygoddess (Oct 1, 2006)

Jon said:


> Serious Question - Why can't we take a BP in an arm that has a dialysis shunt, or on the side someone had a masectomy on?
> 
> I've heard different reasons for both. RidRyder?



Dialysis shunt -can clot off and could also rupture. 
Masectomy- due to the veins and arteries that where cut during the surgery, and also the lymph node glands that were also cut.
Hope it helps!


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## pvit486 (Nov 6, 2006)

Okay, so let's make this clear, I would put the cuff around the calf or thigh to obtain a accurate reading?


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## Airwaygoddess (Nov 6, 2006)

The back of the bee's knees with a thight cuff!! practice practice practice


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## bikenburn (Nov 7, 2006)

When a mastectomy is completed, the surgeon typically will go up superiorly into the axillary region and remove some of the lymph nodes in the axial plexus.  The lymph system serves as a great defense for infection and health status, although it also tends to be a secondary pathway to spread cancers throughout the body.  If you occlude the arm on a side with a mastectomy, you have a good chance of compressing the lymphatic system and causing lymph edema in the arm/armpit.  While this is typically not a pleasant side effect, it also can cause medical complications in the long run such as more surgery to relive the affected area.


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