Educational Info on Taking BP?

[4mybabies]

Last week at my BPP I got a BP of 90/50...that is freakishly low for me. I also thought it was funny that the auto cuff would tighten up, start to take my BP, then tighten up again. I have had mostly REALLY low readings there. Anyway, at the appt. last week, I asked her to take it again. She took it on my right arm and got 130/70 or something..major difference and closer to what I get at home laying down. I am wondering if it had anything to do with the machine being closer to my right side? I do not have much faith in hospital BP's. I hope it all worked out for you!

[anthonyleah12]

I love this post. I can not tell you how many times during my preg. the nurses and I had arguments about this. they insisted that the RIGHT BP was on my left side, I had to explain about 1000000 times that I did not live on my left side. They always reported left side pressuers too. I wonder why so many of us have had the same issues regarding this topic.

[kara]

*THAT* is why Caryn is our 2008 Volunteer of the Year!!

[kelly w]

Caryn, I really wanted to thank you for this info - I DID print this up just before I left for the hospital. I really appreciated having it, because, of course, the nurses did try to pull the old "lay on your left side - you are really OK" stunt this time too.

Thank you so much for taking the time to provide such a thorough reply!

Kelly

[jenni_ann]

Thank you for sharing this information! I had an experience yesterday where this would have been so helpful. I called my dr because of a severe migraine and was told to come in to the office. When I got there, the nurse took my bp in a seated position and it was 160/94 Another nurse came in a little later and talked to me about my symptoms and then asked me to lie on my left side and took my bp again while I was lying down. This time it was 136/78 She said that made her feel much better about my bp. I still didn't feel better because I knew that the minute I sat up and got home it would be right back up where it was, and of course, when I got home it was 158/98. The dr DID increase my bp medication from twice a day to three times a day, but I still feel like I have reached the point I was at with my last pregnancy where my bp just couldn't be controlled with medication. I am at 25 weeks right now, and I have a LONG way to go. I have a really hard time speaking up at the drs when I feel like something just isn't right with the way they are doing things. I know I should have said something to the nurse when she was taking my blood pressure lying down and it was a lower reading.

[caryn]

Can you talk your new OB into taking your pressures?

*sigh*

I would take:

1) the Experts reply here:
http://www.preeclampsia.org/forum/viewtopic.php?t=321

2) the British PRECOG full-text paper here: http://www.bmj.com/cgi/content/full/330/7491/576

with this passage highlighted (it's under Content of the Assessment):

The method of measuring blood pressure is critical: errors have been implicated in maternal deaths.

3) APEC's summary of the guidelines here:
http://www.apec.org.uk/education.htm

Always use accurate equipment (a mercury sphygmomanometer or validated alternative method).

Use a sitting or semi-reclining position so that the arm to be used is at her heart level.

Do not take the blood pressure in the upper arm with the woman on her side, as this will give false, lower readings.

Use an appropriate cuff size:
• Standard size (13 x 23cm) for an arm circumference of up to 33cm.
• Large size (33 x 15 cm) for an arm circumference between 33 and 41cm.
• A thigh cuff (18 x 36cm) for an arm circumference of 41cm or more.

You will introduce less error by using too large a cuff than by using too small a cuff.

Deflate the cuff slowly, at a rate of 2 mmHg to 3 mmHg per second, taking at least 30 seconds to complete the whole deflation.

Use Korotkoff V (disappearance of heart sounds) for measurement of diastolic pressure, as this is subject to less intra-observer and inter-observer variation than Korotkoff IV (muffling of heart sounds) and seems to correlate best with intra-arterial pressure in pregnancy. In the case of the 15% of pregnant women whose diastolic pressure falls to zero before the last sound is heard, then both phase IV and phase V readings should be recorded (eg 148/84/0 mmHg).

Measure to the nearest 2 mmHg to avoid digit preference.

Obtain an estimated systolic pressure by palpation, to avoid an auscultatory gap.

If two readings are necessary, use the average of the readings and not just the lowest reading. This will minimize threshold avoidance (the tendency to repeat a reading until one that is below a known threshold is recorded that requires no action).

Keep us posted, Kelly.

[hols537]

Have you checked the American Heart Association? I think I remember reading about the correct way to take blood pressure - it's not specific to preeclamptics, but I would assume the procedure should be the same. I was trying to check it for you, but my internet is really slow today...

Hope everything is OK on your trip to the hospital. Keep us posted?

[kelly w]

Does anyone know if there is a pdf file or print off anywhere that would explain the *correct* way to take a preeclamptic's blood pressure?

I suspect I'll be heading in to the hospital here in a little while [waiting on a call back from my OB] and it is going to be on a holiday weekend - which means I'll have the "second string" nursing staff most likely.

I really want to avoid the conflict over "you can't lie me on my left side and take a blood pressure on my right arm and then report my BP as low to my doc when it is 160/100 sitting up....".

I thought it might be nice if I could just print off some clinical education media of some sort from either ACOG or the PE foundation or *somebody* reputable and take it with me...

Anyone know of such a thing?

Thanks!

Kelly