Aa
Proper bp taking
We have been trying to track my son's (dx POTS...undiagnosed other issues) blood pressure for a little while now to see if we can find a pattern. (no luck yet) One problem we're having is getting a good blood pressure reading when he's standing up. I've read (on dynakids) that it's best to elevate his arm onto something so it's level with his heart while we're taking his bp. That's not so easy to do since he's 6'3", but that's not the real problem.
We've also heard (from our cardiologist) that it's fine to take it with his arm hanging by his side. That's what they did when they gave him the "poor man's tilt test" as Christydrake called it once. :)
When Nick is feeling poorly and we try to take his bp with his arm at his side we get crazy readings. Sometimes it is too low or high and the machine takes 2 or 3 times to get a reading. We get a lot of error messages when he is feeling his worst. Last night it was 176/132 after a few tries. We tried once more with his arm elevated to horizontal, and the bp was118/58. Nick felt like after standing there for so long trying to get a good reading he had started to feel better and the last reading wasn't a good indicator of what it was when he was feeling bad. He commented to me that whenever we take his bp with his arm elevated the numbers are closer to "normal" than what he is actually feeling.
What is your experience? Do you find that either way (hanging or horizontal) gives you a more accurate reading?
We've also heard (from our cardiologist) that it's fine to take it with his arm hanging by his side. That's what they did when they gave him the "poor man's tilt test" as Christydrake called it once. :)
When Nick is feeling poorly and we try to take his bp with his arm at his side we get crazy readings. Sometimes it is too low or high and the machine takes 2 or 3 times to get a reading. We get a lot of error messages when he is feeling his worst. Last night it was 176/132 after a few tries. We tried once more with his arm elevated to horizontal, and the bp was118/58. Nick felt like after standing there for so long trying to get a good reading he had started to feel better and the last reading wasn't a good indicator of what it was when he was feeling bad. He commented to me that whenever we take his bp with his arm elevated the numbers are closer to "normal" than what he is actually feeling.
What is your experience? Do you find that either way (hanging or horizontal) gives you a more accurate reading?
wow--great information about the narrow pulse pressure! And it makes perfect sense. Nick is feeling his worst when his pulse pressure is narrow, whether his blood pressure is high or low. I've been thinking that we must be getting errors b/c his blood pressure is too low, then when we actually get a reading, it's high. But if it's the pulse pressure causing the error, that makes complete sense. Thank you!
FWIW, our cardiologist told me it is very unlikely that Nick has such narrow pulse pressure. He seemed surprised that I knew anything about it, and told me that it's very unlikely my readings are accurate. In the next sentence he told me that he believes my readings are true and he prescribed atenolol. go figure.
FWIW, our cardiologist told me it is very unlikely that Nick has such narrow pulse pressure. He seemed surprised that I knew anything about it, and told me that it's very unlikely my readings are accurate. In the next sentence he told me that he believes my readings are true and he prescribed atenolol. go figure.
thank you very much ,
all the discription make sence now! I thought my erroor 's were from a fainter pulse.
i will much more aware now to figure the lowest pulse pressure
yes, just yesterday at my cardo, my nurse does hold my arm at her ellbow and hip
when i do take it at home alone, i have a dresser drawer i put the machine on and pull out the drawer to rest my arm on
i'v have a clinic machine get error with the tech scratchh her head, now i can tell themm why it is!
all the discription make sence now! I thought my erroor 's were from a fainter pulse.
i will much more aware now to figure the lowest pulse pressure
yes, just yesterday at my cardo, my nurse does hold my arm at her ellbow and hip
when i do take it at home alone, i have a dresser drawer i put the machine on and pull out the drawer to rest my arm on
i'v have a clinic machine get error with the tech scratchh her head, now i can tell themm why it is!
Thanks for the info. The EE's drive my son crazy and then he just wants to give up, so it sounds like maybe we should post EE. Although, Cody's blood pressure goes up-not down.
I'm not sure about the cardiologist, but all of my cardiologists and cardiac nurses do it with arm at heart level and ask that I do the same.
I can, however, give you a pretty good explanation for why you're getting all those errors and then finally a number that doesn't seem accurate. It happens to me A LOT when I'm doing especially poorly. Many BP machines (for some reason—I really wish I knew why, I have talked directly to the manufacturer, and have narrowed down *what* the problem is but not *why* or found any solution, unfortunately) will not take a reading and will instead say E or error if the pulse pressure is too low. The threshold for my machine (Omron's top model for home use) is a pulse pressure of 17 or 18; below that it will *always* give an error.
Pulse pressure is the number you get when you subtract your diastolic (bottom number) from your systolic (top number) blood pressure. A normal resting pulse pressure is 40. Plummeting pulse pressures upon standing are not unusual in pre-syncope and an extremely narrow pulse pressure may be present when a person has syncope. That being said ... back to the machine ...
So while I'm there fussing with my machine, getting "E" reading after "E" reading, I'm (often inadvertently) fidgeting around more than I normally would be, maybe readjusting the cuff a bit, trying to elevate my arm a little more or less ... ANYTHING to coax a reading out of the machine because let's face it: my heart is beating over 150 bpm, my blood pressure is low and my pulse pressure is abysmal (so I'm not perfusing well), and I feel like I could keel over at any minute. I just want it to be OVER WITH!! Well, all that fidgeting (and likely some of the frustration as well) gets the skeletal muscles helping the blood return to the heart more efficiently, raises the blood pressure (we all know anger/frustration can do this), and so by the time you DO get the machine to give you a reading, it's because you've brought yourself out of the wonky state that you were trying to quantify and document in the first place. The reading is bogus, and often pretty useless. Also, if you've been inflating and deflating that cuff over and over and over from error after error trying to get a decent reading out of it, you've likely squeezed the heck out of your blood vessels in that arm anyway, so who knows whether anything in there is working normally at this point regardless of what else you're doing differently?
The short of it: it may be more informative to just record "error, pulse pressure <X, HR=" in lieu of a machine reading at that time. If you start calculating your pulse pressures for every reading you take, you'll find out over time below what pulse pressure your machine goes to error and you can use that number as X. As for the heart rate, you'll have to get that the old fashioned way. A note on that: some may have localized vasoconstriction funkiness that makes taking the pulse at the wrist inaccurate; not sure how many this affects, but it's a problem I have so I want to make others aware of it in case it's happening to others without them realizing. It may be best to take your pulse at a larger vessel like in the neck or by listening directly to the heart (each lub-dub counts as one because a heartbeat has two parts ... guessing we all know this, but just a reminder).
The other thing you may want to note over time is how much your BP typically drops from sitting to standing under different circumstances (will likely be more under heat stress like in 90 degree weather, e.g., so track different ranges for different circumstances). Then you can estimate what the standing pressure might have been from what you know about how much a typical drop would be, how much the sitting pressure was, and what the current circumstances are (sick or healthy, temperature, been resting or active, etc.).
Sorry I don't know of a machine that doesn't have the pulse pressure issue. I've even seen the ones they wheel around in the hospital ward have this problem and the PCAs think they have a "broken" machine only to go find another one to have the same issue. The ones built in to the ECG/resp monitors in the wall don't seem to have the same problem but goodness knows how much the hospital pays for those, LOL!!
I can, however, give you a pretty good explanation for why you're getting all those errors and then finally a number that doesn't seem accurate. It happens to me A LOT when I'm doing especially poorly. Many BP machines (for some reason—I really wish I knew why, I have talked directly to the manufacturer, and have narrowed down *what* the problem is but not *why* or found any solution, unfortunately) will not take a reading and will instead say E or error if the pulse pressure is too low. The threshold for my machine (Omron's top model for home use) is a pulse pressure of 17 or 18; below that it will *always* give an error.
Pulse pressure is the number you get when you subtract your diastolic (bottom number) from your systolic (top number) blood pressure. A normal resting pulse pressure is 40. Plummeting pulse pressures upon standing are not unusual in pre-syncope and an extremely narrow pulse pressure may be present when a person has syncope. That being said ... back to the machine ...
So while I'm there fussing with my machine, getting "E" reading after "E" reading, I'm (often inadvertently) fidgeting around more than I normally would be, maybe readjusting the cuff a bit, trying to elevate my arm a little more or less ... ANYTHING to coax a reading out of the machine because let's face it: my heart is beating over 150 bpm, my blood pressure is low and my pulse pressure is abysmal (so I'm not perfusing well), and I feel like I could keel over at any minute. I just want it to be OVER WITH!! Well, all that fidgeting (and likely some of the frustration as well) gets the skeletal muscles helping the blood return to the heart more efficiently, raises the blood pressure (we all know anger/frustration can do this), and so by the time you DO get the machine to give you a reading, it's because you've brought yourself out of the wonky state that you were trying to quantify and document in the first place. The reading is bogus, and often pretty useless. Also, if you've been inflating and deflating that cuff over and over and over from error after error trying to get a decent reading out of it, you've likely squeezed the heck out of your blood vessels in that arm anyway, so who knows whether anything in there is working normally at this point regardless of what else you're doing differently?
The short of it: it may be more informative to just record "error, pulse pressure <X, HR=" in lieu of a machine reading at that time. If you start calculating your pulse pressures for every reading you take, you'll find out over time below what pulse pressure your machine goes to error and you can use that number as X. As for the heart rate, you'll have to get that the old fashioned way. A note on that: some may have localized vasoconstriction funkiness that makes taking the pulse at the wrist inaccurate; not sure how many this affects, but it's a problem I have so I want to make others aware of it in case it's happening to others without them realizing. It may be best to take your pulse at a larger vessel like in the neck or by listening directly to the heart (each lub-dub counts as one because a heartbeat has two parts ... guessing we all know this, but just a reminder).
The other thing you may want to note over time is how much your BP typically drops from sitting to standing under different circumstances (will likely be more under heat stress like in 90 degree weather, e.g., so track different ranges for different circumstances). Then you can estimate what the standing pressure might have been from what you know about how much a typical drop would be, how much the sitting pressure was, and what the current circumstances are (sick or healthy, temperature, been resting or active, etc.).
Sorry I don't know of a machine that doesn't have the pulse pressure issue. I've even seen the ones they wheel around in the hospital ward have this problem and the PCAs think they have a "broken" machine only to go find another one to have the same issue. The ones built in to the ECG/resp monitors in the wall don't seem to have the same problem but goodness knows how much the hospital pays for those, LOL!!
what do you make of the cardiologist taking his bp while his arm was hanging down then? Just lazy on their part or is there something to that?
When Cody is standing, we have his arm held out, rather than hanging. His readings with his arm bent are still really high. But his readings, and how he is feeling frequently don't tie together.
His readings can be extremely high, he doesn't even feel it and he feels okay. While sometimes the readings are fine and he feels horrible.
To check if we are getting a good reading, sometimes I take my bp/hr to make sure it is normal. We also frequently get EEEE on the machine and it is usually when he has high readings. It also is usually when he is feeling bad and doesn't want to keep retaking the reading and I have to push him to not take the cuff off and redo it.
His readings can be extremely high, he doesn't even feel it and he feels okay. While sometimes the readings are fine and he feels horrible.
To check if we are getting a good reading, sometimes I take my bp/hr to make sure it is normal. We also frequently get EEEE on the machine and it is usually when he has high readings. It also is usually when he is feeling bad and doesn't want to keep retaking the reading and I have to push him to not take the cuff off and redo it.
Thanks Tonya--it makes sense to me that keeping his arm level with his heart would give the most accurate reading. We do that when he's sitting.
But he feels like it's not right when we keep his arm up--that the reading we get when it's down matches up better with how he's feeling. FWIW, his heart rate doesn't change much on the machine, so it's not machine error....
But he feels like it's not right when we keep his arm up--that the reading we get when it's down matches up better with how he's feeling. FWIW, his heart rate doesn't change much on the machine, so it's not machine error....
Hey there :)
Yes, I too find a more accurate reading when arm is around heart level or even waist level is better than hanging.
Even when sitting down, for a better reading.....It is best to have arm sitting oustretched on a counter or whatever you are sitting near so that arm is about heart level. (learned that in nurse school).
So that would make sense while standing too right? Just my 2 cents :)
Have a Great Week.
~Tonya
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