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The lateral position is too common for doctors and nurses in the operating room.
Many operations require a lateral position during the operation.
Even in some departments, most operations are performed on the side, such as thoracic surgery and urology.
At this time, monitoring blood pressure is A question: Since the height difference between the upper limbs on both sides and the level of the heart is obvious, there will be errors in the results of non-invasive blood pressure measurement.
How much is the difference? Is there a more individualized plan to predict this error? In this article, we try to talk about this issue.
Most of the time, as a first-line anesthesiologist encounters this problem and consults a superior doctor, most of them may be told that the difference is 10-20mmHg, and the cuff is higher than the heart level, and vice versa.
Generally speaking, when measuring blood pressure, the cuff is required to be at the same level as the heart.
In the supine position, the mid-axillary line is flat and the fourth intercostal space is flat in the sitting position.
What about the lateral position? It is basically impossible to reach the same level as the heart; the distance between the left midclavicular line of normal adults and the left upper brachial artery is about 15cm (ie 11.
0mmHg), and the distance from the right upper brachial artery is about 25cm (ie 18.
4mmHg).
Can it be corrected according to the above error? Blood pressure level? For example, the blood pressure of the patient in the right supine position measured by the right brachial artery is 138/85mmHg, and the correction is actually 120/67mmHg.
Is this result correct? If it is a static liquid, the above process is impeccable, but the blood vessels of the human body have tension and the blood in the blood vessels flows at a high speed, and simple difference correction may not be correct.
Reading articles about the influence of lateral position on non-invasive blood pressure [1,2,3], I found that there are not many such studies and they were published earlier, and the quality is not high.
Maybe everyone is not bothered to study such a "simple" problem.
But the results of the study have a surprising discovery.
The actual measurement of the brachial blood pressure of the awake patient in the supine and lateral positions found that the cuff was lower than the brachial blood pressure of the heart (cuff underneath), and the results were not statistically different from the blood pressure in the supine position; while the measurement was higher than that of the heart (cuff) Bring on top) Brachial artery blood pressure is significantly lower than supine position, with an average lower of 14~17mmHg.
This is a surprising finding.
The blood pressure measured on the cuff is lower than supine position and the reduction is expected, but the experiment found that there is no statistical difference.
If the experiment is credible, it is strongly recommended that patients in the lateral position be non-invasive The blood pressure monitors the lower upper arm, the measurement result does not need to be corrected! In order to verify this result, I performed actual measurements with a colleague.
During the measurement, there was no sudden change in blood pressure.
The cuff was tied to the right upper limb, and the blood pressure was measured in the supine position, the cuff is on the upper side, and the cuff is on the lower side.
The following results: Although the experimental results have been verified many times, the evidence is still insufficient, and the selected patients are all conscious patients.
Is there any difference in general anesthesia patients? Further experimental verification is still needed.
Obviously, the experimental results have obvious guiding significance for clinical work.
So far, I suggest: 1.
Non-invasive blood pressure monitoring of patients in lateral position, the first choice is the cuff below.
2.
The upper extremity fluid pathway is the same as that of the operation side or the lower extremity is indwelled.
3.
When the cuff is on the upper side, it is recommended that the blood pressure difference between the last group before turning over and the first group after turning over is used as the correction value.
A little knowledge sharing, I hope you can gain something! References: Ding Zhenjiang, Wang Hong, Xin Hongju, et al.
The influence of posture on non-invasive blood pressure monitoring[J].
CLINICAL HYBRID, 2004, 19(20):1169-1169.
Guo Zhichang, Li Hongwei, Li Jinping.
Posture for non-invasive blood pressure monitoring The impact of blood pressure monitoring[J].
Shanxi Medical Journal (11):861-862.
Fang Yaqun, Ding Zhenjiang, Hao Zhimin, et al.
Comparison of ambulatory blood pressure monitoring results in different positions in the elderly[J].
Guangdong Medical Journal, 2010, 31(10 ): 1367-1367.
Many operations require a lateral position during the operation.
Even in some departments, most operations are performed on the side, such as thoracic surgery and urology.
At this time, monitoring blood pressure is A question: Since the height difference between the upper limbs on both sides and the level of the heart is obvious, there will be errors in the results of non-invasive blood pressure measurement.
How much is the difference? Is there a more individualized plan to predict this error? In this article, we try to talk about this issue.
Most of the time, as a first-line anesthesiologist encounters this problem and consults a superior doctor, most of them may be told that the difference is 10-20mmHg, and the cuff is higher than the heart level, and vice versa.
Generally speaking, when measuring blood pressure, the cuff is required to be at the same level as the heart.
In the supine position, the mid-axillary line is flat and the fourth intercostal space is flat in the sitting position.
What about the lateral position? It is basically impossible to reach the same level as the heart; the distance between the left midclavicular line of normal adults and the left upper brachial artery is about 15cm (ie 11.
0mmHg), and the distance from the right upper brachial artery is about 25cm (ie 18.
4mmHg).
Can it be corrected according to the above error? Blood pressure level? For example, the blood pressure of the patient in the right supine position measured by the right brachial artery is 138/85mmHg, and the correction is actually 120/67mmHg.
Is this result correct? If it is a static liquid, the above process is impeccable, but the blood vessels of the human body have tension and the blood in the blood vessels flows at a high speed, and simple difference correction may not be correct.
Reading articles about the influence of lateral position on non-invasive blood pressure [1,2,3], I found that there are not many such studies and they were published earlier, and the quality is not high.
Maybe everyone is not bothered to study such a "simple" problem.
But the results of the study have a surprising discovery.
The actual measurement of the brachial blood pressure of the awake patient in the supine and lateral positions found that the cuff was lower than the brachial blood pressure of the heart (cuff underneath), and the results were not statistically different from the blood pressure in the supine position; while the measurement was higher than that of the heart (cuff) Bring on top) Brachial artery blood pressure is significantly lower than supine position, with an average lower of 14~17mmHg.
This is a surprising finding.
The blood pressure measured on the cuff is lower than supine position and the reduction is expected, but the experiment found that there is no statistical difference.
If the experiment is credible, it is strongly recommended that patients in the lateral position be non-invasive The blood pressure monitors the lower upper arm, the measurement result does not need to be corrected! In order to verify this result, I performed actual measurements with a colleague.
During the measurement, there was no sudden change in blood pressure.
The cuff was tied to the right upper limb, and the blood pressure was measured in the supine position, the cuff is on the upper side, and the cuff is on the lower side.
The following results: Although the experimental results have been verified many times, the evidence is still insufficient, and the selected patients are all conscious patients.
Is there any difference in general anesthesia patients? Further experimental verification is still needed.
Obviously, the experimental results have obvious guiding significance for clinical work.
So far, I suggest: 1.
Non-invasive blood pressure monitoring of patients in lateral position, the first choice is the cuff below.
2.
The upper extremity fluid pathway is the same as that of the operation side or the lower extremity is indwelled.
3.
When the cuff is on the upper side, it is recommended that the blood pressure difference between the last group before turning over and the first group after turning over is used as the correction value.
A little knowledge sharing, I hope you can gain something! References: Ding Zhenjiang, Wang Hong, Xin Hongju, et al.
The influence of posture on non-invasive blood pressure monitoring[J].
CLINICAL HYBRID, 2004, 19(20):1169-1169.
Guo Zhichang, Li Hongwei, Li Jinping.
Posture for non-invasive blood pressure monitoring The impact of blood pressure monitoring[J].
Shanxi Medical Journal (11):861-862.
Fang Yaqun, Ding Zhenjiang, Hao Zhimin, et al.
Comparison of ambulatory blood pressure monitoring results in different positions in the elderly[J].
Guangdong Medical Journal, 2010, 31(10 ): 1367-1367.
