Friday, July 13, 2007
This presentation is part of : EBN Innovations
Alternatives to Manual Cuff Blood Pressures on Bariatric Patients
Shirley A. Thomas, RN, BSN, MPA, Vascular and GI Surgery Unit and Lift Team, University of California Davis Health System, Sacramento, CA, USA
Learning Objective #1: Identify 2 articles on vitals signs on bariatric patients.
Learning Objective #2: Identify proper measurements and fit of blood pressure cuffs.

In one case study it was determined that the arterial blood pressure and manual blood pressure on one bariatric patient had as much as 18 mmHG difference. A chart review showed in the PACU a manual blood pressure that was consistently higher than the arterial blood pressure.


I was tasked with investigating the state-of-the-art measurement of blood pressures or best practice for bariatric patients and to make recommendations of monitoring the blood pressures in bariatric patients for the hospital.


We conducted an extensive literature review. We found very little published on the topic of vital signs on bariatric patients. There were references that made recommendations primarily for proper fitting of the manual cuff. All products in the studies were for home use only and could not be properly cleaned for infection control measures in the hospital.


One new product referred to as a wrist sensor pressure device was discovered. We trialed the device for 2 weeks on staff members. The data results showed inconsistency in blood pressures from manual blood pressures of 30 mmHG or less and inconsistencies with the staff’s stated known blood pressure. The device was significantly higher in nearly every case. The product was rejected.


It was decided to adapt the vital signs policy to (1) watch for trending of blood pressures, (2) to properly fit the cuff and (3) to accept wrist manual blood pressures as an alternative to upper arm blood pressures if the proper cuff size was not available.