Nurse bias lingers against automated pressure cuffs
Opposition stems from nursing myths
ICU nurses continue to show reluctance to using automated, electronically adjusted blood pressure cuffs on heart patients, despite a growing body of evidence that shows automated pressure cuffs are as safe as manual cuffs on thrombolytic therapy patients.
Recent studies have shown that automated cuffs are no more harmful than manual cuffs in preventing skin hemorrhages linked to the use of thrombolytic, or anti-blood-clotting, medications on patients suffering from myocardial infarction.
In fact, the occurrence of purpuric lesions has more to do with the type of thrombolytic agent used than the type of cuff favored by clinicians, according to researchers. Yet, nurses appear to favor using manual cuffs nonetheless.
The use of manual cuffs is perfectly all right, says researcher Lauren Saul, RN, MSN, a cardiovascular clinical nurse specialist at UPMC Shadyside, a hospital affiliated with the University of Pittsburgh Medical Center in Pennsylvania. But bedside nurses should not avoid automated cuffs out of safety concerns.
When using either type of cuff, however, bedside nurses need to be on guard against the development of purpura, which normally results from the combination of taking frequent blood-pressure readings and the thrombolytic therapy, Saul says. The bruising could occur from the repeated rubbing of the cuff around the patient’s arm.
Patients with myocardial infarction are particularly vulnerable to skin bruising due to the heavy dosages and types of anti-blood-clotting agents used on them, Saul adds. Much of the bias in favor of manual cuffs has been the result of myths and anecdotal observations, not research, studies have shown.1
Nurses can, in fact, bias the accuracy of assessments when using manual cuffs by interjecting their own values on how tightly the cuff should be placed or how high the starting pressure level should be on a individual patient. These biases can alter the final pressure reading in subtle ways.
Reference
1. Saul L, Smith J, Mook W. The safety of automatic vs. manual blood pressure cuffs for patients receiving thrombolytic therapy. Am J Crit Care 1998; 7:192-196.
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