Is blood pressure a shoulder-shrugging matter?I

[oldborris]

I ask 'cos I'm all topsy-turvey at the moment. I don't know whether I'm over the moon or under the carpet. To put it in a single word of one syllable - I'm totally confused, bejabbered, and bewildered.

In my dialysis room there are four beds, three patients, one nurse, one weighing machine [inaccurate] and two blood pressure machines.

The latter are the cause of my bejabberment. One machine, for the purpose of clarification, we will call.....sorry, I will call [I must get out of this habit of speaking in the Royal plural: it's a habit I picked up from my friend in the Big House on the Mall] Blood Pressure Machine No. 1, hereinafter conveniently condensed to BPM 1. The other machine is, unsurprisingly, called Blood Pressure Machine No 2, or BPM 2. I ussually used BPM 1 'cos that was most conveniently situated in respect to my dialysis bed and, on average, this gave a pre-dialysis reading of round about 132, mid-dialysis going down to 97 and sometimes as low as in the eighties and post-dialysis of 123 which encouraged me sufficiently to considered the possibility that I might still be alive and to risk the journey home.

Essential to the understanding of my predicament is that both machines are, despite sharing the same room, the same nurse and the same patients, totally at odds with each other. One will give one reading. The other, in a rebellious spirit of contradiction, for which it is famous, gives a quite different reading. Until recently I learned to live with this.

But a month or so ago my neph increased my dry weight from 62.5 kilometres...sorry, kilogrammes to 63. This, apparently, for I can think of no other explanation, so infuriated BPM 1 that it went completely berserk and recorded a pre-dialysis reading of 197. While waiting for either a doctor or an undertaker to arrive [to be on the safe side I asked for both] I tried BPM 2. This, in a more conciliatory mode, partially reassured me with a reading of 154 which, although much higher than usual, was a lot better than the heart-attacking, pulse-stopping reading from BPM 2. A mid-dialysis reading from BPM 2 showed a gentle slow-down to 114 [again beeter than the usual eighties and ninetines favoured by BPM 1] and finished post-dialysis with a comfortable-going-home-with 123.

Now - and this is the crux, the kernel, the point [you knew I would get around to it eventually, did you not?] of my dilemma. It was obvious to me that BPM 1 was off its head, out to lunch, in la-la land, it's BUN gone through the roof and should be reported. I couldn't think that it had it in for me personally and that I was the only victim of its dearranged mind.

I suggested to the nurse that if I was getting wrong readings so were other patients and that neither they nor I were being treated properly if reliance were placed on such inaccurate readings.

Her response was a shrug of her shoulders. Never mind that they were exceptionally nice shoulders, beautifully shaped and contoured, an open invitation to seduction although concealed beneath a cascade of golden hair. A shrug is a shrug is a shrug irrespective of the nature of the shoulders from which it emanates.

Now my question to my fellow members of this board. Should she have shrugged? Are blood pressure readings of so little importance in the treatment of renal failure and the administration of dialysis that inaccurate readings can be dismissed so casually.

I await, with consuming concern, your verdict.

[oldborris]

Sooorrrryyy! In the above I wrote "a lot better than the heart-attacking, pulse-stopping reading from BPM 2".

That should, of course, have read: "heart-attacking, pulse-stopping reading from BPM 1"

But, naturally, you will have already noticed that.

[JMan]

In short no she shouldn't but this is typical of the 'oh they get checked so they are OK' attitude of todays staff.. You will still find a few staff, nurses and doctors etc, who would bother to go and dig out a manual sphygmanometer, usually a dial type these days though there is the odd Accoson mercury lurking about in docs offices. This they would then use to gain an accurate reading. This of course illustrates where problems lie when we rely COMPLETLY on technology, with no manual backups in place.

Those machines are supposed to be rechargeable, but rarely are they serviced often enough for them to hold a charge to make them usable. So they have to be plugged in, switched on etc etc. A well trained staff member can do 2 - 3 patients with a pocket sphyg in that time.

(And I'm not even going to go into the possible hygeine problems:))

Just my 2p's rant.

You may have noticed that hearing of this sort of thing occurring irritates me slightly. But its up to you if you want to take the matter further with them. I probably would.

[debbie]

I agree.... what was wrong with the manual method? When on hd I would insist on having it checked manually if machine gave rogue reading, staff didn't like doing it but tough.... often my bp would have dropped and machine didn't agree. The machines always gave me a high pulse because they pick up extra beats, but when done manually it was at least 20 bpm less!!!! As for hygiene I would make sure my bp was taken with the cuff over a sleeve... and I always wiped the scales before getting on them

[oldborris]

Yes, me too. I always keep my sleeve rolled down tho' staff tell me that I won't get an accurate reading. As if they cared! But I never argue with my neph who insists on bare flesh. I just don't have that kind of courage even though I have in my lifetime commited some quite extraordinary acts of courage, once actually crossing a street in Bangkok! But being probably the most modest man in the Universe [with the possible exception of one chap I met on Ursa Minor], I don't boast about it.

[Rachel in NY]

Off track yet on topic... just like sometimes they don't care about the fact that machine is causing inaccuracies.. they sometimes don't care what your BP is. Once post surgery I was in recovery room I guess and I had a bp cuff on my arm which automatically inflated/checked my bp every few minutes. I was able to twist my head back and up and 'read' the results on the digital display behind me. Once it began beeping and beeping and it was super high, everything was alarming, yet nobody came over to me. Nobody even turned in my direction. It didn't bother me, bc I tend to be very 'erratic' post surgery. During surgery for some reason my bp always plunges, sometimes incredibly low, but they moniter it, etc, and afterwords it jumps around for a few hours, and from minute to minute it'll jump 20 pts or so. up or down. So like I said, it didn't bother me, but what's the point of unmonitered monitering?

Oh and by the way, manual vs. automatic. At home I have both an automatic bp checker, and a manual. We get VERY varied readings between the 2. In addition, if the battery is low on the automatic, we'd tend to get funky readings. If its plugged in to an outlet rather then using the battery, we'd get a diff set of readings. We thought it was the machine, and got the best on the market, but it still has very flakey results. Its more convienent bc I can do it myself. But the manual way (which someone else has to help me with) gives perfect results, every time. Bc its technically flawless.

[JMan]

just an addition that we also bought a manual BP cuff.. a mercury one is quite pricy around £80. an aneroid (dial) one I think is cheaper)

http://www.accoson.com/ are the peeps to talk to if you think of getting your own. They are based in Islington London and what they don't know about BP machines isn't worth knowing. Their front page makes some interesting reading relevent to this thread as well.

[Rachel in NY]

Also sometimes you can get them from like hospital/medical supply shops that either go out of business, or dr.'s offices/clinics that move/go out of business. Then they have odd sales and sell off old equipment. That's how we got our manual mercury blood pressure cuff with stand, and stethescope, etc. The whole deal, just like a dr. would have. You don't need a prescription to purchase. And a medical supply shop was selling out, and we got it then. So that's a thought if yu want/need this sorta thing.

[rubincain]

You can get a wrist cuff BP monitors for £30 on eBay. I would defiantly go for one of those (In fact i have ). In terms of the electronic ones at the hospital learn to read your own blood pressure off of the digital reading as it goes down. Even if it gives you an incorrect reading at the end thats only because of the sensor is needing recalibrated, you should still be able to sense when the vein starts pumping blood again, this gives you the systolic (upper) and when you cant feel the pumping anymore this gives you the diastolic (lower) Blood pressure is the number one killer of dialysis patients as it leaders to heart problems. You definatly want to be less than 130/90 pre dialysis and not too much lower post.