Comparison of the left upper arm and forearm non-invasive blood pressure's in adult Emergency Department patients: a randomised cross over study

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It is important Emergency Department (ED) staff gain accurate and timely blood pressure measures on acute patients. The blood pressure (BP) measurement is a vital component of a patient’s assessment. It provides an essential cardiovascular measurement for ED clinician’s to use for assessing the stability of a patient and for prescribing acute medical treatment. Evidence advocates that auscultation of the upper arm at heart level is the recommended technique for a non-invasive blood pressure measurement. However internationally, when the upper arm is unavailable or the patients arm circumference is too large; the forearm is being utilised as a blood pressure site. Although guidelines suggest that the forearm can be used, there is limited evidence to support this practice. In New Zealand, a forearm BP is not common practice. Forty four Emergency Department patients that meet the inclusion criteria will be recruited to have both their left upper and lower arm blood pressure measures taken using standard technique by an automated device. The order of blood pressure measurement will be randomised using a simple block two computer generated sequence. Allocation concealment will be done by sequentially numbered sealed opaque envelopes. Agreement between the two measures will be determined using Bland-Altman plots which plot the difference between the two blood pressure measures (for both systolic and diastolic blood pressure) against the average of the two measures

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