Biceps muscle injury associated with non-invasive automatic blood pressure monitoring.

This case describes a young, healthy woman who developed a grade 1 biceps muscle strain after the use of automatic non-invasive blood pressure monitoring during an elective surgical procedure. She was treated conservatively with simple analgesia, physiotherapy and a sling for comfort. Follow-up conducted 1 week later revealed occasional soreness, but she had almost returned to her baseline activity. The patient made a full recovery without any residual symptoms by the end of 6 weeks. This case highlights the importance of careful monitoring to ensure that routine use of blood pressure cuffs does not cause any pressure injuries.

Eliminating Medical Device-Related Pressure Injury From Blood Pressure Cuffs During Continuous Monitoring in the Perioperative Setting: A Novel Approach.

Hospital-acquired pressure injuries have a significant impact on quality of life. Health care organizations continually strive to improve care and patient satisfaction, for the well-being of the patient and the fiscal health of the organization. A commitment to protecting skin and reducing risk for pressure injury in the perioperative setting is gaining momentum.

Study of the disparity of noninvasive and invasive blood pressure measured by the Philips Intellivue MP50 monitor in surgeries inducing gall cardiac reflex under general anesthesia.

OBJECTIVE: The aim of the present study was to comprehensively compare noninvasive and invasive blood pressure (BP) measured by the Philips Intellivue MP50 monitor in surgeries that may induce gall cardiac reflex under general anesthesia. PARTICIPANTS AND METHODS: Seventy-eight patients undergoing cholecyst or bile duct operations under general anesthesia were enrolled in our study. Both invasive (intraradial, femoral, or dorsalis pedis artery) and noninvasive (oscillometric) BP were monitored by the Philips Intellivue MP50 monitor simultaneously. Data were analyzed using Bland-Altman plots. RESULTS: In a supine position during operations, between intraradial and oscillometric measurements, the bias and precision (mmHg) were 9.34±12.98 and 12.47±10.00 for systolic blood pressure (SBP) and 3.26±8.22 and 6.53±5.97 for diastolic blood pressure (DBP), between intrafemoral and oscillometric measurements, the bias and precision (mmHg) were 14.40±14.38 and 16.93±11.28 for SBP and 4.35±9.72 and 7.52±7.54 for DBP, between intradorsalis pedis and oscillometric measurements, the bias and precision (mmHg) were 15.69±14.37 and 16.91±12.91 for SBP and 0.99±7.69 and 5.67±5.27 for DBP. CONCLUSION: The oscillometric BP showed poor agreement with intra-arterial BP in cholecyst or bile duct surgeries that may induce gall cardiac reflex under general anesthesia. Therefore, according to the present data, application of oscillometric BP measured by the Philips Intellivue MP50 monitor in these surgery patients under general anesthesia cannot be recommended generally.

Effects of telemetry implantation surgery on blood pressure and its underlying mechanism.

OBJECTIVE: This study aimed to investigate the effects of radio-telemetry implantation surgery on blood pressure (BP) and renin-angiotensin-aldosterone system (RAAS), calcitonin gene-related peptide (CGRP) and endothelin-1 (ET-1) in rats. METHODS: Six spontaneously hypertensive rat (SHRs) and six WKY rats successfully implanted telemetry were used as experimental group, while six SHRs and six Wistar-Kyoto (WKY) rats of comparable age, weight and BP free from implantation surgery were used as normal control group. BP in each group was monitored using the tail cuff method; furthermore, the content of PRA-I, PRA-II, ALD and ET-1, CGRP in plasma was measured with the ELISA. RESULTS: After implantation surgery, there was no general strain difference in systolic blood pressure (SBP) and diastolic blood pressure (DBP) in either SHRs or WKY rats. But there was a significant increase in renin and a suppression of the difference in angiotensin and aldosterone in SHRs and WKY rats. CGRP, ET-1 showed an overall decrease in SHRs and WKY rats. CONCLUSION: These results indicated that although radio-telemetry is regarded as an efficient and reliable technology for measuring BP, we must pay attention to the influence of the operation itself on BP regulators. After the implantation surgery, decrease in arterial BP or decrease in circulating blood volume might stimulate the secretion of renin, and with the increase of BP and local blood flow, the level of CGRP was decreased. And the decrease of ET-1 may be a kind of protective suppression.

Acute radial nerve injury associated with an automatic blood pressure monitor.

Perioperative radial nerve injury is a rare anesthetic complication, and is rarely seen in association with the use of an automatic blood pressure monitor. As far as we know, only one case has been reported. Here, we report a 26-year-old healthy, lean female who sustained acute radial nerve palsy after appendectomy. A dropped wrist improved 5 days later. The cause of the radial neuropathy is discussed. We recommend that when an automatically cycling blood pressure monitor is used on a lean patient, caution should be taken against such a complication.

Convenience of ambulatory blood pressure monitoring: comparison of different devices.

OBJECTIVE: Twenty-four-hour ambulatory blood pressure monitoring has emerged as an important tool supporting physicians in the diagnosis and management of arterial hypertension. Compared with office measurements and self-measurements, however, ambulatory blood pressure monitoring shows the lowest patients' acceptance. The present study compares the convenience of different monitors in order to examine whether the patients benefit from new technologies. METHODS: In a prospective randomized study, we compared the side effects of the Spacelabs 90207 with the I.E.M. Mobilograph monitor in 250 patients by means of a questionnaire that covered the following aspects: restriction in everyday activities, noise, sleep disturbance, pain and mobility. Complaints were measured by a five-point scale ranging from 'no complaints at all' to 'severe complaints'. RESULTS: In all, 205 patients returned completed surveys (101 patients of the I.E.M. group, 104 patients of the Spacelabs group), yielding an 82% final response rate. The overall mean complaint score was significantly higher in the Spacelabs group than in the I.E.M group (2.24 vs. 1.78; P<0.001). The Mobilograph revealed less discomfort in every single question and differences were significant for restrictions in everyday activities, noise, pain, disturbance of the patient's or the patient's partner's sleep and restrictions in walking. Sleep disturbance was the aspect with the highest difference in the two groups. CONCLUSION: The present work confirms that ambulatory blood pressure monitoring monitors are cumbersome to wear. Devices, however, differ in their comfort. Monitors with an improved convenience might lead to a higher patients' acceptance of this powerful diagnostic tool.

Los manguitos del esfigmomanómetro son reservorio de bacterias potencialmente patógenas / Sphygmomanometer´s pressure cuffs are potentially pathogenical bacterial reservoirs

Este estudio se diseño para evaluar si los manguitos para la medición de la presión arterial pueden ser un reservorio de bacterias con potencial patogenicidad. Material y métodos: En condiciones asépticas, se obtuvo la cobertura de tela de 11 manguitos (seleccionados aleatoriamente) provenientes de consultorios externos o salas de internación de un hospital público. Resultados: El cultivo de los manguitos mostró en todos los casos desarrollo bacteriano, que abarcó 27 aislamientos: 12 Staphylococcus coagulasa negativo (4 de ellos meticilinorresistentes), 6 Staphylococcus aureus (2 meticilinorresistentes), 3 Acinetobacter spp (1 multirresistente), 1 Corynebacterium spp, 1 Streptococcus viridans, 1 Micrococcus spp, y 3 bacilos gramnegativos no fermentadores (diferentes de Pseudomonas aeruginosa y Acinetobacter spp). Conclusiones: Los manguitos de los esfigmomanómetros constituyen un reservorio de bacterias potencialmente patógenas.

Compartment syndrome of the arm: a complication of noninvasive blood pressure monitoring during thrombolytic therapy for myocardial infarction.

We report a rare case of tricep compartment syndrome caused by a hematoma which resulted from noninvasive blood pressure monitoring (NIBPM) during thrombolytic therapy. Clinicians administering thrombolytic agents should be aware of the risk of bleeding and compartment syndrome at the site of NIBPM. Appropriate preventative measures should be instituted when using automated pneumatic cuffs. An understanding of the pathophysiology and clinical presentation of an arm compartment syndrome will allow for prompt diagnosis and surgical treatment.

The safety of automatic versus manual blood pressure cuffs for patients receiving thrombolytic therapy.

BACKGROUND: Patients receiving thrombolytic therapy for acute myocardial infarction require frequent monitoring of blood pressure. Historically, many nurses have been reluctant to use automatic blood pressure cuffs during thrombolytic therapy because of concern that the automatic cuffs might increase risk of bleeding. This concern is not based on research findings but on case reports, anecdotal observations, and possible myths in clinical practice. OBJECTIVE: To determine the safety of using automatic blood pressure cuffs during thrombolytic therapy in patients with acute myocardial infarction. METHODS: Ninety-six patients with acute myocardial infarction who received thrombolytic therapy (streptokinase or tissue plasminogen activator) were randomized to have blood pressure measurements obtained with either automatic or manual blood pressure cuffs. Patients were checked at least every 2 hours for purpuric lesions (petechiae, ecchymoses, or hematomas). The study ended after 24 hours of measurements or when a purpuric lesion was noted. RESULTS: We found no significant difference in frequency of purpuric lesions between patients who had blood pressure measured with a manual cuff and patients who had blood pressure measured with an automatic cuff. The most common purpuric lesions noted were ecchymoses. A significant difference was noted in the frequency of purpuric lesions depending on which thrombolytic agent was used, regardless of cuff type. CONCLUSIONS: Automatic blood pressure cuffs are as safe as manual blood pressure cuffs in patients with acute myocardial infarction who are receiving thrombolytic therapy.

[A case of crush syndrome resulting from continuous compression of the upper arm by automatically cycled blood pressure cuff].

We report a case of crush syndrome (rhabdomyolysis) resulting from the prolonged compression of the inadvertently inflated blood pressure cuff around her upper arm. A 61-yr-old woman had undergone total gastrectomy, splenectomy and cholecystectomy for gastric cancer. At the end of the surgery lasting for 5 hrs 40 mins, we found the right upper arm extremely swollen with cyanotic petechiae beyond the inflated cuff. Failure of deflation of the automatically cycled blood pressure cuff was strongly suspected as a cause. She complained numbness and ardor on her hand with motor nerve disturbance and plasma CPK level was elevated. Diuretics were given and fluids were infused vigorously to prevent the renal failure, and continuous cervical epidural block was instituted to increase the blood flow to the injured arm. Prostaglandin E1 and ulinastatin (a protease inhibitor) were also effective for recovery from the crush syndrome. One month later she was discharged home accompanied with a slight numbness on the arm. Attention should be paid to deflation of the automatically cycled blood pressure cuff during anesthesia.