Arterial line vs cuff Blood Pressure

Arterial catheterization (AC) is commonly used in critically ill patients to monitor blood pressure. In Critical care literature, there is a never ending debate about its co-relationship with cuff based blood pressure. In one recent small work, relationship between cuff- and AC-measured BPs in 34 patients was investigated.

A total of 1,363 paired arterial and cuff BP readings (13-82 per patient) were measured within 1 to 2 min and recorded by bedside nurses.

Overall, 18.9% of the paired systolic BP readings differed by at least 20 mm Hg, and 29.1% of paired diastolic BP readings differed by at least 10 mm Hg.

To adjust for potential clustering of measurements, bootstrap Bland-Altman analysis averaged over 5,000 replications yielded similar results to unclustered analyses for systolic BP (bias, 1.2 mm Hg; 95% LOA, −35.7 to +38.0 mm Hg) and diastolic BP (bias, −1.2 mm Hg; 95% LOA, −24.9 to +22.4 mm Hg).

Editors' note: Good bedside practice is to remove arterial line as soon as its not needed!

Reference and further reading:

1. Daniel Horowitz, MD; Yaw Amoateng-Adjepong, MD, PhD; Stuart Zarich, MD; Allan Garland, MD; Constantine A. Manthous, MD, FCCP - Arterial Line or Cuff BP? - Chest. 2013;143(1):270-271.

2. Garland A, Connors AF Jr. Indwelling arterial catheters in the intensive care unit: necessary and beneficial, or a harmful crutch?. Am J Respir Crit Care Med. 2010;182(2):133-134.