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Mar 7, 2010 09:34AM
, edited Mar 7, 2010 09:51AM
Sheila, it's a great idea, and we're working on it--so far this is the best reference I found:
• Calf BP measurement is also referred to as an ankle BP. If a stethoscope is used, Korotkoff's sounds are auscultated over either the doralis pedis or posterior tibial artery (for calf BP) or the popliteal artery (for thigh BP). Results of comparisons of automatic, noninvasive upper arm and calf BPs in adults vary. Overall systolic BP measurements were higher in the calf than the arm in patients undergoing surgery, colonoscopy, and caesarean delivery under spinal anesthesia.20-22 (Level V) Differences in mean BP and diastolic BP were not consistent. Large differences for some individuals make it difficult to devise a predictive formula that would be applicable in all situations.21 In adults, calf BPs should be used only if the upper arm is not accessible20 or if the appropriate size cuff is not available.
• Multiple reasons exist why an extremity may not be suitable for BP measurement. BP cuffs should not be used on an extremity with a deep vein thrombosis, grafts, ischemic changes, arteriovenous fistula, or arteriovenous graft.23-25 BP cuffs should not be applied over a peripherally inserted central catheter (PICC) or midline catheter site but may be placed distally to the insertion site.23 BP measurements should not be taken in extremities with peripheral IV while an infusion is running26 or any trauma/incision. For patients who have had a mastectomy or lumpectomy, do not use the involved arm(s) for BPs if there is lymphedema.13,27 (Level II)
Sheila, here's a decent one, no pictures though:
How to Take Correct Blood Pressure Reading in the Calf Muscles
By Katrina Josey
eHow Contributing Writer
Article Rating: (1 Ratings)
Clinicians sometimes measure blood pressure in the calf for comparison with a reading from another part of the body in patients with certain medical conditions. While it is possible to measure the blood pressure in the calf, this should only be done if the pressure can't be measured in the arm. Some reasons to avoid reading the blood pressure in the calf include swelling from lymphedema or the presence of blood clots. Still, if the person is large or there isn't an appropriate size of cuff available, measuring in the calf is best.
Difficulty: Moderately Easy
Things You'll Need:
Blood pressure cuff/sphygmomanometer
Instruct the person whose pressure is being measured to lie flat on his or her back and remain silent. Speaking while having the blood pressure measured can cause a false reading that is higher than normal.
Bend the knee of the leg the pressure will be measured in. Allow the foot to remain flat.
Strap the blood pressure cuff around the leg. The bottom of the cuff should stop about 1 inch above the ankle. Make sure the inflatable portion of the cuff is big enough to go around 80 percent of the leg to avoid a false high or low reading.
Place the stethoscope on the dorsalis pedis artery. It can located by placing the finger halfway between the inner ankle bone and the Achilles tendon. Feel for the pulse there before proceeding to make sure the Korotkoff sounds can be heard there. Keep in mind that in about 2 to 3 percent of healthy people, the sound can't be heard in one or both legs.
Turn the dial on the cuff to make sure no air can escape and pump it up with air past 180mm/Hg (millimeters mercury). Slowly release the air and listen for the first Korotkoff sound. Note this reading on the cuff as it will be recorded as the systolic pressure (top number). Listen for the when the sound dies off completely and record this number as the diastolic pressure (bottom number).
They say that this article is associated with the Lance Armstrong Foundation, so maybe that's a good place to search--the article can be printed without ads. The place that they tell you to palpate the artery is the posterior tibial, not the dorsalis pedis, which is on the top of the foot.
Here's a wikepidia reference to how to palpate the dorsalis pedis pulse, which is not present in 2-3% of people
We're closing in on it--this was almost perfect, except for the wrong pulse. Nothing on the Lance Armstrong site, except to say thigh blood pressures in the LE handout.
Knowledge is the antidote to fear, Ralph Waldo Emerson
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