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Clinical Opal - Taking blood pressure in children - Should we bother?

25 August 2023 - Grace Larson

Stacey's Post-Tonsil and Adenoid Removal Observations

You have just received Stacey (6 years) to the paed’s unit following her tonsil and adenoid removal today. 

She is receiving routine post anaesthetic observations, she is complaining of pain and a strange sensation in the back of her mouth.

HR 140

RR 22

Sp02 98% in Room Air

Temperature 36.2

There is no BP recorded in her pre-operative assessment, or in the recovery observations. The handover from the other nurse is that it is not necessary to perform.

Is there any need to perform a BP on this child?

  1. Yes
  2. No

 

Correct Answer - Yes

Recognising the Critical Need for Baseline Blood Pressure

Hypotension in children is considered a pre-terminal sign (indicating that they are close to cardiac arrest). Taking a baseline blood pressure is important, but noting a trend is more helpful especially if the child is unsettled during the initial reading. Ensuring you have the appropriate cuff size is also essential to ensure an accurate reading:

  • Too small cuffs will overestimate blood pressure whilst 

  • Too big cuffs will underestimate

Selecting the Right Cuff Size for Accurate Readings

As a general rule BP cuff size should be 40% of the arm circumference at a point midway between the olecranon and the acromion.

Frequency of Blood Pressure Monitoring in Pediatric Patients

A blood pressure should be performed on every child at least once per shift (or every 8 hours) if the child is stable. More frequent blood pressure monitoring is required if the child is unwell. 

Detecting Hidden Complications: The Role of Blood Pressure

In this case study, a potential complication from this surgery can be bleeding, blood can be swallowed meaning that clinicians may not see the degree of blood loss until it is too late. Children cannot vary their stroke volume to increase their cardiac output, so will often present with tachycardia initially if they are becoming volume depleted due to blood loss. However, this sign may get overlooked in a child who is distressed or in pain. 

Regular blood pressure monitoring along with assessment of capillary refill time and other indicators of fluid status can be used to monitor for this complication.

References:

Pawar D. Common post-operative complications in children Indian Journal of Anaesthesia 2012; 56: 486-501

https://drive.google.com/file/d/1qbJ8G_gLduIfv00IdVJPktcGhctXBabl/view?usp=share_link

Grace Larson
Grace Larson

Grace Larson, RN, BN, CertIV(TAE), GradDipClinNurs(PaedCritCare), MAdNursPrac(PaedCritCare), has extensive experience in paediatric nursing, with 13 years in Paediatric Intensive Care Units (PICU). She’s published journal articles in the specialty area of pain and sedation in PICU, and has presented at national and international conferences on the area of pain and sedation in paediatrics. Grace has previously worked with the ACCCN delivering Paediatric Advanced Life Support in Victoria, bringing a wealth of experience into her clinical teaching on paediatric resuscitation. She has also consulted with NSW Health on quality and safety delivering within PICU, and has been contracted with the ANMF to develop nursing programs for nurses who require additional education as part of their practice requirements.

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