Ridiculed For Writing NO bps, No needles on arms

Linda, hi! Great to "see" you!

Thanks for this. Have you used it? What a relief that would be, and how great to know it's coming as a possibility!
Hugs,
Binney

Hi Binney

No, I have not used the Nexfin finger cuff system.  I had never even heard of it until I found this article.  I routinely google for any new research involving methods for monitoring BP just because I feel the current options for LE patients are pretty dismal.  It really is not so simple as thinking all we have to do is avoid the affected or at risk limbs. We obviously do not want to increase LE or infection risk unnecessarily but I think we must also be concerned with the increased risk of inaccurate BP readings, embolus and pain, as a result of improper technique, equipment and lack of experienced staff when it comes to using the legs.  In addition, current critical care units, surgical settings and IV sedation procedures use automatic BP devices that can pose particular risk to lymphedema patients. 

The fact is, none of us know when we might end up in an ICU as a result of trauma or a health crisis.  Current critical care technology involves a fair amount of invasive procedures that pose risk to any patient but higher risk to diabetic, cardiac, pulmonary and other chronic condition patients, including LE patients.  In the bigger picture, any technological advancement that can accurately collect vital patient data in a non-invasive method is a win-win situation for us all.

This research article (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3391359/) was trying to identify accurate, non-invasive methods for continuous monitoring of a patient's vital status without resorting to the more expensive and risky invasive methods such as an arterial line. Obviously the researchers were not considering potential benefits to LE patients, however there certainly could be a positive impact for LE patients as a result. 

Typically, ICU or critically ill patients are continuously monitored with invasive lines.  This most often means an arterial line which involves cannulating either the radial artery in the wrist, femoral artery in the groin or axillary artery in the chest. Other less common sites used for arterial lines are the brachial, ulnar, dorsal pedis, tibial posterior and temporal arteries.  These lines are used for monitoring BP, cardiac output and frequent blood gases.  While there may also be benefits in continuous monitoring of BP or cardiac output in non-critical, stable patients, the use of invasive lines in a stable patient is not advised due to the inherent risks and costs. So stable patients who might benefit from continuous monitoring are not currently getting that benefit. 

The research article identifies potential patient populations where continuous monitoring is not currently the standard but could benefit from the new technology:

Anesthesiology

"Continuous, totally noninvasive monitoring is possible in groups currently (nearly) unmonitored. Examples include orthopedic surgery in the elderly, abdominal surgery and bariatric surgery. In obese patients upper arm cuffs for BP measurement often do not fit, and thigh cuffs are needed, or a brachial cuff is used on the forearm. While the arms and legs can increase significantly in circumference, fingers do get larger but usually not up to the degree that the finger cuff does not fit."

If a non-invasive method such as the Nexfin finger cuff system ultimately is deemed accurate and safe enough for providing continuous BP and CO readings in the critical patient, then hopefully that same technology can also be applied for more common use in the stable patient population when needed.  I suspect the cost and design of the current finger cuff technology would be too expensive and impractical for widespread use in individual outpatient offices or clinic settings.  Hopefully, if the demand becomes broader, the technology can be refined to lower cost and more portable designs that become the standard in doctor's office, diagnostic centers etc.

Meanwhile, we continue to advocate for ourselves, educate our medical professionals and make the best choices that we can when possible.  Personally, I worry more about the emergent, critical care settings where our degree of personal control is much less or even non-existent. LE cannot be the primary focus in a life threatening emergency, but if the standards for critical care technology are moving towards more non-invasive methods, I am all for it!

Great anesthesiologist Leah.

Let me just say what youre probably only too aware of. Getting a poke in the foot is only 1/2 the story. Once you manage to actually get it, then you have to get someone whose competent at it. I would unequivoacally state that the difference here can be night and day.

Long story short, I had an incompetent doctor (unsuccessfully) attempt to do this when I needed a blood test when I was in hospital after 1st chemo. It was one of the worst experiences I've ever had. He wouldn't stop driling and twisting and turning. I was SO ANGRY I cried all night. I was neutropenic as it was and had numerous attempts in my "good" arm. Equally painful or worse was a surgeons effort to give me a sedative in the foot for a procedure which left me with a damaged nerve.

There is a couple of ladies of much "lower rank" who are both excellent for blood draws. Im mentioning all this to encourage people that there can be a big difference and that difference is not necessarily from some high up dude with big credentials although I relaize theres a difference between "input" and "output". Still, I reckon great phlebotomists have a gift.