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Inconsistency of intra-arterial pressure estimation

Barry J Materson and Seema Chandra

The practice of quality clinical medicine is predicated by evaluating accurate historical, physical, laboratory and imaging data, and making decisions based thereon. Intra-arterial pressure estimation has evolved over millennia from detailed analysis of the pulse to sophisticated instruments that determine pressure indirectly and display it as numerical data. Such data are only as accurate as the device permits. No matter how accurate the device, if the subject is not properly prepared and positioned, the data may be inaccurate. Those who take blood pressure in the clinic should be well trained in the correct technique and be aware of the factors that cause variation in the readings. Accurate estimation of intra-arterial pressure is even more challenging in pediatric patients. The correct cuff size must be used and motion artifacts minimized. Oscillometric readings are good for screening, but auscultation remains the gold standard.