Measuring Orthostatic Vital Signs from the Emergency Nurses Association

Clinical Practice Guideline: Orthostatic Vital Signs–Full Version [Full Text PDF]
Authored by the 2011 ENA Emergency Nursing Resources Development Committee of the Emergency Nurses Association
I have always found the measurement of orthostatic vital signs valuable in my practice.
[For another view of the usefulness of orthostatic vitals to assess volume status see The Futility of Orthostatic Measurements by Chris Nickson from the emergency medicine blog Life In The Fast Lane. The reader comments that follow are excellent also. And remember, orthostatic vital signs are useful to evaluate for orthostatic intolerance.]
[Note in the Resources that follow page 9 that
What follows is from page 9 of the pdf:
Description of Decision Options/Interventions and the Level of Recommendation
1. Adults (age 17 years and older)*
i. The individual should rest in a flat, supine position 5-10 minutes prior to the first blood
pressure measurement. Level B – Moderate
ii. Blood pressure measurements should be taken at one and three minutes after standing.
Level B – Moderate
iii. Position change from supine to standing has better diagnostic accuracy in volume
depleted adults compared to position changes from supine to sitting and then to
standing. Level B -Moderate
iv. Orthostatic vital signs alone lack the sensitivity to reliably detect volume losses less than
1,000 ml. Level B – Moderate.
v. Symptoms such as dizziness and syncope, in combination with orthostatic vital signs, are
more sensitive indicators of volume loss that vital sign changes alone. Therefore,
symptoms and vital signs should be documented as the orthostatic variables. Level B –
vi. When measuring orthostatic vital signs, one or more of the following findings may
indicate intravascular volume loss in adult patients (Level B – moderate):
a.Decrease in systolic blood pressure of 20 mmHg or more
b.Decrease in diastolic blood pressure of 10 mmHg or more
c. Increase in heart rate of 20 or greater beats per minute (Durukan et al., 2009).
2. Pediatric and Adolescent (less than 17 years)
i. There is insufficient evidence in the literature to make recommendations regarding
orthostatic vital signs in the pediatric or adolescent population with fluid volume
*The correct procedure for measuring blood pressure while the patient is seated or standing is to measure the blood pressure in the upper arm while supporting the patient’s arm and back. The legs should be uncrossed.
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