Was this hospital procedure usual? Thinking about complaining/giving feedback

[didntlikethis]

I've been having palpitations (could be Covid or jab-related or maybe menopause but that's a side issue) and was referred for a CT angiogram - a scan of the heart.

Long version (short one to follow)...

Long NHS waiting list, so I went to a private hospital.

I have a low resting heart rate - it can dip under 40 at times (it's been measured by doctors, this isn't just my assessment).

I also have terrible veins and after some horrible experiences of people trying to draw blood or get needles in, it's not something I like having done and it stresses me a bit. I always warn the person trying to get the needle in and ask them to talk to me about something else as they do it.

In order to get a good scan, they warned me in advance my pulse needed to be below 60. That's not usually a problem, if I relax my breathing and rest, it usually easily drops below that.

But, as one nurse was (painfully) trying to get the needle in for a catheter, the other one was taking my BP (which was unsurprisingly, elevated) and telling me my pulse was too high.

They were then trying to insist on giving me beta blockers to lower the pulse, which I didn't want to do because I knew if I could calm down and make myself less stressed after the needle stuff, my pulse would go down. I wasn't keen on the beta blocker because I know how low my heartrate can naturally go and didn't want to artificially lower it.

I persuaded them to let me go out and slow my breathing but the BP nurse rather cattily said as I suggested that that he'd never seen anyone bring their pulse down by breathing.

Rightly or wrongly, I felt like I was a piece of meat on a conveyor belt, a Saturday afternoon, they wanted to get home and shove the drugs in me even if that wasn't my preference.

With some deep breathing, I managed to get my HR down and the procedure went ahead, they said were happy with the image results.

When I came back into the scan room, the catty nurse had left and a lovely female one had taken his place and chatted to me about everything other than what they were doing. (Not bothered about the sex of the nurse by the way, but the replacement female one was compassionate and understanding and tried to help me).

Short version: Is it usual to measure BP and pulse at the same time as trying to put a needle in a patient's other arm?

And is it worth complaining/giving feedback to the hospital?

Thanks for reading all this!

I’ve never had them done at the same time and I’ve had a lot - both NHS and private. I don’t think there’s any reason not to provide feedback or complain but I’ve no idea of the general stance on this.

@ABitOfAShitShow Thank you, that's good to know.

What is catty about the fact that the nurse commented about not having seen anyones blood pressure being reduced by deep breathing?

@Soontobe60 Tone of voice.
And no need for him to be negative.

Yes provide feedback.

www.sciencedaily.com/releases/2021/06/210630135033.htm

www.health.harvard.edu/blog/stress-raising-your-blood-pressure-take-a-deep-breath-201602159168

Example in the second article - doctors ask patients to take a deep breath before taking blood pressure reading.

It sounds completely ridiculous to measure a persons blood pressure whilst simultaneously trying to get a needle in! All the times I’ve ever had mine measured they’ve waited until I was calm. White coat syndrome is a thing! I can’t imagine anyone feeling calm when someone is digging a needle into them. 🤦🏻‍♀️

Definitely report it to someone (not sure who, as we don’t use private hospitals) but you absolutely deserved better than that!!

Thanks, I'll track down the complaints procedure for that hospital.

My gut instinct is that it wasn't right at all and they were rushing to finish their shifts.

I've had many cannulas, BPs etc but never at the same time.
I suffer from various palpitations and SVT.
It's perfectly possible to lower your heart rate by taking slow deep breaths. You can watch it drop if you use a pulse oximeter. I can't imagine a health professional not knowing that.
They were rushing you and uncaring at best. There will be some complaints process on their website.

@Soontobe60

What is catty about the fact that the nurse commented about not having seen anyones blood pressure being reduced by deep breathing?

They were being deliberately sarcastic. I’ve heard that kind of comment from HCPs, my stock answer would be “Good job you’ve got an open mind and are prepared to learn then”.

Ha!! I had a practice nurse tell me my blood pressure was too high when she took it immediately after 3 .. THREE !!! .. failed attempts to take a smear test!!
My knuckles were white.. but she walked out of the room unscathed..
Bitch.

OK.

CT cardiac angio. I so cannot comment about the private experience. I'd never go private for anything other than a bit of dermatology, personally!

I'm NHS, and we do this test a lot.

We get 'a feel' for the heart rate (HR) from the cannulator (we use competent HCAs to do this). We don't care about blood pressure, just HR. We know about white coat syndrome!

The thing is, most CT machines do cardiac CT within a fairly narrow HR range. 50-62/3/4? A variable HR can be a nightmare! Even low! That can throw it!

We very much find that once cannulated, on our CT couch, calm, HRs go down. We (as the operators, the radiographers) measure that, and scan accordingly. 50-75% of our selected patients, i.e unlikely to have coronary artery disease, but it has to ruled out) need beta blockers. Sounds like the radiographers did, aided with some betablockers, given that your scan was diagnostic; the whole purpose of the exercise!

Brilliant that you were able to calm yourself into a non-beta blocker zone. Seriously. What mattered was your HR once you laid on that scanner couch. And, you didn't get BBs because you didn't need them Result!

You went in wanting a diagnostic cardiac CT scan. You got one.

And I am not sure there was a single 'nurse' involved! 😂

@Fordian So, the end justifies the means?

Is it usual to be simultaneously inserting a catheter while also measuring BP on the opposite arm?

And would you give the patient time to let the HR settle before deciding whether to offer beta blockers? Neither of those things happened, I had to insist on having some time to let my system relax naturally.

It is if you've gone private and time is money.

Sorry, but those are the facts.

I work (NHS) with quite a few staff who've come to us from the private sector, and many are quite hide-bound and inflexible because bonuses (and ongoing employment and visa- renewals) depend on productivity. There is little 'time to let it settle'.

Thankfully, we generally do have some time (because my unit is so physically small we cannot have two patients in there at once, covid etc.). But we still give 50-75% of our patients beta blockers, as this is the most efficient way of reducing HR.

If I were you, I wouldn't bother complaining; unless you feel a 'Oh gosh, yes, thank you for your feedback' response, as they hit 'delete' on your email. They're not about to increase appointment times.

Your BP doesn't matter for a cardiac CT; your HR does.

Hi. I don't know about lowering your resting heart rate, but I do know that my BP goes down a lot after I've sat down and relaxed a bit (especially after rushing to get to the doctor's).

I would write and comment / complain - of course steady breathing calms you and lowers hr.
you were paying for the service - they need to shape up. And learn to be pleasant.
You can probably address it to the head of dept

@Soontobe60

What is catty about the fact that the nurse commented about not having seen anyones blood pressure being reduced by deep breathing?

Well it's incorrect for a start.

You are absolutely right that you can lower the heart rate by breathing. If you increase the expiration length you lower the heart rate. We were taught this at medical school to lower a racing heart to help an anxious patient feel better.

It is pretty common however to have a pulse oximetry /sats probe and BP monitor on while putting a cannula into a vein, it’s just multitasking. In fact you can use a BP cuff to give you a good tourniquet effect to help put a cannula in .

I have encountered this in urgent situations and in perioperative care. However if you were finding it distressing and asked for one to be done at once they should have waited. Most people don’t find a BP excessively painful. I suspect the staff were just trying to be efficient and might not have anticipated that you would find it distressing.
The staff are under pressure to get all the scans done ina session. If a patients take much longer than average, there may be cancelled patients. In honesty they were probably trying to juggle every demand on the time pressures. I don’t think this is worth a complaint.

The fact that they were trying to stuff beta blockers into someone with a history of low heart rate is very worrying to me. I think it's a good thing you stopped them as surely that could have had serious consequences? I'm not a HCP though, so perhaps someone else has more knowledge?

Me and colleagues do deep breathing to see who can get the lowest heart rate 😂

@Fordian

Your BP doesn't matter for a cardiac CT; your HR does.

I assume they were doing BP as another measure in general. But the same machine also records heart rate alongside BP and the OP does state they commented in the pulse being too high, not the BP.

@RobinDyed14 I suggest you copy your post and then start a new thread, possibly In elderly parents.

Definitely wrong to try and take BP whilst drawing blood. Definitely wrong to say you cannot slow heart rate by deep breathing.

It is hard to stop an arrhythmia with deep breathing; but you can definitely slow an ordinary rhythm with breath control - my GP OH used to ask me to deep breathe when my heart rate was high to distinguish between a recurrence of AF and just a fast rate.

Technique is: one deep breath to fill your lungs completely, then five slow breaths out - repeat, whilst increasing the number of outbreaths each time.