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INPRESS: INvasive PRESSure Monitoring Knowledge and Practice Survey
Oliver Coolens1, Rolf Dubb1, Arnold Kaltwasser1
1Academy of the District Hospitals Reutlingen gGmbH, Reutlingen, Germany.
Background:
In patients on Intensive Care Units (ICU), invasive arterial pressure monitoring with closed transducer systems is widely used, yet the accuracy of measurement depends on correct zeroing, levelling and interpretation of arterial waveforms.
Aim:
The aim was to assess the knowledge and practice of clinicians (nurses, physicians, anaesthesia/operation technicians) working in critical care, operating theatres and emergency departments about arterial blood pressure assessment and managing the closed transducer system.
Study Design:
A cross-sectional online survey was conducted in Germany in May 2025. The questionnaire included 26 single- and multiple-response items on zeroing, transducer level, arterial waveform, phlebostatic axis and practical handling of the arterial line system. Data were analysed using descriptive statistics and Fisher's exact test to assess associations between knowledge and professional experience or institutional setting.
Results:
A total of 303 clinicians participated, the majority being ICU nurses n = 245 (81%), with n = 21 (7%) answering all questions correctly. The percentage of correct answers in multiple questions were in the sections about zeroing procedures n = 34-48 (11%-16%), transducer reference levels n = 5-232 (2%-77%), arterial pressure waveform n = 33-53 (11%-17%) and phlebostatic axis identification n = 11-101 (4%-33%). Recognition of hydrostatic, gravitational effects was higher n = 232 (77%), but scenario-based questions were correctly answered by only half. Practical handling showed variation, with n = 147 (48%) reporting correct pressure bag inflation and n = 147 (48%) avoiding heparin in flush solutions. More years of experience and employment in tertiary centres were associated with higher accuracy.
Conclusions:
Clinicians demonstrated limited knowledge of invasive blood pressure monitoring, with significant variability across domains. Structured education, protocols and simulation-based training are needed to improve accuracy and safety.
Relevance To Clinical Practice:
Strengthening haemodynamic monitoring competence is essential to ensure reliable, homogenous measurements, reduce errors and enhance patient safety.
Related Concept Videos
01:30Equipments Used To Measure Blood Pressure
This invasive approach involves cannulating a peripheral artery. During each cardiac contraction, pressure generates mechanical motion within the catheter, transmitted through rigid, fluid-filled tubing to a transducer. This transducer converts mechanical motion into electrical signals displayed as waveforms on a monitor. An automatic flushing system prevents blood backflow. Due to the potential risk of unexpected arterial blood loss, this method is primarily used in intensive...
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