Assess for signs and symptoms of hypotension, such as dizziness, lightheadedness, pallor, diaphoresis, or syncope throughout the procedure. If the patient is attached to a cardiac monitor, assess for arrhythmias. Immediately return the patient to a supine position if symptoms appear during the procedure. Do not have the patient stand if symptoms of hypotension occur when the patient is sitting. Use the following guidelines to assess for orthostatic hypotension:

• Lower the head of the bed. Place the bed in a low position.
• Ask the patient to lie in a supine position for 3 to 10 minutes. At the end of this time, take initial blood pressure and pulse measurements.
• Assist the patient to a sitting position on the side of the bed with the legs dangling. After 1 to 3 minutes, take the blood pressure and pulse measurements.
• Assist the patient to stand, unless standing is contraindicated. Wait 2 to 3 minutes, then take blood pressure and pulse measurements.
• Record the measurements for each position, noting the position with the readings. A decrease in systolic blood pressure of ≥20 mm Hg or a decrease in diastolic blood pressure of ≥10 mm Hg within 3 minutes of standing when compared with blood pressure from the sitting or supine position is significant for orthostatic hypotension (Angelousi et al., 2014).

Source: Adapted from Angelousi, A., Gererd, N., Benetos, A., Frimat, L., Gautier, S., Weryha, G., & Boivin, J. M. (2014). Association between orthostatic hypotension and cardiovascular risk, cerebrovascular risk, cognitive decline and falls as well as overall mortality: A systematic review and meta-analysis. Journal of Hypertension, 32(8), 1562-1571; discussion 1571. https://doi.org/10.1097/HJH.0000000000000235; Lanier, J. B., Mote, M. B., & Clay, E. C. (2011). Evaluation and management of orthostatic hypotension. American Family Physician, 84(5), 527-536; and Pickering, T. G., Hall, J. E., & Appel, L. J. (2005). American Heart Association Scientific Statement. Recommendations for blood pressure measurement in humans and experimental animals. Part 1: Blood pressure measurement in humans: A statement for professionals from the subcommittee of professional and public education of the American Heart Association Council on High Blood Pressure Research. Circulation, 111(5), 697-716. http://circ.ahajournals.org/content/111/5/697.abstract