Hospital placement update

A few months into my second placement in the Bristol Royal Children’s Hospital and it's going great! I am involved in multiple projects; my main ongoing task at the moment is all around the mid-upper arm circumference (MUAC) measurement. When a paediatric patient first comes into the hospital they have to go through a screening process. This involves the nurses measuring their weight, and height. Specific challenges exist around achieving accurate nutrition risk assessment and prompt nutrition support. Weight, a traditional anthropometric measure of nutrition state can be skewed by tumour mass, resections (the process of cutting out tissue or part of an organ), fluid balance and organomegaly (abnormal enlargement of organs) etc. Meaning the next nutritional steps for this patient could be inaccurate.

One simple, accurate and non-invasive indicator of nutrition status is mid-upper arm circumference (MUAC). It is an anthropometric measurement providing information on nutrition status, as an estimate of body composition, and it is used for children 6 months - 5 years old. Many researchers have said it is a good screening measure; however, it isn’t used widely enough.

Bristol Royal Children’s Hospital is aiming to routinely incorporate this measurement into the nutrition assessment process when a child is admitted into hospital.

I have been taught and assessed measuring MUAC, and I have been measuring patients MUAC’s. I will be teaching the nurses who will then routinely measure MUAC when screening children. The nurses will teach the nurse practitioners so they can then use the measurement too. The more people who are trained, the better! This is exciting but also nerve wracking.

Below is a very brief step by step guide on how to measure mid-upper arm circumference.

1. Ensure the child’s upper arm is parallel to the side of their body, and bent at the elbow at a 90 degrees angle with their palm facing upwards.
2. Palpate the shoulder to locate the acromion (bony protrusion) and mark it with a surgical marker
3. Place the zero point of the tape over the mark on the bony protrusion and run it downward along the back of the arm to the tip of the elbow.
4. Make a small mark at the mid-point of these two distances on the back of the child’s arm (see figure 1).
5. Ask the child to let their arm hang loose. Wrap the tape around the arm over the marked mid-point (see figure 2).
6. Record the measurement in centimetres to the last completed millimetre e.g. 12.6cm.
7. Repeat the measure twice and take the mean average.
8. If the results are worrying then the patient will be referred to a dietitian. They will assess and set out dietary plan for the patient, which will be evaluated often and adapted when necessary.

I am currently writing up a questionnaire to ask the patient/parents/guardians and the staff who have and will be using MUAC, to analyse the acceptability and feasibility of the MUAC measurement. Some questions that may be asked to the patient or parents/guardians- if the child is unable to answer the questions then the parents/guardians will be asked them. E.g., how was the experience for patient of the measurement of the mid upper arm circumference? Was there anything that could have been done to improve the measurement process?

Questions for staff will be things like; do you think MUAC measurement is useful? Do you feel comfortable taking a MUAC measurement? And do you feel you have the appropriate training?

My next blog will explain my other projects and work I’ve been doing.