# INPRESS: INvasive PRESSure Monitoring Knowledge and Practice Survey

## TL;DR

This study found that clinicians in critical care settings have significant knowledge gaps in invasive blood pressure monitoring, especially regarding transducer reference levels and proper positioning.

## Contribution

The paper provides a systematic assessment of clinicians' knowledge and practice in invasive arterial pressure monitoring across professions and highlights the need for structured education and training.

## Key findings

- Only 7% of participants answered all questions correctly, with significant variability in knowledge across domains.
- Professional experience and employment in tertiary centers were associated with higher accuracy in haemodynamic assessment.
- Structured education and simulation-based training are recommended to improve monitoring practices and patient safety.

## Abstract

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.

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.

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.

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.

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.

Strengthening haemodynamic monitoring competence is essential to ensure reliable, homogenous measurements, reduce errors and enhance patient safety.

What is known about the topic
○Accurate haemodynamic monitoring is essential for the evaluation of therapy and ensuring patient safety.○Knowledge deficits in zeroing, levelling and waveform interpretation have been reported, but systematic assessment across professions is limited.
What this paper adds
○In a survey among clinicians, knowledge gaps in invasive arterial blood pressure monitoring, especially regarding transducer reference levels and the phlebostatic axis, were present.○Professional experience and employment in tertiary centres are associated with higher accuracy in haemodynamic assessment.○Structured education, protocols and simulation‐based training are needed to ensure patients' safety and reliable monitoring practice.

What is known about the topic
○Accurate haemodynamic monitoring is essential for the evaluation of therapy and ensuring patient safety.○Knowledge deficits in zeroing, levelling and waveform interpretation have been reported, but systematic assessment across professions is limited.

Accurate haemodynamic monitoring is essential for the evaluation of therapy and ensuring patient safety.

Knowledge deficits in zeroing, levelling and waveform interpretation have been reported, but systematic assessment across professions is limited.

What this paper adds
○In a survey among clinicians, knowledge gaps in invasive arterial blood pressure monitoring, especially regarding transducer reference levels and the phlebostatic axis, were present.○Professional experience and employment in tertiary centres are associated with higher accuracy in haemodynamic assessment.○Structured education, protocols and simulation‐based training are needed to ensure patients' safety and reliable monitoring practice.

In a survey among clinicians, knowledge gaps in invasive arterial blood pressure monitoring, especially regarding transducer reference levels and the phlebostatic axis, were present.

Professional experience and employment in tertiary centres are associated with higher accuracy in haemodynamic assessment.

Structured education, protocols and simulation‐based training are needed to ensure patients' safety and reliable monitoring practice.