Blood Pressure Cuffs • • Are we taking blood pressures correctly? Are we using the correct size cuff for the patient? Cindy Dayen, ADN, BSBA, RN-BC December 2014 Miscuffing is most frequent error in measuring BP O Obesity is on the rise in America with >30% of Americans being obese. O Under cuffing large arms is the most common error in taking blood pressures. O The correct cuff should be a 2:1 ratio of length to width. O Using the wrong size cuff can over or under estimate the patients blood pressure. Other Common Errors O The bottom of the cuff should be 2-3cm above the O O O O O O patients AC. No one should be talking while the blood pressure is being taken. The patient should be seated comfortable with their back supported. The patients legs should not be crossed. The arm should be supported at heart level. BP’s should not be taken on top of tight clothing. BP cuff should not criss cross. This can happen if arms are misshaped or obese. Correct Cuff Sizes as recommended by American Heart Association O Arms 22-26cm use a small adult O Arms 27-34cm use a regular adult O Arms 35-44cm use a large adult O Arms 45-52cm use a adult thigh Lets Pick the Correct Cuff for our Patients O On admission to the floor we will measure the patients O O O O arm to determine the correct cuff for that patient. Each cuff is labeled with the arm circumference it should be used for. The correct cuff will then be written on the patients white board and this should be the cuff used with each blood pressure reading. This will help keep the patients blood pressures more accurate. Any patient with upper arm circumference of 40cm or greater will be issued a radial cuff to be used during their stay. Radial Blood Pressure Cuffs O Rectangular cuffs on forearms can overestimate the patients blood pressure. O Radial cuffs are a conical shape to correctly fit the patients forearm for more accurate readings. When to use a Radial Cuff per GE Healthcare O Adults over age 18. O Forearm between 26-36 cm. O Upper arm greater than 40 cm. O Upper arm cuff cannot be closed straight. O Upper arm cuff overlaps the elbow due to upper arm being to short in length. O Can only be used with an automated blood pressure device. Cannot be used with wall units. More on Radial Cuffs O Yes, they are disposable cuffs but they can be used up to about 3000 times. O Yes, they can be cleaned with Clorox wipes and used on different patients. O Yes, If used on and isolation patient it must be thrown away at the end of the patients hospital stay. O Yes, these cuffs are actually positioned upside down compared to how we normally place cuffs on the upper arm. References O Hersh, L. T., Sesing, J. C., Luczyk, W. J., Friedman, B. A., Zhou, S., Batchelder, P. B. (2014). Validation of a conical cuff on the forearm for estimating radial artery blood pressure. Blood Pressure Monitoring, 19(1), 38-45. O Palatini, P., Benetti, E., Malipiero, G., & Saladini, F. (2012). Rectangular cuffs may overestimate blood pressure in individuals with large conical arms. Journal of Hypertension, 30(30), 530-536. O Palatini, P., Longo, D., Toffanin, G., Bertolo, O., Zaetta, V., Pessina, A. C. (2004). Wrist blood pressure overestimates blood pressure measured at the upper arm. Blood Pressure Monitoring, 9(2), 77-81. O Pickering, T. G., Hall, J. E., Appel, L. J., Falkner, B. E., Graves, J., Hill, M. N., Jones, D. W., Kurtz, T., Sheps,S. G., & Roccella, E. J. (2005). 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. Hypertension, 45, 142-161. O Pierin, A. M., Alavarce, D. C., Gusmao, J. L., Halpern, A., & Mion, D. (2004). Blood pressure measurement in obese patients: comparison between upper arm and forearm measurements. Blood Pressure Monitoring, 9(3), 101-105. O Schimanski, K., Jull, A., Mitchell, N., & McLay, J. (2014). Comparison study of upper arm and forearm non-invasive blood pressures in adult Emergency Department patients. International Journal of Nursing Studies, Epub ahead of print. doi: 10.1016/j.ijnurstu.2014.03.008 O Sprafka, J. M., Strickland, D., Gomez-Marin, O., & Prineas, R. J. (1991). The effect of cuff size on blood pressure measurement in adults. Epidemiology, 2(3), 214-217.
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