Blood pressure cuff question...

memphispanda, RN · Aug 28, 2003

I haven't been a nurse at all yet, but I do work as an extern and I have had problems with cuff sizes already. The other day I had a lady whose arm was huge near the shoulder, tiny near the elbow, and very short. The regular adult cuff would barely wrap around her arm, and would be shaped like a funnel if I did put it on her. Then when I blew it up, it would just riiiiip right off. So I got a larger cuff--not huge, just the next size up. It would just barely width-wise between her elbow and armpit (and in school they taught us that if it's more than about 1/3 of the arm it won't give you an accurate reading). Well, fine, I tried it anyway, still have the same problem with the funnel shape, couldn't get a BP on her to save my life. I felt SO stupid. I finally ended up taking it on her lower leg (this was a young chick in with a HA, so it wasn't contraindicated).

boggle, ASN, RN · Aug 28, 2003

For those hard to fit arms, we usually take the BP on the forearm. A regular adult cuff usually fits there just fine.

When it comes to cuffs, one size definitely does not fit all!

Marie_LPN, RN, LPN, RN · Aug 28, 2003

Forearm BP is what we do.

I actually had to use a large cuff on a forearm once, since the lady was 605 lbs and her forearms were big. No regular cuffs would fit around her forearm.

angelbear · Aug 28, 2003

I dont mean to hijack this thread but can someone explain the procedure for taking the BP on the forearm? The reason I ask is I was not taught this method in school and I work with a population with alot of contractures so using the forearm on alot of them would probably work better. Thanks for the help.

angelbear · Aug 28, 2003

Oh yae and when is it contraindicated. Thanks

NICU_Nurse, BSN, RN · Aug 28, 2003

I don't know a hoot about when it's contraindicated, but taking the pressure on the forearm is easy. All you do is line the artery mark up with the radial artery (by the thumb) with the cord itself pointing down the arm (towards the fingers) just like you do with an upper arm pressure.

Edited to add: Off the top of my head, I can think of a couple of contraindications. The first is if the patient is female and has had breast removal on that side- never give a pressure on that side (You'll have to ask this during your history assessment). The second is if that patient has an IV on that arm, or possibly a central catheter (ie, one that is inserted into the side of the neck). With those patients, you'd want to choose the other arm as well.

P_RN, ADN, RN · Aug 29, 2003

Forearm here also. I've also taken leg pressures....noted as such on the graphic.