Do we just guess at blood pressure readings?

New research documents the cheap disposable cuffs are not accurate and could by error be responsible for unnecessary treatment. Nurses General Nursing Article

Do we just guess at blood pressure readings?

Recent research documents that a hypertensive ward found the BP readings of 1/3 their patients were in error when they switched to disposable washable cuffs to prevent cross-contamination. Another research just came out documenting the bladderless cuffs were in error by 27mmHg systolic and 17 diastolic. A normal person with BP of 113 could be labeled stage 2 hypertensive at 140 if there were an error of 27mmHg.

The adage you get what you pay for seems to fit in regard to the cheap cuffs on the market. We should strive for accuracy and not estimation when measuring Blood Pressures.

There are many accurate reusable cuffs on the market, and disposable covers available to prevent cross-contamination. There should never be a compromise with vital sign assesment. In areas of Surgery and Critical Care the lack of accuracy could be a life-threatening event.

IS BLOOD PRESSURE READING JUST A NUMBER?

One of the most critical factors in patient assessment is the blood pressure reading. If the accuracy of the blood pressure reading is compromised then the ability for accurate assessment of the patient is also compromised. For many years we were exposed to cross-contamination due to microbe-laden blood pressure cuffs. The medical industry has solved this dilemma through the use of cheap disposable blood pressure cuffs. New research questioning the accuracy of these cuffs is now available.

A major teaching hospital was concerned about the cross-contamination of their manufacturer-validated cuffs. They substituted a washable cuff. In their hypertensive unit, they documented that 33% of their patients with poorly controlled hypertension were wrongly diagnosed as normotensive due to lack of accuracy of the washable cuffs. One-third of the entire patients in this hypertensive unit would not be given the proper medication to control their hypertension had they not discovered the compromise in accuracy.1

The most comprehensive research to date on the accuracy of various types of cuffs compared eight different types of cuffs made of coated woven and non-woven fabrics. There were variations of up to 27mmHg for systolic readings and 17mmHg for diastolic reading.2

Using the American Heart standards for blood pressure- a person with an accurate blood pressure reading of 113 systolic that had an erroneous 27mmHg systolic cuff could be diagnosed as Stage 2 hypertensive at 140. This lack of accuracy should alarm every health care worker. The blood pressure measurement should be focused on accuracy, not the lowest cost of a cuff.

There is a remedy for the compromise of accuracy by using a reliable well-made reusable cuff such as the W.A.Baum company makes and a low-cost cover to protect the cuff, like Bowen Medical Cuff-Guard to prevent cross-contamination. Cleaning of the reusable cuffs between each patient is also an option if it is thorough and documented. The most basic of healthcare are accurate evaluations of vital signs. The blood pressure reading should always be the most accurate we can strive to obtain. "Since hypertension is a major worldwide problem affecting millions of people, its accurate estimation is imperative and needs further attention. The methods of measurement, equipment and the size of the cuffs have already been standardized but the cuff fabric construction and the material of the cuffs which are the cornerstone of accurate BP measurement have been neglected."2

1. Unsafe health and safety: sphygmomanometer cuffs are not interchangeable. By Shaw KC, McEniery CM, Wilkinson and Brown. Published in Journal of Hypertension 2013 July,27(7):434-36

2. Variation in BP values for different cuff types by Naqvi, Potluri, Mandal and Lewis published in Journal of Industrial Textiles 2018, Vol.47(7) 1478-1495.

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TMB41

About TMB41

I am BSN from University of Texas with over 35 years experience in critical care and ER.

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I would wager that outside of the controlled environment of a study the biggest cause of errors is incorrect cuff size and arm positioning.

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I would wager that outside of the controlled environment of a study the biggest cause of errors is incorrect cuff size and arm positioning.

Readily observable at any moment.

The lack of attention to these two details (and lack of concern for educating about such) is disturbing.

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Readily observable at any moment.

The lack of attention to these two details (and lack of concern for educating about such) is disturbing.

Tell me about it.

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Specializes in Pediatrics Retired.
Readily observable at any moment.

The lack of attention to these two details (and lack of concern for educating about such) is disturbing.

Tell me about it.

Geez. In pediatrics I see this all the time. A cuff that looks like you've wrapped a knee immobilizer around a kids arm, or one that so small it barely makes it through the reading before it busts loose, or a cuff around the calf instead of above the ankle. Drives me out of my mind!!

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Yep.... I once called a rapid for low bp and altered mental status. The responding nurse promptly told me it was because I was using too large of a cuff (I actually measured). She used a smaller one, had to hold the cuff in place while it was pumping up to keep it from popping off the arm, and was so proud of herself when the reading came back normal. One of the bigger WTF moments I've had in nursing.

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.

Not only arm positioning, but body positioning, talking during the reading, etc.

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I've followed nurses who reported the doctor had been called because of low or high blood pressure. I put on an appropriate size cuff and le voila they're cured.

I get a guilty enjoyment out of doing that.

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Specializes in Pediatrics Retired.
I've followed nurses who reported the doctor had been called because of low or high blood pressure. I put on an appropriate size cuff and le voila they're cured.

I get a guilty enjoyment out of doing that.

"SHAMAN"

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Specializes in Urgent Care, Oncology.

Those portable BP machines are never checked and calibrated routinely, either.

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Those portable BP machines are never checked and calibrated routinely, either.

Yep, we're lucky if they even turn on.

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Specializes in OB.

We recently changed our BP-taking practice at the birth center where I'm a CNM. We had an abnormally high number of transfers due to gestational hypertension in a 6 month period, so one of our higher-ups dove into the literature and gleaned that the inner bladder of the BP cuff that actually inflates should encircle at least 70% of the patient's arm. If it can't do that, you need to move to a bigger cuff. We were surprised to see that the majority of our patients require a large cuff based on this guideline.

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