Impact of cuff positioning on blood pressure measurement accuracy: may a specially designed cuff make a difference?

Abstract

During blood pressure (BP) measurement, the recommended positioning of the cuff bladder center is directly above the brachial artery. We investigated the relevance of incorrect cuff positioning during (1) auscultatory measurement with an appropriate or improperly small cuff and (2) oscillometric measurement with a wide-range cuff designed to guarantee accurate measurements regardless of position. In subjects with wide BP and arm circumference ranges, (1) auscultatory BP was repeatedly measured with a properly positioned cuff (reference) and, simultaneously, with an identical cuff placed on the other arm in either a correct or an incorrect position (test). The measurements were performed with a properly sized (N=57) or an improperly small cuff (N=33). (2) Auscultatory measurements obtained with a properly positioned and sized cuff were compared with oscillometric measurements obtained with a specially designed wide-range cuff (Omron IntelliWrap) placed on the contralateral arm either in a correct or an incorrect position. Auscultatory BP measures were unaffected by incorrect positioning of a properly sized cuff, whereas with undercuffing, BP was overestimated with the cuff displaced by 90° laterally (systolic/diastolic BP differences: 4.9±4.6/4.0±4.6 mm Hg, P<0.01) or by 180° (3.9±5.4/4.2±5.1 mm Hg, P<0.01) in relation to the correct position. Incorrect placement of the oscillometric cuff had no significant effect on the accuracy of the measurements (difference with correct position <1.5 mm Hg). Incorrect cuff positioning introduces a systematic overestimation of auscultatory BP when the cuff is too small in relation to arm circumference but not when it is correctly sized. No systematic error was observed with oscillometric measurements obtained with a specially designed wide-range cuff.

The Haemodynamic Response to Endotracheal Intubation at Different Time of Fentanyl Given During Induction: A Randomised Controlled Trial

“…There are limitations in this study. First, the accuracy of actual BP readings might be vary owing to the improper size of BP cuff 27 and patient mobilisation since noninvasive blood pressure measurement was applied. Moreover, the exact BP value might be lost at the time of intubation due to the delay measurement of non-continuous noninvasive BP cuff.…”

Validation of the Omron HEM-7320-LA, upper arm blood pressure monitor with Intelli Wrap Technology Cuff HEM-FL1 for self-measurement and clinic use according to the European Society of Hypertension International Protocol revision 2010 in the Mexican population

“…The dimensions of this device are (width×height×depth) 124×90×161 mm. The cuff Intelli Wrap HEM-FL32 (Omron Healthcare Co. Ltd) included in the device provides a wide range of arm circumferences of 22–42 cm (9–17 inch), avoiding undercuffing, which has been proven to be a key source of error BP measurement 8 . The cuff is also preformed, which makes it easier to place it on in the arm by a single hand also by the patient himself/herself, making BP measurement even more simple, which can avoid incorrect BP.…”

Resistant Hypertension

“…Inaccurate blood pressure measurement is not uncommon; it occurs when patients are not instructed to sit calmly and quietly and when the cuff is too small [17]. In diagnostic algorithm of resistant hypertension, stepwise approach is recommended.…”