Postanesthesia Patients With Large Upper Arm Circumference: Is Use of an “Extra-long” Adult Cuff or Forearm Cuff Placement Accurate?

Arm Circumference, Shape, and Length: How Interplaying Variables Affect Blood Pressure Measurement in Obese Persons

“…In 2 studies, 11,13 cuff types were compared (standard vs large, rigid cylindrical vs conical); in 3 studies, 4,17,21 blood pressure measurements obtained via direct intra-arterial vs ausculatory/oscillometric techniques were compared; and in 6 studies, [14][15][16][18][19][20] blood pressure measurements obtained from the upper arm versus the forearm were compared.…”

“…7,8,18 When assessing blood pressure at alternative locations, it is essential to recognize that blood pressure varies appreciably in different parts of the arterial system, with SBP increasing in more distal arteries and DBP decreasinig. 23 Thus, because measurements of blood pressure in the forearm generally yield overestimates of SBP, DBP, and mean arterial pressure (MAP) compared with the upper arm (reported variances, 2.3-27 mm Hg), 10,14,[19][20][21]24,25 it is important to decide what discrepancy is clinically acceptable. 10,14,20 As McFarlane 10 described, a difference of ±5 mm Hg (standard deviation ≤8 mm Hg) is the standard used by the International Standards Organization and manufacturers that test noninvasive devices for measuring blood pressure against mercury sphygmo manometers.…”

Level of Agreement Between Forearm and Upper Arm Blood Pressure Measurements in Patients With Large Arm Circumference

“…Despite detailed descriptions in national guidelines by the AHA on the proper technique to be used for upper arm BP cuff location, 1 no guidance is provided for forearm cuff location. In our prior study comparing forearm and upper arm BP measurements, 10 we arbitrarily chose the middle forearm position because BP guidelines were not clear regarding BP location. This middle forearm location is also the site frequently used when clinicians obtain forearm BP measurements.…”

“…11,12 Effect size was calculated based on data from a prior study, 10 and expert opinion that average BP differences (bias) of more than 4 mm Hg 13-15 would make the forearm BP location unacceptable as a substitute for upper arm BP measurement determinations.…”

“…[2][3][4][5][6][7][8][9][10] However, most of these studies had serious methodological problems (ie, poorly described procedures for BP measurement [2][3][4]6 ; incorrect positioning of the BP cuff in relation to the heart 6,9 ; inappropriate statistical analysis 2,4-9 ), making generalization of their findings difficult. Additional studies are needed to determine if forearm BP can be used to replace upper arm BP.…”