BP cuff sizes

 Q: In a morbidly obese patient, an"adult thigh" cuff can be applied to arm for blood pressure measurement if arm circumference is above 44 cm?

A) True

B) False

Answer: A

If arterial line is not present, blood pressure measurement via cuff is still a standard of care in ICU. Said that this may give a wrong reading in obese patients. Smaller size cuff may give erroneously higher systolic blood pressure. By definition the length of the BP cuff bladder should be 80 percent, and the width at least 40-45 percent of the circumference of the upper arm. 

 The American Heart Association has designated a guideline of different cuffs per arm circumferences. 

• Arm circumference 22 to 26 cm, "small adult" cuff, 12 x 22 cm
• Arm circumference 27 to 34 cm, "adult" cuff, 16 x 30 cm 
• Arm circumference 35 to 44 cm, "large adult" cuff, 16 x 36 cm 
• Arm circumference 45 to 52 cm, "adult thigh" cuff, 16 x 42 cm

#hemodynamic

References:

1. Muntner P, Shimbo D, Carey RM, et al. Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association. Hypertension 2019; 73:e35. 

2. ESH/ESC Task Force for the Management of Arterial Hypertension. 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens 2013; 31:1925. 

3. Beevers G, Lip GY, O'Brien E. ABC of hypertension. Blood pressure measurement. Part I-sphygmomanometry: factors common to all techniques. BMJ 2001; 322:981. 

4. Pickering TG, Hall JE, Appel LJ, et al. 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. Circulation 2005; 111:697.