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The difficulty of measuring blood pressure in patients whose upper arms are too large for a blood pressure cuff poses a challenge to nurses, but it should be easy enough for manufacturers to resolve ("Clinical Comparison of Automatic, Noninvasive Measurements of Blood Pressure in the Forearm and Upper Arm With the Patient Supine or With the Head of the Bed Raised 45°: A Follow-Up Study," March 2006:196-205).

Picture a blood pressure cuff laid out flat on a table. Keep in mind that the length of the cuff is what goes around not the length of the patient’s arm but its width or circumference; the width of the cuff is what covers the length of the patient’s arm. In my experience, every set of manual or automatic cuffs has the same problem: the cuffs that are longer also are made wider. The manufacturers seem to assume that wider arms are necessarily longer arms; ie, that patients who need longer cuffs to go around their arm must need wider cuffs to go down them, too. Again, in my experience, that is rarely the case.

The longer cuffs are simply made too wide for the length of the patient’s upper arms (the "thigh cuffs" often have the same problem). These cuffs are difficult to place, especially on patients who are unwilling to cooperate. Large cuffs frequently are uncomfortable for patients who are awake, and this discomfort may affect accuracy during cuff inflation. This confluence of factors forces nurses to use cuffs that fit patients’ forearms—often easier to do—and hope for the best.

This problem would be solved if manufacturers would simply make longer cuffs narrower than they do now. More sensibly sized cuffs could greatly benefit our growing population of patients who need them.

David A. Sherman, RN, MSN, CCRN
Needham, Mass

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