Classification of BP for adults aged

18 and older

Getting an
Accurate Blood
Pressure
Upper Arm vs Forearm

Figures based on the average of seated

BP readings properly measured during 2
or more office visits.

Why is the right sized

cuff important?
The right cuff size is very
important.
Blood pressure readings may
be wrong if your cuff is the
wrong size.
If the cuff is too wide, it will
underestimate the BP
While a cuff that is too
narrow tends to overestimate
the BP.

Cayuga Community College

Nursing Class 2015

Kelly Pinckney
Kayla Wood
Kady Wysocki

Upper Arm Placement and

measurement

The brachial (upper arm) site is the gold

standard for non-invasive BP monitoring.
However, in some situations, this site is
inaccessible due to injury, surgery, dialysis
shunts, intravenous devices, and
lymphedema.
When the upper arm is unavailable to be
used, the forearm site is sometimes the
alternative. The increased incidence of
obesity also contributes to a heightened use
of forearm BP monitoring.

Forearm BP's differ from upper

arm BP's.
Recent evidence suggests forearm
BPs overestimate systolic, diastolic
& mean values anywhere from 10
to 33 mmHg.
Trends in BP readings & patient
status will need to be carefully
evaluated prior to treatment.
As a result, it is critical that when
the forearm method is
indicated, all caregivers
consistently use the forearm for
BP readings.

American Heart Association guidelines

recommend the forearm method
for selected Bariatric patients
only when 1 of the following 2 criteria is met:

Place BP cuff 1 inch (2.5 cm) above the

antecubital fossa. Position the cuff on the arm
properly by placing the arrow on the inside of
the elbow to line up with the brachial artery.

Forearm Placement and

Measurement

More so, the difference in BP

measurement sites can be used as a
basis for a change in current
practice to include recording the
BP measurement along with the
site, as is current practice with
temperature measurement.

Upper arm circumference is >20 (50 cm)

Size & shape of upper arm suggest
available cuffs will fit extremely poorly

Place BP cuff 2-3 cm above radial artery,

with the arrow positioned over the radial
artery. Support forearm at heart level and
auscultate at the radial artery.