Paper
Saturday, 22 July 2006
This presentation is part of : Clinical Strategies and Techniques
The Effect of Anatomical Structures on Adult Forearm and Upper Arm Automatic Non-Invasive Blood Pressure Measurements
Kathleen Schell, DNSc, RN, School of Nursing, University of Delaware, Newark, DE, USA
Learning Objective #1: discuss the relationship between forearm and upper arm non-invasive blood pressure measurements.
Learning Objective #2: describe anatomical structures that influence non-invasive blood pressure measurements.
Use of automatic noninvasive blood pressure (BP) monitors has become a standard healthcare practice, integral to client assessment and treatment. The forearm has been used for BP measurement when the upper arm is inaccessible or available cuffs do not fit the upper arm. Studies have demonstrated that forearm and upper arm BPs are not interchangeable for some adults. However, identification of these individuals is elusive as results have shown no correlation to age, race, gender, body mass index, presence of cardiovascular risk factors, medical diagnosis or cuff size. The purpose of this pilot study was to determine the effects of anatomical structures, specifically limb subcutaneous tissue and vessels on differences between forearm and upper arm automatic non-invasive blood pressure measurements. Twenty subjects with a mean age of 21.7 years and without peripheral vascular disease or coronary artery disease participated. Circumference and skinfolds were measured for the upper arm and forearm. Body mass indices were calculated. Ultrasound measured vessel depth and diameter in the upper arm and forearm. Dual Energy X-ray Absortiometry (Dexa) determined percent of subcutaneous tissue in the arm. With subjects seated, American Heart Association guidelines were used to measure BPs, first by auscultatory method (upper arm only) and then by oscillometric method (upper arm and forearm) with a Dinamap 100 automatic BP monitor. There were significant differences between upper arm auscultatory and automatic systolic BPs (t=-4.88, p=.000) and mean arterial pressures (MAP) (t=-3.07, p=.007). Differences between automatic forearm and upper arm BP readings were significant for MAP (t=-2.39, p=.028). A regression model established that only skin caliper measurements of the biceps and triceps and upper arm circumference explained a significant portion of the difference between forearm and upper arm BPs. Further study is needed to extend the findings to a larger, less homogenous sample.

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