Comparison of Upper Arm and Forearm Blood Pressure Cuff Placement in an Intensive Care Unit

Wednesday, July 13, 2011: 1:45 PM

Candace C. Cherrington, PhD, RN
Miami Valley College of Nursing & Health, Wright State University, Dayton, OH
Sieglinde Ewing, BSN, RN
Intensive Care Unit, Adena Medical Center, Chillicothe, OH

Learning Objective 1: Describe the importance of correct BP cuff placement in the ICU setting.

Learning Objective 2: Discuss alternatives to incorrect BP cuff placement in the ICU setting.

Purpose: Nurses are responsible for the correct measurement of blood pressure of the patients under their care and, if necessary, the administration of proper treatment. Experience shows that guidelines for correct placement and correct size of blood pressure cuffs are not always followed. Previous studies have shown that incorrect technique will lead to incorrect blood pressure measurements and subsequent improper treatment. An understanding of the daily practice of blood pressure assessment was necessary to answer the research question: What is the frequency of improper blood pressure cuff placement and use of incorrect cuff size in the intensive care unit?

Methods: An observational, exploratory study was conducted on a 12-bed intensive care unit and a convenience sample of 100 patients were observed on randomly selected days and shifts.

Results: For 25% (n=25) of patients the cuff was improperly placed and 8% (n=8) of patients were found to be wearing the incorrect size of cuff. The majority of incorrectly placed cuffs were found on the forearm and almost all incorrectly sized cuffs were too small.

Conclusion: Ongoing education about correct blood pressure cuff size and placement are needed but the observations suggest that nurses are often forced to place cuffs on forearms due to the patients’ co-morbidities, such as upper arm obesity or mastectomy. As multiple studies have shown that upper arm and forearm blood pressure measurements are not interchangeable. To enhance the quality and safety of patient care further studies are needed to determine the appropriate formula for translation of forearm blood pressure readings to comparable upper arm measurements.