title: Postanesthesia patients with large upper arm circumference: is use of an "extra-long" adult cuff or forearm cuff placement accurate?
abstract: The purpose of this study was to determine if blood pressure (BP) measured in the forearm or with an extra-long BP cuff in the upper arm accurately reflects BP measured in the upper arm with an appropriately sized BP cuff in patients with large upper arm circumference. A method-comparison design was used with a convenience sample of 49 PACU patients. Noninvasive blood pressures were obtained in two different locations (forearm; upper arm) and in the upper arm with an extra-long adult and recommended large adult cuff sizes. Data were analyzed by calculating bias and precision for the BP cuff size and location and Student's t-tests, with P < .0125 considered significant. Significantly higher forearm systolic (P < .0001) and diastolic (P < .0002) BP measurements were found compared to BP obtained in the upper arm with the reference standard BP cuff. Significantly higher systolic (t(48df) = 5.38, P < .0001), but not diastolic (t(48df) = 4.11, P < .019), BP differences were found for BP measured with the extra-long cuff at the upper arm site compared to the upper arm, reference standard BP. Findings suggest that the clinical practice of using the forearm or an extra-long cuff in the upper arm for BP measurement in post anesthesia patients with large upper arm circumferences may result in inaccurate BP values.
authors.affiliation: Providence Portland Medical Center, Post Anesthesia Care Unit, Portland, OR 97213, USA. sheri.watson@providence.org
authors.forename: Sheri
authors.initials: S
authors.lastname: Watson
authors.forename: Marita
authors.initials: M
authors.lastname: Aguas
authors.forename: Tracy
authors.initials: T
authors.lastname: Bienapfl
authors.forename: Pat
authors.initials: P
authors.lastname: Colegrove
authors.forename: Nancy
authors.initials: N
authors.lastname: Foisy
authors.forename: Bonnie
authors.initials: B
authors.lastname: Jondahl
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Yosses
authors.forename: Larissa
authors.initials: L
authors.lastname: Yu
authors.forename: Zoe
authors.initials: Z
authors.lastname: Anastas
mesh_terms: D000328:Adult; D000886:Anthropometry; D001132:Arm; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016528:Postanesthesia Nursing