A Cuff Too Tight Causes Discomfort
If the tight cuff is too small for the upper arm, it will have to inflate longer to cut off the blood supply. The extra inflation and excess squeezing causes discomfort. Any discomfort during a measurement can cause the readings to be inaccurate 6.
For some people, including older and frail, the tightness of the cuff may exceed discomfort and cause pain 7.
What Affects A Blood Pressure Reading
Many things can affect a blood pressure reading, including:
- Nervousness about having your blood pressure taken. This is called white coat syndrome. As many as 1 in 3 people who have a high blood pressure reading at the doctors office may have normal blood pressure readings outside of it.1
- What you ate, drank, or did before your reading. If you smoked, drank alcohol or caffeine, or exercised within 30 minutes of having your blood pressure measured, your reading might be higher.2
- How you are sitting. Crossing your legs and letting your arm droop at your side rather than rest on a table at chest height can make your blood pressure go up.2
Its important to get an accurate blood pressure reading so that you have a clearer picture of your risk for heart disease and stroke.
A reading that says your blood pressure is lower than it actually is may give you a false sense of security about your health. A reading that says your blood pressure is higher than it actually is may lead to treatment you dont need.
Take A Different Reading
If you find that your blood pressure is high, but you still want to continue with the blood pressure measurement, you should take a different reading. For example, if you are having a blood pressure measurement at home, you can take your blood pressure at another location, such as your doctors office.
You should take a different reading if you are still having high blood pressure, even if your blood pressure is within normal range. A different reading will help you determine if there is a problem with your blood pressure.
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Before Checking Your Blood Pressure
- Find a quiet place to check your blood pressure. You will need to listen for your heartbeat.
- Make sure that you are comfortable and relaxed with a recently emptied bladder .
- Roll up the sleeve on your arm or remove any tight-sleeved clothing.
- Rest in a chair next to a table for 5 to 10 minutes. Your arm should rest comfortably at heart level. Sit up straight with your back against the chair, legs uncrossed. Rest your forearm on the table with the palm of your hand facing up.
Measuring Your Blood Pressure
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A Blood Pressure Cuff Too Tight
A blood pressure cuff can be too tight for two reasons:
Lets tackle each one of these reasons and explain what happens in each situation.
How To Use An Automated Blood Pressure Cuff Correctly
Using an upper arm blood pressure cuff might require practice, but once you get it down, its very simple. Follow the below steps suggested by Dr. Del Conde:
- Relax. Sit quietly and in an upright position for two to five minutes before checking your blood pressure.
- Keep your feet flat on the ground and your arm supported at heart levelon a table, for example.
- Place the machine on a table next to you so while youre seated, you can keep your arm next to it comfortably.
- Wear the cuff over bare skin. Place it around your upper arm about one inch above the bend of your elbow. Secure the cuff tightly and evenly, but make sure you still have room to slide two fingers under the top edge of the cuff.
- Turn the power on.
- Press the start button to begin inflation. Automatic models inflate on their own and, once inflated, release air slowly.
- Look at the screen to get your blood pressure reading, separated into two numbers: your systolic and diastolic pressures.
- Write down your blood pressure reading so you can track it over time. The systolic pressure is listed before the diastolic pressure, so it should look something like 120/80 mmHg.
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What Is Ambulatory Blood Pressure Monitoring
If a doctor recommends ambulatory blood pressure monitoring, you will need to wear a blood pressure cuff for 24 hours. It’s connected to a small, portable measuring device that automatically measures your blood pressure at set times and records the readings.
Ambulatory blood pressure monitoring is used, for example, to see whether blood pressure levels vary greatly over the course of the day and night or whether they are constantly elevated. During those 24 hours, you can do all of the usual things you would otherwise do over the course of the day. If you are especially active at certain times, you can make a note in a diary. Then the doctor has a better idea of how to interpret the recorded values when evaluating them.
Manual Blood Pressure Readings
Blood can only be heard through a stethoscope if it is turbulent. As the cuff is inflated, the artery is compressed, making the blood flow through the artery turbulent. When the artery is completely closed, there is no blood flow and no sound. As pressure in the cuff is reduced, the point at which the artery is open just enough to let the blood pass, is the systolic blood pressure.
This is detected by turbulent blood flow heard through the stethoscope. As pressure in the cuff is further reduced, the vessel will once again be completely open and non-turbulent. At this point, no more sound is heard and diastolic blood pressure has been reached.
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A Step By Step Guide On How To Take A Blood Pressure Measurement
Step 1
- Introduce yourself and verify patient identity using your clinical setting protocol.
- Obtain consent from the patient for the assessment and explain the procedure.
- Ensure that the patient has not had caffeine or tobacco in the last 30 minutes.
- The patient should be allowed to rest for 5 minutes following activity.
- Prepare the environment by making the room quiet, ensure patient privacy and equipment is intact and clean. Blood pressure is measured indirectly with a stethoscope or doppler and a sphygmomanometer. A sphygmomanometer includes the blood pressure cuff, connection tubes, air pump and manometer.
- Perform hand hygiene.
Step 2
Choose a measurement site:
- The preferred site is the brachial pulse site where the brachial artery runs across the antecubital fossa.
- Another site is the posterior thigh, where the popliteal artery runs behind the knee joint.
- A site should be free from pain, injury, surgical incisions, intravenous cannulas, central venous or arterial lines, areas with poor perfusion, arteriovenous fistulas or AV shunts. This reduces the risk of patient harm and helps to ensure result accuracy.
Step 3
Position the patient either sitting, standing, supine or prone depending on your choice of measurement site.
Step 4
Palpate the artery to determine the systolic BP:
Step 5
Position the stethoscope over the brachial artery and use the bell side.
Step 6
Advise the patient of the result.
Step 11
Clean and return the equipment.
Step 12
Document.
How To Apply The Cuff Correctly
Upper arm blood pressure monitor
- CHECK.1Apply the cuff to bare skin or light innerwear
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Wrap the cuff snuggly around the arm, on bare skin or light innerwear,making sure the cuff is securely in place. Remove heavy clothes such as a sweater before measurement, instead of rolling up the sleeves.
- CHECK.2Make the air tube run down the inside of your arm
-
Adjust the position of the air tube so that it runs down the inside of your arm and is positioned at the center of your arm.
- CHECK.3Cuff wrapping position
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Position the cuff about 1-2cm above the bend of your elbow.Make sure that the cuff does not cover the joint region.
Wrist blood pressure monitor
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Wrap the wrist cuff securely around your wrist. Do not apply the cuff over clothing.
- CHECK.2Wrap the cuff around whichever wrist is easier to apply to
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The cuff may be wrapped around either the right or left wrist. However, because measurement values vary between the right and left wrists, make sure to always measure on the same side.
- CHECK.3Cuff wrapping position
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Position the cuff leaving a clearance of about 1-1.5cm between the cuff and the bottom of your palm. Make sure the wrist cuff does not cover the wrist bone.
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What Kind Of Blood Pressure Cuff Should You Use
Of the two types of at-home blood pressure cuffsa wrist cuff and an upper arm cuffexperts generally recommend using an upper arm cuff because they are more accurate.
Experts also recommend opting for a digital monitor over a manual one. Automated electronic machines using an upper arm cuff are usually accurate, says Dr. Del Conde. If there is any question about their accuracy, they can be validated against a blood pressure machine at a doctors office.
Youre Not Factoring In Electronic Units Correctly
Electronic blood pressure units also called Non Invasive Blood Pressure machines, sense air pressure changes in the cuff caused by blood flowing through the BP cuff extremity. Sensors estimate the Mean Arterial Pressure and the patients pulse rate. Software in the machine uses these two values to calculate the systolic and diastolic BP.
To assure accuracy from electronic units, it is important to verify the displayed pulse with an actual patient pulse. Differences of more than 10 percent will seriously alter the units calculations and produce incorrect systolic and diastolic values on the display screen.
Given that MAP is the only pressure actually measured by an NIBP, and since MAP varies little throughout the body, it makes sense to use this number for treatment decisions.
A normal adult MAP ranges from 70 to 105 mmHg. As the organ most sensitive to pressure, the kidneys typically require an MAP above 60 to stay alive, and sustain irreversible damage beyond 20 minutes below that in most adults. Because individual requirements vary, most clinicians consider a MAP of 70 as a reasonable lower limit for their adult patients.
Finally, and especially in the critical care transport environment, providers will encounter patients with significant variations between NIBP and arterial line measured blood pressure values.
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What Is Normal Blood Pressure And When Is Blood Pressure Considered To Be High
Blood pressure is always measured on a number of different days and when you are at rest. If several of these measurements are too high, you are said to have high blood pressure, even if only one of the two either the systolic or the diastolic one is high. The medical term for high blood pressure is hypertension. In adults, blood pressure is considered to be normal under a systolic value of 140 mmHg and under a diastolic value of 90 mmHg.
When taking your blood pressure for the first time, it makes sense to measure the blood pressure in both arms, because it’s sometimes high on only one side. The values that are higher are always the ones used for assessing blood pressure. After that it is enough to measure the blood pressure only in the arm that produced the higher reading. A person is considered to have high blood pressure if the systolic value is over 140 mmHg, the diastolic value is over 90 mmHg, or if both are higher than these readings.
Table: Normal and high blood pressure readings
| systolic over 140 mmHg and/or diastolic over 90 mmHg |
Monitoring Blood Pressure5 Key Points
- POINT1Make sure you are comfortable and relaxed
-
Your physical or mental conditions immediately before measuring your blood pressure affect your readings. So if you are frustrated or nervous,you won’t be able to take an accurate reading. Before measuring your blood pressure, rest in a chair for 1 or 2 minutes. It’s recommended that you take 5 or 6 deep breaths before you start the measurement.
- POINT2Empty your bladder and bowels
-
Measure your blood pressure several minutes after you have emptied your bladder and bowels. Do not measure your blood pressure when you have an urge to urinate or defecate.
- POINT3Sit on a chair with your legs flat on the floor and secure the cuff to your arm/wrist
-
Maintaining a correct sitting posture and correct application of the cuff are the keys for getting accurate blood pressure readings. Sit up straight with your back against the chair and keep relaxed, with your legs uncrossed. To make the height of your arm or wrist aligned with the heart level , adjust the height of the desk with a book or cushion if the desk is too low. The cuff should be wrapped snuggly and securely.
- POINT4Measure your blood pressure at about the same time each day
-
Checking blood pressure readings regularly over a long period makes your monitored data more effective in the detection and prevention of hypertension. Choose the time period when you are in the most stable condition and take a blood pressure reading at about the same time each day.
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Understanding Blood Pressure Readings
Blood pressure readings are written as two numbers. It usually looks like a fraction, followed by the letters “mmHg.” For example, 120/80 mmHg.
The first number is your systolic blood pressure, which refers to the pressure in your blood vessels when your heart beats. The second number is your diastolic blood pressure, which refers to the pressure in your blood when your heart rests in between beats.
The “mmHg” stands for “millimeters of mercury.” Doctors used mercury in the first accurate blood pressure monitors, and the unit has remained the standard for measurement.
Every time you take your blood pressure, the reading will fall into one of five categories. Here’s a breakdown of the different blood pressure categories.
The top number is your systolic blood pressure, and the bottom number is your diastolic blood pressure.
Normal: Less than 120/80 mmHg. You’re doing great! Keep eating healthy and exercising regularly.
Elevated : 120-129 systolic and less than 80 mmHg. Example: 125/75 mmHg. Make some small tweaks to your lifestyle, such as adding aerobic exercise to your day and keeping stress levels low, to reduce your risk of developing hypertension.
Hypertension stage 1: 130 to 139 systolic or 80-89 diastolic. Examples: 131/75 mmHg and 127/85 mmHg. Doctors will prescribe lifestyle changes at this stage and may prescribe medications depending on your risk of atherosclerotic and cardiovascular diseases.
Dress Properly And Expose Your Wrist
The wrist cuff should wrap around your skin and not over any clothes. This will allow the monitor to receive the best signal from your blood vessels as possible. Also, consider wearing a short sleeve shirt or a sleeve that can easily be moved up your forearm and out of the way.
A looser more comfortable sleeve would be best, so it doesnt have to be tight or uncomfortable after its moved up your arm.
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How Can I Measure My Blood Pressure At Home
Talk with your health care team about regularly measuring your blood pressure at home, also called self-measured blood pressure monitoring.
SMBP means you regularly use a personal blood pressure measurement device away from a doctors office or hospitalusually at home. These blood pressure monitors are easy and safe to use. A health care team member can show you how to use one if you need help.
Evidence shows that people with high blood pressure are more likely to lower their blood pressure if they use SMBP combined with support from their health care team than if they dont use SMBP.3
Use these additional tips for SMBP:4
- Use a blood pressure log pdf icon to record your blood pressure measurements.
- Take your blood pressure at the same time every day.
- Take at least two readings, 1 or 2 minutes apart.
If Cuff Fit Isnt The Issue
If youre experiencing intense arm pain when you take your blood pressure even after youve measured your arm circumference and made sure you have a cuff that fits, double check your cuff placement to be sure the monitor is able to correctly detect your blood pressure. If the device cant get the signals it needs because the cuff is not in the right place, it may end up over-inflating. Similarly, if youre moving during the reading, your monitor may be thrown off and the cuff may remain inflated for a longer period in order to take a measurement.
Keep in mind, too, that your cuff needs to inflate to a higher pressure than your systolic blood pressure in order to take a measurement so if your blood pressure is especially high, the cuff may inflate to a higher level than usual and cause some pain.
If you find that arm pain frequently occurs at the doctors office with an automatic blood pressure monitor, you can ask your nurse or doctor to measure your blood pressure manually with a pump instead to see if that helps.
And if you cant seem to find a way to take your blood pressure without experiencing pain, talk to your doctor. You could be dealing with an underlying injury or other condition thats causing your discomfort.
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