It seems most of the problems people encounter when measuring blood pressure are with the cuff. The majority of them have to do with size, position, inflation, frequency and tightness. In addition, medical issues like injuries, swelling, nerve damage, capillaries bursting and more, are all part of blood pressure cuff complications.
The majority of the medical complications typically occur at a health care facility. The automatic blood pressure monitoring practiced during surgery and in hospital rooms cause most of the problems. Although rare, they do occur. Some of them are minor, and others require additional surgery to correct the problem.
This blog post will inform you of those complications and real-life stories how they occurred. I researched them in medical reports and translated the language into words the average person without a medical degree will understand. I’ll also inform you of cuff complications that can occur with home monitoring.
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Blood Pressure Cuff Complications
Bacteria On Blood Pressure Cuffs
I have to admit, I never gave this topic much thought in the past. It’s not your typical blood pressure cuff complication resulting in an injury. It’s more of a concern how germs can be transmitted from one person to the next.
After reading this, you might think twice before you allow a nurse to wrap a blood pressure cuff around your arm.
An Australian study back in 1969 identified the blood pressure cuff as a reservoir for bacteria. They noted that no other piece of hospital equipment was used more without being cleaned (r).
A study in 1996 found blood pressure cuffs were contaminated with a bacteria that causes diarrhea and colitis. The bacteria levels were the same as bedside commodes (r).
In 2006, researchers evaluated the level of contamination of blood pressure cuffs used in hospitals. In total there were 18 organisms isolated from 24 cuffs. 11 of the cuffs grew a single organism and 3 of them grew a mixture of organisms.
They identified blood pressure cuffs as a major environmental source for cross-contamination (r).
In 2007 the Center For Disease Control recommended disposable cuffs to prevent transmission from one person to another. The problem with this recommendation is the cost of the cuffs. Others have suggested a disposable sleeve which would cost a lot less money.
It’s almost 15 years later, and I haven’t come across a sleeve in my doctor’s office.
In 2013, blood pressure cuffs used in a university hospital was examined for a bacteria called methicillin-resistant Staphylococcus aureus. The blood pressure cuffs were checked using a gauze wiping method and found the bacteria 31.4% of the time.
After washing the cuffs or wiping with alcohol, the bacteria was found 0% (r).
In 2016, 50 blood pressure cuffs were sampled. 68% showed high contamination, 20% showed insignificant growth and 12% had no growth. They found an urgent need to notify and educate the hospital staff, so they can develop and implement a validated standard operating procedure for the maintenance of cuffs (r).
BP cuff complications is one of 14 sections in my article about blood pressure cuffs. Learn more about BP cuffs, including how to apply them, errors made and sizes, here in the article, Blood Pressure Cuffs.
Blood Pressure Cuff Causes Redness and Swelling
This report, from the University of Pittsburgh, noted a blood pressure complication to an athletic male after a six-hour procedure. A cuff was placed on the patient’s upper arm while he was lying in the face up position.
After his body was moved to a face down position, the cuff was immediately inactivated after a radial arterial catheter was inserted, which monitored his pressure.
Immediately after surgery, redness and swelling were observed on his upper arm. The patient also felt numbness to his hand and fingers. An orthopedic doctor confirmed swelling and a compression injury to his nerves of the upper arm. The next day, the patient’s symptoms went away.
The report noted, initially the cuff was wrapped around the arm while it was fully extended. After the patient’s body was moved to a face down position, his arm was bent at the elbow causing the upper arm to flex, increasing its diameter.
This caused constriction beneath the inactive cuff leading to the injury.
The report noted this is typically tolerated on a daily basis without any adverse effects. But they noted cuff placement, even on an inactive cuff cannot be assumed to be harmless.
They don’t specifically state this, but I’m assuming by them referencing the male as athletic, he probably had more muscle than the average male. This would cause the cuff to get extra tight with his arm flexed.
Blood Pressure Cuff Causes Crush Syndrome Resulting In Rhabdomyolysis
What is a crush syndrome? Crush syndrome is the compression of a body part that causes muscle swelling and/or neurological disturbances in the infected areas of the body. Typically, it occurs in car accidents or earthquakes when a person becomes trapped (r).
In this situation, the patient’s crush syndrome was caused by the compression of the blood pressure cuff on his arm.
Rhabdomyolysis is the release of the cellular contents into the bloodstream after damage to the muscle fibers. It can sometimes lead to kidney failure and in rare cases can cause death (r).
The following was reported in the Indian Journal Of Anesthesia in 2012 (r). A man underwent surgery for 6 hours because he suffered a pelvic fracture. During this time his blood pressure was automatically monitored and was measured every 3 minutes.
After the surgery, the man complained of severe pain to his upper arm where the blood pressure cuff was attached. The man could not lift his arm, and there was no numbness.
He was given pain medication and low blood pressure treatment because of a drop in blood pressure. He was then moved to a high-dependency unit for monitoring. After a series of testing it was determined his complication was crush syndrome and was treated accordingly.
The patient was released from the hospital after 6 days.
The report concluded, although the non-invasive blood pressure monitor is useful and mandatory, the anesthetist should be aware of its complications connected to prolonged use and its limitations.
They suggested the cuff can be alternated between arms, or removed and have the pressure taken manually.
Blood Pressure Cuff Causes Skin Necrosis
What is skin necrosis? Skin necrosis is the premature death of cells. It can be caused by an external injury or trauma. Untreated, it results in a build-up of dead skin tissue and cell debris. It is often necessary to remove the dead tissue surgically (r).
This report, published in the Journal of Postgraduate Medicine, tells the story of a 65 year-old woman who underwent heart valve surgery (r). Six hours after her initial surgery, she was returned to the operating room due to complications.
A non-invasive blood pressure monitor was used, and a cuff wrapped around her upper arm. The monitor was set to measure blood pressure every 15 minutes.
After surgery, the non-invasive monitoring was continued, but the cuff was moved to the other arm every 4 hours. On the following day, the non-invasive monitor was changed to an occasional inflation done manually by the medical staff.
On the 3rd day after surgery, the skin on her arms became discolored. The complication worsened resulting in skin necrosis of both arms, which involved about 2/3 of the arm circumference.
She was examined for plastic surgery, and a plan was made for a split skin graft to the arm. Luckily, the arm healed and the skin grafting was never performed.
The report noted the blood pressure equipment was used properly, and the arms were switched as recommended. They concluded the brief, repeated compressions by the blood pressure cuff damaged the microcirculation and led to the skin necrosis.
Petechiae From Blood Pressure Cuff – Broken Capillaries
This blood pressure complication looks like a rash but it isn’t. Petechiae are tiny spots on the skin that are red, brown or purple. The tiny spots are caused by bleeding under the skin from broken capillaries.
There are many causes but with a blood pressure cuff it’s caused by the compression trauma or friction against the skin (r).
A report published in the BMJ Journals explains how a 62 year-old man developed petechiae (r). He was admitted into a cardiac care unit after undergoing a heart catheterization earlier that day. During the procedure a 2 compression bands were used and then removed after 2 hours.
Several hours later his blood pressure was measured. Immediately following the measurement, he developed red dots around his lower arm. The upper boundary of the rash ended at the exact spot where the lower end of the blood pressure cuff was wrapped around his arm.
They concluded his petechiae were aggravated by many medical issues and not just the cuff. His medication, vascular fragility related to his hypertension and compression from the cuff all contributed. His rash disappeared completely after several weeks.
I wrote a whole article on Petechiae and included many pictures of what it looks like. Check out the shocking photos in the article here, Petechiae From A Blood Pressure Cuff.
Blood Pressure Cuff Causes Numbness and Radial Nerve Damage
A report published in 2001 explains how a 19 year-old man suffered from a blood pressure cuff complication (r). He was admitted into the hospital and underwent emergency surgery for an ulcer. A non-invasive blood pressure monitor and cuff was attached to his left upper arm.
The monitor was set to measure his BP every 3 minutes. The following day he complained of numbness to his left hand. He had no strength in his left wrist and finger muscles.
The diagnosis was an acute radial nerve injury and rehab and physical therapy was prescribed. The radial nerve runs down the underside of the arm and is responsible for extending the wrist and fingers.
Four months later his muscle strength and hand returned back to normal. They concluded that placing the cuff higher on his arm to avoid the most superficial part of his radial nerve may have prevented this type of compression injury.
Compartment Syndrome Caused By A Blood Pressure Cuff
What is compartment syndrome? Compartment syndrome is a dangerous and painful condition. The pain is caused by a build-up of pressure within a muscle compartment. The pressure decreases blood flow and starves the muscles and nerves of oxygen and nutrients.
The symptoms include pain, weakness and a tingling sensation. It can be caused from swelling or bleeding after an injury (r).
This case was reported by the British Journal of Anaesthesia (r). A 21 year-old man underwent surgery to reconstruct his right thumb. His pressure was monitored by a non-invasive automatic BP monitor with the cuff attached to his left arm. The surgery lasted for 8 hours and 10 minutes.
Immediately after surgery he complained of pain to his left arm. His left arm was examined, and it was red with some scraps that matched the shape of the blood pressure cuff. Two hours later he complained of pain and tingling to his fingers.
His compartment pressure was measured and found to be very high. A diagnosis was made of compartment syndrome to his arm. A short while later, about 4 hours after his initial surgery was completed, he was returned to the operating room where he underwent decompression of the affected arm.
They do this by making deep incisions of the affected areas. After surgery his symptoms were relieved.
The report noted the patient’s BP was high and because the way the monitor operates, it produced longer measuring times than typical. During his initial surgery, his blood pressure was recorded 805 times.
They noted in cases of prolonged monitoring, the way the monitor is used may need to be modified by reducing the number of measurements.
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Home Blood Pressure Cuff Complications
Blood Pressure Cuff Is Leaking
It’s possible your home cuff may develop an air leak. If it has one, your pressure may be measured unproperly. If you need a new cuff, you don’t have to replace your entire monitor. You can replace the cuff which they sell at an affordable price online.
How to check your cuff for a leak. Remove the tube from the monitor and the connector. Blow air into the tube until the cuff is partly inflated and then pinch the tube so the air doesn’t escape out of the cuff. GENTLY squeeze the cuff and listen for any possible air leaks.
Blood Pressure Cuff Is Causing Pain
If your cuff is the wrong size, it can cause some discomfort and possible pain. This is more likely to happen if the cuff is too small or tight. Always check the size range of your cuff and make sure your arm measurement is within the proper range.
If the cuff does not fit properly, wrapped around wrong or your arm is more cone shaped, it can lead to discomfort and possibly leave marks on your skin. There is no need to measure your pressure all day long. This can bring on more discomfort.
Typically 2 times, once in the morning and once in the evening are enough. Always check with your physician to find out if he has any specific instructions for you.
The Frequency of Blood Pressure Cuff Complications
A study was conducted to examine how often blood pressure complications occurred while using an ambulatory blood pressure machine (the automatic monitor used in hospitals) (r). They studied 219 patients and found 4 of them had a blood pressure cuff complication, 1.8% of the time.
It was determined all 4 patients developed petechiae from the cuff. One of the patients also had superficial abrasions due to the repeated cuff inflations. All 4 of the people were smokers and had a vascular murmur, a turbulent flow of blood in an artery.
They were all at high risk of high blood pressure and associated complications.
Overall, the researchers determined the monitors were safe with a low incidence of complications.
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