There are so many variables involved when measuring blood pressure. If one of them is not performed properly, your blood pressure readings will not reflect your typical pressure. Blood pressure cuff placement is one of those variables. Therefore, what is the correct blood pressure cuff placement?
A properly sized blood pressure cuff should be placed around your bare upper arm. The middle of the cuff should be positioned at the level of the right atrium. In addition, home monitor cuffs should be positioned slightly above the arm bend with the artery marker on the cuff lined up to the artery. The cuff should be pulled taught, enough to fit two finger tips under the top edge of the cuff.
There are many blood pressure articles explaining tips and proper techniques for measuring your blood pressure at home. Of course, they all address arm cuff placement, but they rarely go into complete detail. Often it’s just one numbered step out of many others.
This post will go into the nitty gritty and tell you everything you need to know about arm cuffs and how it can affect your blood pressure readings.
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Blood Pressure Cuff Placement
Blood Pressure Cuff Size
When it comes to blood pressure cuffs, size does matter. The wrong size cuff can cause your readings to be either too high or low. Most home monitors and cuffs have an arm size range on the cuff.
Some home monitors come with one size range cuff and others may give you a choice of cuffs. If your arm size changes, some monitor cuffs can be changed to a different size (r).
Before you purchase a home monitor, make sure you know what cuff size you’re getting. The home monitor I use and recommend comes with a standard cuff size that fits most people. It measures between 8.75″ and 16.5″.
The best way to measure your upper arm is with a cloth measuring tape. Keep your arm relaxed, supported or hanging straight down. Wrap the measuring tape around the middle of your upper arm and make sure it is even all the way around.
Make a note of your measurement and make sure it falls within the range of the cuff you’re buying.
Blood pressure cuff placement 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 Over Clothing
A cuff should never be placed around clothing because your measurement won’t be accurate. If you’re at home, wear a loose, shirt sleeve shirt. Do the same prior to going to your doctor appointment.
In addition, if you happen to have a long sleeve shirt on, take it off instead of rolling up your sleeve. Often rolling up your sleeve causes the sleeve to tighten up around your arm.
Two reasons why this is incorrect. One, the tight sleeve acts as a tourniquet and can affect blood flow (r). Two, it frequently results in less room and may cause the cuff placement to be too low.
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Blood Pressure Cuff Placement
For the best cuff placement, it should be wrapped around the upper arm, just above your elbow bend. Different home monitors recommend slightly different distances.
The Omron home monitor I recommend states the bottom of the cuff should be about 1/2″ above the elbow bend. The Welch Allyn Cuff I use, states the bottom of the cuff should be about 1″ above the elbow bend.
Check your monitor instructions and see what they recommend.
Regardless of the type of monitor, when the cuff is placed on your upper arm, it has to be at heart level when measuring your blood pressure. Specifically, the middle of the cuff should be at the height of your right atrium, the midpoint of your sternum (r).
Your sternum is about where your clavicle bones meet in the middle of your upper chest. It runs down to where the bottom of your ribcage turns up and meets in the middle of your lower chest.
Your arm should be supported when measuring your blood pressure. Make sure the support you use will keep your cuff at the correct height. Your arm should not be supported by yourself or hanging down your side to achieve the proper level (r).
In addition, the cuff on a home monitor has an artery marker. The cuff has to be positioned so that marker lines up with the artery in your arm bend. When the cuff is in this position, the tube will run down the inside of your forearm.
Blood Pressure Cuff Tightness
Having the proper cuff size doesn’t mean it will be the correct tightness. It is essential not to wrap the cuff around too tight or loose. The cuff should be taut and not free to move around (r). At the correct tightness, you should be able to slip 2 finger tips under the top of the cuff.
Blood Pressure Cuff Placement Effect On Blood Pressure
Measuring your blood pressure accurately is essential for managing and diagnosing your blood pressure (r). The placement of your blood pressure cuff can affect your measurements in different ways.
If you fail to follow the guidelines outlined above, your results are going to suffer. The following will tell you how different cuff complications affect your blood pressure.
Applying Blood Pressure Cuff Too Tight
When the cuff is too tight, it can give readings higher than if the cuff was at the correct tightness. A cuff too tight can add up to 10 mmHg systolic and between 2-8 mmHg diastolic (r).
Blood Pressure Cuff Too Loose
You’ll get readings lower than your typical pressure. This is dangerous, because it’s possible to have high blood pressure only to think it may be normal (r).
Cuff At Wrong Height
If the cuff height is lower than heart level (right atrium), the readings will be higher. If the cuff is higher than heart level, the readings will be lower (r).
Blood Pressure Cuff Wrong Size
If the cuff is too big, it may be unpossible to wrap it around tight enough which will lead to a lower BP measurement. If your cuff is too small, you may place it around your arm too tight, resulting in a higher measurement.
Blood Pressure Cuff Over Clothing
The cuff placed over clothing of any kind can give readings higher than what it should be. A cuff over clothing can add anywhere between 5 to 50 mmHg systolic (r).
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