Blood Pressure Cuffs

A blood pressure cuff and how it’s secured to your arm is one of the most important aspects of measuring blood pressure. A blood pressure cuff is sometimes confused with the monitor itself. It’s a separate component. Therefore, what does a blood pressure cuff do?

A blood pressure cuff contains an air bladder which fills up with air and compresses the brachial artery to stop the flow of blood. When the air from the bladder is released, the blood flow restarts. The physician records the systolic and diastolic BP by listening to the flow of blood through a stethoscope.

Many factors about the blood pressure cuff determine the accuracy of the measurement. These factors include the blood pressure cuff arrow, artery marker, sizing, placement, height and tightness. All these factors are discussed in this article, including many BP cuff problems like red marks on the skin.

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How To Use A Blood Pressure Cuff

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Blood Pressure Cuff Arrow

Most blood pressure cuffs have an arrow. Different companies use the arrow on the cuff for different purposes. For this reason, where to align the arrow can get confusing. Therefore, when placing a blood pressure cuff, how should the arrow be aligned?

The blood pressure cuff arrow should be aligned with the brachial artery if the arrow is used as an artery marker. When the arrow is used for cuff size index, the arrow should point towards the size range indicator line.

When the arrow is utilized for cuff sizing, the arrow should point somewhere on the size range indicator line if the cuff is the correct size. If the arrow points before or after the line, it’s not the correct size cuff for the arm.

When the arrow is used as an artery marker, it should align with the brachial artery on the arm ((John Hopkins Children Center: Blood Pressure Measurement Essentials)). This helps center the air bladder over the artery. The centering of the air bladder is important because it will squeeze the arm and stop the flow of blood as it’s intended to do.

To see some photos of the arrow as an artery marker and size range indicator, check my article, Blood Pressure Cuff Arrow Placement – Which Way Does It Go? The article dives into the topic in more detail and provides images of every kind of cuff and arrow.

Blood Pressure Cuff Placement On Arm

How should a blood pressure cuff be placed?

The cuff should be wrapped around the upper arm above the elbow bend.
The middle of the cuff should be at heart level.
Align the artery marker with the brachial artery.
The cuff should be taut and not free to move around. At the correct tightness, two fingers should be able to slip under the edge of the cuff.
Do not place the cuff over clothing.
The cuff should be the correct size.

Herat level is even with the right atrium of the heart. This is the mid point of the sternum¹.

I wrote an article which goes into the nitty gritty of each of the above steps. In addition, how each one affects the blood pressure reading. Check out the article here, Blood Pressure Cuff Placement.

What Happens When A Blood Pressure Cuff Is Too Small

An incorrectly sized cuff is going to be either too small or too large. Of the two, having a cuff too small occurs more often ((American Journal Hypertension: P-175: Accurate cuff size in blood pressure measurement)). Therefore, let’s answer a question asked many times, what happens if a blood pressure cuff is too small?

When a blood pressure cuff is too small, the blood pressure measurements are 5 mmHg systolic higher. The air bladder doesn’t fully wrap around the arm and affects how the brachial artery is compressed. There is prolonged inflation which causes discomfort because the arm is squeezed for a longer time.

To check the size of your current cuff or prior to buying a new cuff, measure the circumference of your upper arm.

Wrap a cloth tape measure evenly around the middle of the upper arm.
Don’t flex the arm and keep it straight down along the side of the torso.
Write down the size and compare it to the size range of the current cuff or the one which may be purchased.
If the arm size doesn’t fall within the range of the current cuff, obtain a new cuff or a monitor with the correct size.

Learn more about cuffs too small in my article, Blood Pressure Cuff Too Small.

Blood Pressure Cuff Too Big For Arm

A blood pressure cuff too big for the arm will cut the blood flow faster resulting in a lower blood pressure measurement. What is the blood pressure cuff size rule?

It is recommended the blood pressure cuff bladder length should be 75-100% of the upper arm circumference. The width should be 37-50% of the upper arm circumference.

It’s important to use a monitor with an arm circumference range fitting the upper arm. Let’s say a monitor comes with a standard size cuff range between 8.75″-16.5″. If the arm measures 15″, typically this size cuff and inside bladder would be appropriate for measuring blood pressure ((National Center for Biotechnology Information: The effect of cuff size on blood pressure measurement in adults)).

The cuff bladder is located inside the the blood pressure cuff material. The bladder is what fills up with air when the monitor is turned on. The air supply tube connects inside to the bladder and provides air from the monitor.

My article, Blood Pressure Cuff Too Large, contains three studies which informs you how much blood pressure was lower when using a cuff too large. In addition, it has tips on avoiding the problem.

The Difference Between Cuff Bladder Width and Cuff Width

The cuff bladder is the part of the cuff that inflates. It’s not visible by the eye and is sewn inside of the outer cuff material that you do see. Typically, when people refer to the blood pressure cuff, it’s the material you see that contains the printed instructions and velcro. The cuff also contains the bladder².

The bladder is always smaller than the actual cuff size, both width and length. The arm range size listed on the cuff is not the same size of the cuff material.

While the bladder width should be between 37%-50% of the upper arm circumference, the advertised cuff sizes are a different measurement. The manufacturers don’t list or advertise the bladder size, typically they list just the arm size range the cuff is made for.

For example, the blood pressure cuff with my home monitor fits an arm range of 8.75″-16.5″. If your upper arm circumference falls in between those two numbers, typically the cuff and inside bladder should be appropriate for your arm.

So when ordering your home monitor, check their recommended arm circumference for the cuff included with their monitor. If you’re not sure how to obtain your upper arm circumference, you’re in luck because that’s the next topic of this post.

Find out the correct blood pressure cuff bladder width in my article, Blood Pressure Cuff Bladder Width.

Blood Pressure Cuff Bladder Length

How long should the bladder of a blood pressure cuff be relative to a patient’s arm?

The length of the bladder should be no less than 75% of the circumference of the upper arm measurement. If the upper arm measures 15″, the length of the bladder should be no less than 11.25″. Ideally, it should fall in the range of 11.25″-15″ (75%-100% of the upper arm measurement).

The following table indicates different BP cuff sizes, related arm circumference and cuff bladder dimensions ((Hypertension: Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association)).

BP Cuff Size	Arm Circumference	Bladder Size (W X L)
Small Adult	8.66″-10.23″	4.72″-8.66″
Adult	10.62″-13.38″	6.29″-11.81″
Large Adult	13.77″-17.32″	6.29″-14.17″
Extra-large Adult	17.71″-20.47″	6.29″-16.53″

Don’t confuse bladder length with cuff size. Find out how to properly size each one in my article, Blood Pressure Cuff Bladder Length.

Errors Using A Wrist Blood Pressure Cuff

It’s easier to make an error using a wrist cuff over a standard upper arm cuff. It’s because people aren’t used to them and the cuff is smaller allowing more movement away from heart level. The following are errors when using a wrist blood pressure cuff:

Not keeping the wrist cuff at heart level.
Not supporting the upper arm properly. The elbow should be supported on a comfortable surface.
Wrapping the cuff around the protruding wrist bone.
Wrapping the cuff too loose. There shouldn’t be any space between the cuff and the skin.
Using the wrong wrist.
Improper body positioning. It’s the same when using an upper arm cuff.
Wrapping the cuff around a shirt sleeve.
Folding a shirt sleeve up too tight around the forearm.

Keeping the wrist cuff at heart level is easy when the correct steps are taken³. Learn how in my article, How To Take Your Blood Pressure With A Wrist Cuff.

Wrist Blood Pressure Cuff Instructions

The following are wrist blood pressure cuff instructions:

Sit in an upright chair with feet flat on the floor and back supported.
Keep legs uncrossed.
Place the wrist cuff around the bare wrist.
Position the monitor on the inside of the wrist.
Adjust the wrist cuff, so it’s snug with no space between the cuff and wrist.
The end of the cuff should be approximately 1/2 to 1 inch from the wrist crease at the bottom of the palm.
The wrist cuff should not cover the wrist bone protrusion on the outside of the wrist.
Comfortably rest the elbow on a flat surface and raise the wrist to heart level.
Keep the wrist and hand relaxed.
Do not bend the wrist backward or forward.
Begin the measurement.

Learn more details to the instructions above in my article, How To Use a Wrist Blood Pressure Cuff.

Blood Pressure Cuff Problems

At home the blood pressure cuff may cause the following problems:

Pain during inflation.
Redness or red marks on the upper arm.
Excessive squeezing by the cuff.
The cuff is leaking.

The first three problems above are typically caused because the cuff is too small or wrapped too tight. In addition, measuring blood pressure too often can cause red marks. A leaking cuff can cause the inflation process to take longer causing discomfort.

More serious blood pressure cuff problems occur at medical facilities like hospitals. A common reason is multiple inflations and squeezing of the upper arm during surgery⁴. Some surgeries can take six hours with the BP monitor set to measure blood pressure every few minutes.

In addition, repeated inflations can occur when a patient is laying in bed post surgery.

Blood pressure problems at a medical facility can result in the following medical conditions:

Redness and swelling
Crush Syndrome
Skin necrosis
Broken capillaries
Petechiae
Numbness
Nerve damage
Compartment syndrome

Learn more about the above problems in my article, Blood Pressure Cuff Complications. I discuss real-life examples of patients who experienced these problems at hospitals and how each one occurred.

In addition, I wrote a whole article on petechiae. It’s when red dots form on the arm from broken capillaries. It’s incredible how the dots start where the edge of the cuff was and run down the whole arm.

I included some pictures in the article which you can check out right here, Petechiae From A BP Cuff.

Using A Welch Allyn Home Blood Pressure Cuff

Do you have a model 1700 or 1500 series Welch Allyn Home Monitor? If so, here’s how to use a Welch Allyn blood pressure cuff:

Wrap the cuff around the bare upper arm.
The air tube should extend down toward the hand.
The index arrow should be pointing within the size range indicator line.
Line up the artery marker with the brachial artery on the inner arm.
The lower edge of the cuff should be located 1″ above the bend of the elbow.
Adjust the cuff snug, so only two fingers can be inserted between the cuff and arm.
Ensure the cuff is at heart height.
Start the measurement.

The air supply tube comes out of the cuff facing in one direction ((Welch Allyn: Home Blood Pressure Monitors)). When slipping the loose cuff around the arm, ensure the tubing is running down the forearm towards the hand.

Learn more about each step above in my article, How To use A Welch Allyn Blood Pressure Cuff. I also include pictures of the cuff showing the artery marker, cuff arrow, size range indicator line and other markings.

Blood Pressure Cuff Sizes

Extra large Blood Pressure Cuff Sizes

1. LifeSource Home Blood Pressure Monitor (UA-789AC)

The LifeSource monitor comes with an extra large cuff only, but the medium and large cuffs can be purchased separately. The following extra large cuff is included:

LifeSource Extra Large Cuff: 16.5″ – 23.6″ (42cm to 60cm)

This monitor (UA-789AC) only comes with the extra large size cuff⁵. The extra large cuff can only be used with this monitor. Therefore, you cannot purchase a less expensive LifeSource monitor and use the extra large cuff with it.

Check the current price on Amazon: LifeSource Home Blood Pressure Monitor With Extra Large Cuff.

2. Welch Allyn Home 1700 Series Blood Pressure Monitor

The 1700 series comes with the standard size cuff, but the extra large cuff can be ordered separately ((Welch Allyn: Welch Allyn Home Blood Pressure Monitors)). The cuffs can be changed easily within seconds.

The following are the standard and extra large blood pressure cuff sizes:

Welch Allyn 1700 Standard Size BP Cuff: 8.75″ – 16.5″
Welch Allyn 1700 Extra Large Size BP Cuff: 15.75″ – 21.25″

Welch Allyn 1700 Series: Check the current price on Amazon: Welch Allyn 1700 Series Home Monitor.
Welch Allyn Extra Large BP Cuff: Check the current price on Amazon: Welch Allyn 1700 Series Extra large BP Cuff.

3. Omron Professional Intellisense Blood Pressure Monitor (HEM-907XL)

This monitor comes with the following four blood pressure cuffs including an extra large:

Omron Extra Large Blood Pressure Cuff: 17″ – 20″ (42cm to 50cm)
Large Cuff: 13″ – 17″
Medium Cuff: 9″ – 13″
Small Cuff: 7″ – 9″

This monitor is marketed towards the professional but is operated automatically like other home monitors and can be used in the home too ((Omron: Professional Intellisense Blood Pressure Monitor)).

If you prefer to use a sphygmomanometer, they have a wider selection of extra large cuffs available. I list more of those in an article I wrote, Sizes of Extra Large Blood Pressure Cuffs.

Besides the Professional Intellisense Monitor, does Omron make an extra large home blood pressure cuff? Omron doesn’t make an extra large blood pressure cuff for home monitors. They have a large cuff which fits upper arms 9″ to 17″

Let’s take a look at Omron’s blood pressure cuff sizes.

Omron Large Blood Pressure Cuffs

All the Omron home monitors come with a wide range blood pressure cuff or the pre-formed easy-wrap comfit cuff⁶. Both of these cuffs fit upper arms 9″ to 17″ in circumference.

The following Omron Home Monitors come with the Pre-formed Easy-Wrap Comfit Cuff: Fits upper arms 9″ to 17″ in circumference (HEM-FL31-B):

Omron 10 Series (Model BP7450)
Omron 7 Series (Model BP7350)
Omron Silver (Model BP5250)

The following Omron Home Monitors come with the Wide Range Cuff: Fits upper arms 9″ to 17″ in circumference (HEM-RML31-B):

Omron Platinum (Model BP5450)
Omron Gold (Model BP5350)
Omron 5 Series (Model BP7250)
Omron 5 Series (Model BP7200)
Omron Complete Plus EKG (Model BP7900)

The following Omron Home Monitors come with the Wide Range Cuff: Fits upper arms 9″ to 17″ in circumference (CD-WR17):

Omron 3 Series (Model BP7100)
Omron Bronze (Model BP5100)

Check out this Omron blood pressure cuff article which covers them in more detail, Omron Extra large Blood Pressure Cuff

Omron BP Cuff Sizes and Their Monitors

1. Omron 10 Series Home Blood Pressure Monitor (Model BP7450)

The blood pressure cuff that comes with the Omron 10 Series:

Pre-formed Easy-Wrap Comfit Cuff: Fits upper arms 9″ to 17″ in circumference (HEM-FL31-B)

Other blood pressure cuff sizes compatible with the Omron 10 Series:

None

2. Omron Platinum Home Blood Pressure Monitor (Model BP5450)

The blood pressure cuff that comes with the Omron Platinum:

Wide Range Cuff: Fits upper arms 9″ to 17″ in circumference (HEM-RML31-B)

Other blood pressure cuff sizes compatible with the Omron Platinum:

Small Cuff: Fits upper arms 7″ to 9″ in circumference (HEM-CS24-B)

3. Omron Gold Home Blood Pressure Monitor (Model BP5350)

The Blood Pressure Cuff that comes with the Omron Gold:

Wide Range Cuff: Fits upper arms 9″ to 17″ in circumference (HEM-RML31-B)

Other blood pressure cuff sizes compatible with the Omron Gold:

Small Cuff: Fits upper arms 7″ to 9″ in circumference (HEM-CS24-B)

4. Omron 7 Series Home Blood Pressure Monitor (Model BP7350)

The blood pressure cuff that comes with the Omron 7 Series:

Pre-formed Easy-Wrap Comfit Cuff: Fits upper arms 9″ to 17″ in circumference (HEM-FL31-B)

Other blood pressure cuff sizes compatible with the Omron 7 Series:

None

There’s seven more Omron home monitors available, check out all the blood pressure cuff sizes included with them in this article I wrote recently, Omron Home Blood Pressure Cuff Sizes.

Welch Allyn Home Blood Pressure Cuff Sizes

Welch Allyn 1500 Series Cuff Sizes:

Standard Size Cuff: 8.75″ – 16.5″ (22-42 cm)

Welch Allyn 1700 Series Cuff Sizes:

Standard Size Cuff: 8.75″ -16.5″ (22-42 cm)
Extra Small Cuff: 5.75″ – 9.5″ (15 -24 cm)
Extra Large Cuff: 15.75″ – 21.25″ (40-54 cm)

The 1500 and 1700 series both come with the standard size cuff when purchased⁷.

Learn more about Welch Allyn Cuff sizes and one available overseas in my article, Welch Allyn Home Blood Pressure Cuff Sizes.

Blood Pressure Explained