If you ever measured your blood pressure, I’m confident you can remember how tight the cuff feels when it fills with air. Many people have complained about how it squeezes and hurts their upper arm. Some patients have red marks or a petechia rash form after numerous BP measurements. This can occur more in a hospital when it is repeatedly measured.
What is petechiae from a blood pressure cuff? Petechiae from a blood pressure cuff is when reddish color dots form on your skin. This occurs from increased venous pressure during cycling of the cuff, causing the small dermal capillaries to rupture. This is more likely to occur when the patient has more vascular fragility due to a medical condition.
There are procedures the medical staff can practice to help petechiae from occurring. Even though they are sometimes unfollowed, this event is something that doesn’t happen all the time. This blog post will inform you how to prevent this from happening at home. In addition, you’ll what action to perform if it happens to you.
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Petechiae From a Blood Pressure Cuff Cause
Typically petechia, if it occurs, happens in a hospital setting. This is more common when your blood pressure is taken repeatedly over a short period of time. During surgery, your blood pressure is taken with an ambulatory blood pressure cuff. The monitor is set to take your blood pressure every few minutes and is set by the medical staff.
While admitted in a hospital or intensive-care unit, it’s likely you’ll be connected to an automatic monitor. It’s important for the medical staff to monitor your blood pressure constantly during those extremely important situations.
The repeated inflation of the blood pressure cuff puts extra pressure on your arm and capillaries right below the surface of your skin. Even if you’re not at risk for petechiae, damage may occur to your capillaries under certain situations. When this happens, reddish, purple dots or rash will form on your arm or hand. This is also called the Rumpel-Leede Phenomenon 1.
The following increases your risk of getting petechiae and are discussed in more detail in the People at Risk Section further into the article:
- Chronic Steroid Users
- High Blood Pressure
- Old Age
- Antiplatelets and Anticoagulants
Petechiae From A Home Blood Pressure Cuff
Although untypical, it’s possible you can get petechiae at home. If you are using the machine improperly, have the wrong size cuff or take your measurements too often; damage to your capillaries may occur. In addition, being high risk can increase your chances more.
If you get petechiae at home, don’t assume it’s from your blood pressure cuff. It may be a symptom of the following medical issues where a physician should be contacted.
- Rocky Mountain Spotted Fever
- Vitamin deficiency
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Three Real Life Occurrences of Petechiae From A Blood Pressure Cuff
#1) A 62-year old man had heart surgery and was admitted into the cardiac care unit 2. During his surgery, compression bands were used and removed about 2 hours later. After they were removed, there was no evidence of capillary damage.
Several hours later, his blood pressure was measured. Immediately after, a rash and red dots formed on his arm. They started exactly where the lower edge of the blood pressure cuff was wrapped around his arm and continued down to his lower arm.
The physicians concluded his petechia was from a combination of the following four factors:
- Compression from the blood pressure cuff.
- Weakness of his blood vessels.
- High blood pressure.
#2) A 62-year old woman was scheduled for back surgery 3 . She had diabetes for 5 years and high blood pressure for 3 years. During her surgery she was connected to an automatic blood pressure monitor on her left arm. It was set to measure her BP every 5 minutes.
Prior to the surgery a rash was noted on her arm during inflation of the cuff, which disappeared immediately. The operation lasted 60 minutes and at the very end of the operation a severe rash with petechiae on her left arm was visible. Her cuff was moved to the right arm, and a thin piece of cotton was placed between the cuff and her arm. The petechia and rash took 10 days to go away.
The physicians determined 2 causes for the petechiae:
- Weak blood vessels due to diabetes and 6 years of steroid treatment for osteoarthritis.
- The pressure on the blood vessels while having high blood pressure.
#3) A 57-year old woman was checked in for a hypertensive urgency 4. This is when blood pressure is higher than 180/120 mmHg. After being attached to an automatic blood monitor, her measurement was recorded at 272/124 mmHg. During the measurement, she immediately complained about pain in the arm where the cuff was attached.
She developed a petechiae rash from her elbow down to her fingers. When they removed the cuff, marks were noted on her upper arm where the cuff was wrapped around. Her pain quickly disappeared but the petechiae remained. The patient told the doctors that this has happened to her several times in the past.
The physicians noted this case was unusual for two different reasons:
- The patient experienced pain which is typically unlikely.
- The woman didn’t have thrombocytopenia or vascular disease.
They concluded her petechiae were caused by the inflation of the cuff with significant pressure in the blood vessels, causing the capillaries to rupture.
People At Risk For Petechiae From a Blood Pressure Cuff
The following are factors which can increase your risk of petechiae.
This refers to the group of diseases that affect how your body uses blood sugar. This includes, Type 1 and type 2 diabetes, prediabetes and gestational diabetes. These diseases can cause damage to blood vessels and make them more susceptible. The more time a person has diabetes, the more risk increases. Diabetes makes someone more inclined to have weakened blood vessels over time 5.
Chronic Steroid Users
Some autoimmune diseases require long-term steroid use for treatment. The treatments over time effect the collagen in the blood vessels and weaken them. The weakened capillaries make them more susceptible to bleed from minor trauma and pressure 6.
High Blood Pressure
People with high blood pressure typically have damage to their blood vessels as they age. The increased pressure can damage the inner walls of the vessel linings and they become less elastic 7.
As you get older, your body produces less collagen. In addition, health issues and plaque build-up can make capillaries more rigid and prone to damage from pressure, like a blood pressure cuff 8.
Antiplatelets and Anticoagulants
Both of these medications are used for the treatment of blood clots. They can help reduce blood clots by keeping platelets from sticking together. The use of these medications may lead to petechiae from a blood pressure cuff 9.
This is a condition when there is a low number of platelets in the blood. Petechiae may result from a decreased number or function of platelets 10.
How To Prevent Petechiae From A Blood Pressure Cuff
The following are different practices which can prevent petechia from occurring:
- Using the correct size cuff.
- Alternating which arm the cuff is attached to.
- Periodically inspect the arm.
- Using the correct size cuff.
- Less frequent measurements.
- Utilizing a manual cuff.
- Making sure the cuff is the correct size and not too tight.
- Using the proper location on the arm when attaching the blood pressure cuff.
- Consider the possibility of the monitor malfunctioning.
- If your blood vessels are fragile, consider placing a thin cotton cloth between the cuff and arm.
Petechiae From a Home Blood Pressure Cuff: What To Do
When you have petechiae, it’s hard to know if you got it from a blood pressure cuff or if it may be something more serious. It’s always a good idea to call your doctor and play it safe especially if you have any of the following symptoms:
- Breathing trouble
- Dizziness or fainting
Petechiae is a symptom of another condition and there is no treatment. Correcting the underlying condition will remedy the petechiae. For the purpose of this blog post, which is petechiae from a blood pressure cuff, the following action will correct the petechiae:
- Change the frequency of the BP measurements.
- Move the cuff to the other arm.
- Stop the measurements.
What Is The Rumpel-Leede Phenomenon? The Rumpel-Leede Phenomenon is a rare event when the small dermal capillaries rupture in response to the application of a compressive device. This can occur when applying a tourniquet to draw blood or when inflating a blood pressure cuff. The rupture results in a petechia rash on the skin.
The Rumpel-Leede Phenomenon was first reported by Theodor Rumpel in 1909 and again by Carl Stockbridge Leede in 1911. While placing a tourniquet on patient’s arms while treating them for scarlet fever, they both noted petechiae on their arms 11.
If you found this Blood Pressure topic interesting check out these related blood pressure articles found in this site:
- Blood Pressure Cuff Complications
- Checking Blood Pressure Too Often
- Effect of Arm Position On Blood Pressure
- Oxford Academic: Rumpel-Leede phenomenon in a diabetes mellitus patient
- BMG Journals: Petechial purpic rash after non-invasive blood pressure measurement: Rumpel-Leede sign
- National Center for Biotechnology Information: Rumpel-Leede phenomenon associated with noninvasive blood pressure monitoring – A case report
- National Center for Biotechnology Information: Rumpel-Leede phenomenon presenting as a hypertensive urgency
- National Center for Biotechnology Information: Determination of Capillary Lesions During Diagnosis by Means of the Tourniquet Test of Microangiopathies in Diabetes Mellitus
- Science Direct: Vascular Fragility
- American Heart Association: What is High Blood Pressure?
- National Center for Biotechnology Information: Age-related Impairment of Vascular Structure and Functions
- JACC Journals: Rumpel-Leede Phenomenon
- Wiley Online Library: Rumpel-Leede sign in thrombocytopenia due to Epstein-Barr virus-induced mononucleosis
- National Center for Biotechnology Information: Rumpel-Leede phenomenon presenting hypertensive urgency