Arm and finger measurements in the third trimester: Implications for blood pressure measurement

Eley, Victoria; Roberts, Leonie; Rickards, Leah; Pelecanos, Anita; Blackie, Annika; Zhang, Chu; Christensen, Rebecca; Barrett, Helen L.

doi:10.1016/j.preghy.2018.09.002

Cited by 8 publications

(35 citation statements)

References 22 publications

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“…In addition to MAC, BMI and weight were also correlated with conicity index, and of the three variables, BMI was found to correlate the best with arm conicity. These results are similar to that of Eley et al, who also reported that BMI correlated best with arm conicity, accounting for 26% of the variation in conicity index [3]. Furthermore, our nding that BMI, weight, and MAC were collinear was also reported by Eley et al [3].…”

Section: Discussionsupporting

confidence: 91%

“…These results are similar to that of Eley et al, who also reported that BMI correlated best with arm conicity, accounting for 26% of the variation in conicity index [3]. Furthermore, our nding that BMI, weight, and MAC were collinear was also reported by Eley et al [3]. This may be explained by the association between increasing BMI and higher MAC in both pregnant [3,17,18] and non-pregnant populations [19], and is likely due to an increase in arm fat mass as measured using bioelectrical impedance analysis [17].…”

Section: Discussionsupporting

confidence: 91%

“…Furthermore, our nding that BMI, weight, and MAC were collinear was also reported by Eley et al [3]. This may be explained by the association between increasing BMI and higher MAC in both pregnant [3,17,18] and non-pregnant populations [19], and is likely due to an increase in arm fat mass as measured using bioelectrical impedance analysis [17]. Additionally, obese parturients were more likely to experience challenges during BP measurement, with an increased incidence of the arm cuffs popping off and the need to change to a different cuff, compared to non-obese parturients.…”

Section: Discussionsupporting

confidence: 87%

“…A potential solution to inappropriately sized cuffs or trunco-conical arms may lie with the use of nger cuff devices such as the Nex n TM monitor (BMEYE B.V., Holland), CNAP TM monitor (CNSystems Medizintechnik AG, Graz, Austria), and Clearsight TM (Edwards Lifesciences, Irvine, California, USA). In comparison to arm cuffs, nger cuffs from Clearsight TM accommodated up to nger circumference of 6.8cm and failed to t only 0.7% of Australian parturients with maximum nger circumference of 7cm [3].…”

Section: Introductionmentioning

confidence: 95%

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Correlation of patient characteristics with arm and finger measurements in Asian parturients: a preliminary study

Lim

Tan

et al. 2020

Preprint

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Background: Accurate blood pressure (BP) measurement depends on appropriate cuff size and shape in relation to the arm. Arm dimensions outside the recommended range of cuff sizes or trunco-conical arms may result in inaccurate BP measurements. Measuring BP using finger cuffs is a potential solution. Arm cuff size is based on mid-arm circumference (MAC), and trunco-conicity is quantified by conicity index. We aimed to determine the correlation of MAC, body mass index (BMI), and weight with conicity index.Methods: A prospective cohort study was conducted in the KK Women’s and Children’s hospital where third trimester parturients scheduled for cesarean delivery were recruited after obtaining informed consent. Parturients were asked to rate their experience with time taken to obtain BP readings, cuff popping off during measurement, need to move the cuff from the upper arm to lower arm or leg, and need to change to a different cuff. Our primary outcome was the correlation between MAC and conicity index, calculated using Pearson’s correlation. The correlation between BMI and weight with conicity index was also determined.Results: We enrolled 300 parturients. Moderate correlation was found between left MAC and left conicity index (r=0.41, 95% CI 0.32 to 0.51), and right MAC and right conicity index (r=0.39, 95% CI 0.29 to 0.48). Weight (r=0.35 to 0.39) and BMI (r=0.41 to 0.43) correlated with conicity index in this study. MAC of 1 parturient fell outside the recommended range for arm cuffs, but all parturients fit into available finger cuffs. Obese parturients had increased problems with arm cuffs popping off and needing a change of cuff.Conclusions: BMI better correlated with conicity index compared to MAC or weight. Standard finger cuffs were suitable for all parturients studied and may be a suitable alternative.Trial registration: Clinicaltrials.gov NCT04012151. Registered 9 Jul 2019 https://clinicaltrials.gov/ct2/show/NCT04012151

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 95%

See 2 more Smart Citations

Correlation of patient characteristics with arm and finger measurements in Asian parturients: a preliminary study

Lim

Tan

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…Our results highlight the fact that currently available devices using alternate sites, such as the finger, do not adequately cater to all patients who have obesity either. The largest finger cuff supplied by ClearSight was not large enough for all our patients, and this failure also was demonstrated in a pregnant population . While the sizes of the finger cuffs supplied with the CNAP device are ample, the device requires the use of a NIBP arm cuff for calibration.…”

Section: Discussionmentioning

confidence: 88%

Arm Dimensions of Patients with Obesity and Their Experiences with Blood Pressure Measurement: An Observational Study

Ceglowski

Lehane

Chow

et al. 2020

Obesity

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Objective In patients with obesity, it was determined what proportion had an arm slant angle (SA) < 83° and which measure best predicted arm conicity. Patient experience with noninvasive blood pressure measurement was evaluated. Methods Arm SA was calculated from arm measurements. Linear regression determined whether BMI, weight, or right midarm circumference (MAC) best predicted conicity. Patient experiences were evaluated by survey and conventional content analysis of free‐text comments. Results One hundred participants had a median (interquartile range; range) BMI of 44.1 (39.1‐53.1; 31.1‐80.8). Thirty‐three (33%) had a right arm SA < 83°. Seven (7%) had a right MAC outside the recommended range. BMI, weight, and the right MAC showed low correlation with and explained little of the variation (with age and sex adjustment) in right arm SA (r = −0.29, −0.27, −0.31; P = 0.003, 0.007, 0.002; R2 = 0.09, 0.08, 0.10). Forty‐two (42%) reported noninvasive blood pressure measurement caused severe pain, and 30 (30%) reported skin damage. Themes identified in free‐text responses were “problems with equipment,” “feelings and experiences,” and “concerns about accuracy.” Conclusions Current equipment is inadequate for patients with obesity based on MAC and conicity. Pain and skin damage contributed to negative experiences of these patients.

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Finger cuff versus invasive and noninvasive arterial pressure measurement in pregnant patients with obesity

Eley,

Llewellyn,

Pelecanos

et al. 2024

Acta Anaesthesiol Scand

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BackgroundPregnant patients with obesity may have compromised noninvasive blood pressure (NIBP) measurement. We assessed the accuracy and trending ability of the ClearSight™ finger cuff (FC) with invasive arterial monitoring (INV) and arm NIBP, in obese patients having cesarean delivery.MethodsParticipants were aged ≥18 years, ≥34 weeks gestation, and body mass index (BMI) ≥ 40 kg m−2. FC, INV, and NIBP measurements were obtained across 5‐min intervals. The primary outcome was agreement of FC measurements with those of the reference standard INV, using modified Bland–Altman plots. Secondary outcomes included comparisons between FC and NIBP and NIBP versus INV, with four‐quadrant plots performed to report discordance rates and evaluate trending ability.ResultsTwenty‐three participants had a median (IQR) BMI of 45 kg m−2 (44–48). When comparing FC and INV the mean bias (SD, 95% limits of agreement) for systolic blood pressure (SBP) was 16 mmHg (17, −17.3 to 49.3 mmHg), for diastolic blood pressure (DBP) −0.2 mmHg (10.5, −20.7 to 20.3), and for mean arterial pressure (MAP) 5.2 mmHg (11.1, −16.6 to 27.0 mmHg). Discordance occurred in 54 (26%) pairs for SBP, 41 (23%) for DBP, and 41 (21.7%) for MAP. Error grid analysis showed 92.1% of SBP readings in Zone A (no‐risk zone). When comparing NIBP and INV, the mean bias (95% limits of agreement) for SBP was 13.0 mmHg (16.7, −19.7 to 29.3), for DBP 5.9 mmHg (11.9, −17.4 to 42.0), and for MAP 8.2 mmHg (11.9, −15.2 to 31.6). Discordance occurred in SBP (84 of 209, 40.2%), DBP (74 of 187, 39.6%), and MAP (63 of 191, 33.0%).ConclusionsThe FC and NIBP techniques were not adequately in agreement with INV. Trending capability was better for FC than NIBP. Clinically important differences may occur in the setting of the perfusion‐dependent fetus.

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Arm and finger measurements in the third trimester: Implications for blood pressure measurement

Cited by 8 publications

References 22 publications

Correlation of patient characteristics with arm and finger measurements in Asian parturients: a preliminary study

Correlation of patient characteristics with arm and finger measurements in Asian parturients: a preliminary study

Arm Dimensions of Patients with Obesity and Their Experiences with Blood Pressure Measurement: An Observational Study

Finger cuff versus invasive and noninvasive arterial pressure measurement in pregnant patients with obesity

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