Miscuffing: inappropriate blood pressure cuff application.

Manning, David; Kuchirka, C; Kaminski, Julyanna Hyczy

doi:10.1161/01.cir.68.4.763

Cited by 99 publications

(53 citation statements)

References 12 publications

(1 reference statement)

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“…142 The Cuff Studies of brachial blood pressure measurement highlight the importance of an appropriate cuff size to avoid inaccurate measurements. 143,144 Comparable information is not available on the size of the ankle cuff. If the same concept of cuff size used for the arm is applied to that of the ankle, the width of the cuff should be at least 40% of the limb circumference.…”

Section: Conditions For the Measurement Of The Abimentioning

confidence: 99%

Measurement and Interpretation of the Ankle-Brachial Index

Aboyans

Criqui²,

Ábrahám³

et al. 2012

Circulation

1,337

827

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T he ankle-brachial index (ABI) is the ratio of the systolic blood pressure (SBP) measured at the ankle to that measured at the brachial artery. Originally described by Winsor 1 in 1950, this index was initially proposed for the noninvasive diagnosis of lower-extremity peripheral artery disease (PAD). 2,3 Later, it was shown that the ABI is an indicator of atherosclerosis at other vascular sites and can serve as a prognostic marker for cardiovascular events and functional impairment, even in the absence of symptoms of PAD. 4 -6 Rationale for Standardization of the ABIThe current lack of standards for measurement and calculation of the ABI leads to discrepant results with significant impact from clinical, public health, and economic standpoints. Indeed, the estimated prevalence of PAD may vary substantially according to the mode of ABI calculation. [7][8][9] In a review of 100 randomly selected reports using the ABI, multiple variations in technique were identified, including the position of the patient during measurement, the sizes of the arm and leg cuffs, the location of the cuff on the extremity, the method of pulse detection over the brachial artery and at the ankles, whether the arm and ankle pressures were measured bilaterally, which ankle pulses were used, and whether a single or replicate measures were obtained. 10 There is controversy about what ABI threshold should be used to diagnose PAD. The ABI threshold most commonly used is Յ0.90 based on studies reporting Ͼ90% sensitivity and specificity to detect PAD compared with angiography. 2,3 These studies were limited in that they included mostly older white men with PAD or who were at high risk for PAD and compared them with a younger healthy group. A recent metaanalysis of 8 studies of diverse populations, including diabetic patients, confirmed a high specificity but lower sensitivity (at best Ͻ80%) than that reported in earlier studies. 11 Similar to other vascular markers such as carotid intimamedia thickness 12 or coronary artery calcium score, 13 standardization of the techniques used to measure the ABI and the calculation and interpretation of its values is necessary. Aims and ScopeThe goals for this document are to provide a comprehensive review of the relevant literature on the measurement of the The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on September 10, 2012. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional repri...

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Section: Conditions For the Measurement Of The Abimentioning

confidence: 99%

Measurement and Interpretation of the Ankle-Brachial Index

Aboyans

Criqui²,

Ábrahám³

et al. 2012

Circulation

1,337

827

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“…Undercuffing has previously been shown to be the most common cuffing error resulting in an average increase of 8.5 mmHg systolic and 4.6 mmHg DBP 3 . However, our study found overcuffing to be the most common cuffing error resulting in significantly lower blood pressure measurements during triage compared to those obtained using the AHA method.…”

Section: Discussionmentioning

confidence: 99%

“…Differences in blood pressure monitoring technique can result in significantly different readings. Numerous factors such as body position, arm position, inter-arm differences, cuff size, and cuff placement can affect the reading [3][4][5][6][7][8][9][10] . A study conducted recently on hypertensive patients compared usual blood pressure monitoring, ambulatory monitoring, and monitoring following the Canadian Hypertension Education Program protocol 11 .…”

Section: Introductionmentioning

confidence: 99%

Blood Pressure Monitoring Technique Impacts Hypertension Treatment

2011

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BACKGROUND:In 2005 the American Heart Association (AHA) released updated recommendations for blood pressure (BP) monitoring in order to ensure accurate BP measurements. OBJECTIVE: To determine if current methods of BP assessment in an ambulatory clinic result in significantly different BP measurements than those obtained by following the AHA recommendations and if these BP differences impact treatment decisions. RESEARCH DESIGN: Randomized prospective analysis. SETTING: University of New Mexico Hospital Adult Internal Medicine clinic. PATIENTS: Forty adults with hypertension METHODS: Patient BPs were measured using both the traditional triage method and the AHA-recommended method in cross-over fashion in random order. Two complete medical profile summaries were then constructed for each patient: one for each BP measurement obtained by each technique. These profiles were then reviewed by a panel of providers who provided hypothetical hypertension treatment recommendations. RESULTS: Individual BP results varied greatly between the two methods. SBP readings differed by ≥5 mmHg in either direction for 68% of patients while 78% of patient's DBP readings differed by ≥2 mmHg in either direction. Overall, 93% of patients had a BP difference of either ≥5 mmHg systolic or ≥2 mmHg diastolic. Five patients were determined to be at goal with the triage method, but were higher than their goal BP with the AHA method Significant differences were also seen in treatment recommendations for a given patient based on the differences seen between the two obtained BP readings. The number of patients with treatment variations between their two profiles ranged from 13% to 23% depending on the reviewing provider (p<0.01 for all providers). CONCLUSION: Inaccurate BP assessment is common and may impact hypertension treatment decisions.KEY WORDS: blood pressure measurement; hypertension.

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“…82 More importantly, it has been demonstrated that the most frequent error in measuring blood pressure in the outpatient clinic is "miscuffing," with undercuffing large arms accounting for 84% of the "miscuffings." 83 The "ideal" cuff should have a bladder length that is 80% and a width that is at least 40% of arm circumference (a length-to-width ratio of 2:1). A recent study comparing intra-arterial and auscultatory blood pressure concluded that the error is minimized with a cuff width of 46% of the arm circumference.…”

Section: Cuff Sizementioning

confidence: 99%

Recommendations for Blood Pressure Measurement in Humans and Experimental Animals

Pickering¹,

Hall²,

Appel³

et al. 2005

Hypertension

2,042

963

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Abstract-Accurate measurement of blood pressure is essential to classify individuals, to ascertain blood pressure-related risk, and to guide management. The auscultatory technique with a trained observer and mercury sphygmomanometer continues to be the method of choice for measurement in the office, using the first and fifth phases of the Korotkoff sounds, including in pregnant women. The use of mercury is declining, and alternatives are needed. Aneroid devices are suitable, but they require frequent calibration. Hybrid devices that use electronic transducers instead of mercury have promise. The oscillometric method can be used for office measurement, but only devices independently validated according to standard protocols should be used, and individual calibration is recommended. They have the advantage of being able to take multiple measurements. Proper training of observers, positioning of the patient, and selection of cuff size are all essential. It is increasingly recognized that office measurements correlate poorly with blood pressure measured in other settings, and that they can be supplemented by self-measured readings taken with validated devices at home. There is increasing evidence that home readings predict cardiovascular events and are particularly useful for monitoring the effects of treatment. Twenty-four-hour ambulatory monitoring gives a better prediction of risk than office measurements and is useful for diagnosing white-coat hypertension. There is increasing evidence that a failure of blood pressure to fall during the night may be associated with increased risk. In obese patients and children, the use of an appropriate cuff size is of paramount importance.

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Miscuffing: inappropriate blood pressure cuff application.

Cited by 99 publications

References 12 publications

Measurement and Interpretation of the Ankle-Brachial Index

Measurement and Interpretation of the Ankle-Brachial Index

Blood Pressure Monitoring Technique Impacts Hypertension Treatment

Recommendations for Blood Pressure Measurement in Humans and Experimental Animals

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