Accurate Blood Pressure Readings: Choosing the Right-size Cuff

Measuring blood pressure accurately begins with the correctly sized cuff

1. Begin by measuring the patient’s mid upper arm circumference. 
2. Using the sizing chart below, determine what size cuff should be used based on the measurement reading. If a patient’s cm measurement is overlapping between sizes, default to the larger cuff if width is appropriate. 
3. Place the artery mark located on the cuff over the patient’s brachial artery. 
4. Wrap the cuff snugly and securely, allowing space for two fingers to fit between patient and cuff.

Infant: range 8-13 cm

Child (also available in long size): Range 12-19 cm

Small Adult (also available in long size): Range 17-25 cm

Adult (also available in long size): Range 23-33 cm

Large Adult (also available in long size): Range 31-40 cm

Thigh: Range 38-50 cm

Common sources of error in blood pressure monitoring ¹

• False high, cuff error type:
  • Inflatable portion of cuff too narrow 
  • Inflatable portion of cuff too short 
  • Cuff too loose or uneven 
  • Cuff deflated too slowly (Diastolic) 
  • Cuff overinflated 
  • Cuff inflated too slowly (Diastolic)
• False high, human error type:
  • Recording BP immediately after meals, while smoking or with distended bladder 
  • Patient’s arm below level of heart
• False low, cuff error type: 
  • Cuff too wide
• False low, human error type:
  • Patient’s arm above level of heart 
  • Failure to notice auscultatory gap 
  • Inability to hear feeble Korotkoff sounds 
  • Failure to have meniscus of mercury at eye level 
  • Stethoscope bell applied too firmly
• False high or low, human error type:
  • Caregiver’s error 
  • Cuff deflated too fast

Using the WRONG SIZED BLOOD PRESSURE CUFF can affect accuracy UP TO 30 mmHG² . The American Heart Association recommends that a cuff bladder width be 40% of the arm circumference and that a cuff bladder length be 80% of the arm circumference.¹

Reference:

1. Pickering, T., et al Recommendations for Blood Pressure Measurement in Humans: An AHA Scientific Statement from the Council on High Blood Pressure Research Professional and Public Education Subcommittee. Hypertension 45, 142-161 (2005). 
2. Manning, D.M., et al Miscuffing: Inappropriate blood pressure cuff application. Circulation 68(4), 763-6 (1983).