Last updated March 14, 2022

Non-Invasive Blood Pressure Measurement

Recommendations

Use of the wrist for blood pressure measurement is acceptable when upper arm measurement is not possible. Wrist BP measurements will trend lower than upper arm measurements. (B)
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Use of the forearm for blood pressure measurement is acceptable when upper arm measurement is not possible. Forearm BP measurements will trend higher than upper arm measurements. (B)
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There is insufficient evidence to make a recommendation on the accuracy of lower extremity locations (thigh, calf, or ankle) for blood pressure measurement. (I)
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An appropriately sized BP cuff is more important for accurate measurement than location, population, or BMI. (A)
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Measuring BP on the upper arm over sleeved or bare arm below a rolled sleeve is usually comparable to bare arm measurements among adults. Measurements over thicker clothing will trend towards higher BP than on bare arm. Older adults may be more susceptible to variances in blood pressure associated with the effect of clothing. (B)
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Use of continuous noninvasive blood pressure (cNIBP), using a finger cuff sensor, is acceptable for emergency department patients. (B)
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In patients with obesity or large upper arm circumference, wrist and forearm BP measurement may be acceptable when a correctly fitting cuff for the upper arm is not available. Forearm SBP measurements will trend higher than upper arm measurements. (B)
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Measuring BP of adults over 65 requires no special technique. (B)
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Use of arm, ankle, or calf BP locations in children aged 1-15 years may not be as reliably accurate when compared to upper arm measurements and should be used only when upper arm is not available. (C)
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There is insufficient evidence to recommend for or against use of NIBP in the neonatal population. (I)
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Recommendation Grading

Overview

Title

Non-Invasive Blood Pressure Measurement

Authoring Organization

Publication Month/Year

May 1, 2019

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Emergency care, Hospital

Intended Users

Nurse

Scope

Assessment and screening, Diagnosis, Management

Diseases/Conditions (MeSH)

D001794 - Blood Pressure, D001795 - Blood Pressure Determination

Keywords

blood pressure, emergencies, NIBP, oscillometric BP measurement