In search of the optimal cuff for blood pressure measurement in people with severe obesity

Innovation in measuring obese patients' blood pressure: measurement with conical wrapping technique

INTRODUCTION

Accurate measurement of blood pressure (BP) is difficult in obese patients due to their upper arm shape and width. Errors made during BP measurement cause misdiagnosis or lead to wrong treatment.

METHOD

The data of this methodological study were collected from 40 patients who were 18 years old or above, with a BMI above 25 kg/m2, and who were followed up with radial catheter arterial pressure in adult intensive care and postoperative care units between March and December 2020.

RESULTS

In total 55% of the participants were male with a mean age of 63.9 years, mean height of 165.7 cm, mean weight of 85.2 kg and mean BMI of 31.0 ± 2.1 kg/m2. Intra-arterial BP (IABP) measurement values were found to be correlated with conical wrapping technique and cylindrical wrapping technique (P < 0.001). As a result, a statistically significance was found between conical SBP and intra-arterial SBP (r = 0.921; P < 0.05) and conical DBP and intra-arterial DBP (r = 0.902; P < 0.05).

CONCLUSION

It was determined that the SBP and DBP results of the conical wrapping technique were closer to the results obtained by IABP measurements. For this reason, it is more appropriate to measure BP with conical wrapping technique in clinically obese patients.

Improving Accurate Blood Pressure Cuff Allocation in Patients with Obesity: A Quality Improvement Initiative

Accurate noninvasive blood pressure (NIBP) measurement requires use of an appropriately sized cuff. We aimed to improve the perioperative allocation of NIBP cuffs in patients with Class II–III obesity. In the baseline evaluation, we measured the mid-arm circumference (MAC) of 40 patients with BMI > 35 kg/m², documenting the corresponding cuff allocated by pre-operative nurses. The intervention consisted of the introduction of cuff allocation based on MAC measurement and augmented NIBP cuff supplies. We completed a re-evaluation and evaluation of the intervention by staff survey, using 5-point Likert scales and free text comments. At baseline, the correct cuff was allocated in 9 of 40 patients (22.5%). During the intervention, education occurred in 54 (69.2%) peri-operative nursing staff. Upon re-evaluation, the correct cuff was allocated in 30 of 40 patients (75.0%), a statistically significant improvement (χ² = 22.1, p < 0.001). Ninety-three of 120 staff surveys were returned (78%). Eleven out of 18 preoperative staff surveyed (61.1%) felt confident measuring the arm and selecting the correct cuff. Six (33%) agreed that taking the arm measurement added a lot of extra work. Equipment shortages, accuracy concerns, and clinical workarounds were reported by staff. Our intervention increased the proportion of correct cuffs allocated, but equipment and practical issues persist with NIBP cuff selection in obese patients.