Non-Invasive Blood Pressure Measurement
Publication Date: May 1, 2019
Last Updated: March 14, 2022
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
Emergency Nurses Association
Publication Month/Year
May 1, 2019
Last Updated Month/Year
January 30, 2024
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, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Diagnosis, Management
Diseases/Conditions (MeSH)
D001794 - Blood Pressure, D001795 - Blood Pressure Determination
Keywords
blood pressure, emergencies, NIBP, oscillometric BP measurement