Abstract
BackgroundArm conicity is associated with non-invasive blood pressure (NIBP) measurement error and may be avoided by using finger cuffs. Predicting arm conicity may help decisions regarding NIBP measurement techniques.MethodsWe obtained upper limb measurements of adults presenting to the Pre-Anesthetic Clinic to determine: the suitability of arm and finger cuff sizes; the best anthropometric predictor of arm conicity based on the right arm slant angle; the incidence of a right arm slant angle < 83 degrees. Right mid-arm circumference (MAC) was compared to recommended cuff sizes and finger circumference compared to available cuffs. Slant angle was calculated from the measurements obtained. Linear regression was used to determine the better predictor of right arm slant angle. Correlation coefficients were calculated and R2 values compared.ResultsFour hundred fifty-four patients participated and 453 had cone-shaped arms. One participant (0.2, 95% CI 0.0–1.2) had a MAC outside the recommended cuff range. Twenty-five participants (5.5, 95% CI 3.6–8.0) had a middle finger circumference greater than the largest ClearSight™ cuff. Body mass index (BMI), weight and right MAC all had low to moderate correlation with right arm slant angle (r = − 0.49, − 0.39, − 0.48, all p < 0.001) and regression revealed R2 values of 0.24, 0.15 and 0.23. Six participants (1.3, 95% CI 0.5–2.9) had a slant angle < 83 degrees.ConclusionCurrent NIBP equipment caters for most patients, based on the traditional measure of MAC. The utility of finger cuffs is limited by cuff size. BMI and right MAC showed the most promise in predicting arm conicity.
Highlights
Arm conicity is associated with non-invasive blood pressure (NIBP) measurement error and may be avoided by using finger cuffs
Our results suggest that the current range of NIBP cuff size is suitable for the majority of patients presenting to the Pre-Anesthetic Clinic
0.2% of participants were outside the recommended arm cuff range [6] but 5.5% had a finger circumference that would be too large for the largest ClearSightTM finger cuff
Summary
Arm conicity is associated with non-invasive blood pressure (NIBP) measurement error and may be avoided by using finger cuffs. The influence of cuff bladder width and length on the accuracy of obtained readings is well known [5] and the American Heart Association (AHA) provides recommended bladder width and cuff sizes, based on a patient’s mid-arm circumference (MAC) [6]. Palatini et al demonstrated that the difference between readings obtained from a conical cuff and those obtained from a standard rectangular cuff were greatest when the slant angle was less than 83 degrees [8]. Alternative methods of NIBP measurement use finger cuffs, which are not affected by the variation in size and shape of the arm. ClearSightTM and CNAPTM are two such devices, providing continuous NIBP measurement using finger-cuffs in a range of sizes
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