Q: What is the best way to measure blood pressure in obese patients? If the cuff does not fit around the patient’s arm, should I use a larger cuff or just use the standard cuff on the patient’s forearm? Which method is the most accurate?

A: Jennifer McFarlane, RN, MSN, CCRN, CNRN, CBN, replies:

Measuring blood pressure in patients with obesity presents a number of challenges centered on the selection of the right size cuff. Multiple techniques for blood pressure measurement in patients with morbid obesity have been described; however, no evidence is available to support a preference for one method over another, and expert consensus varies.

The most common site for measurement of blood pressure is on the upper arm of the patient. The upper arm is defined as the part of the upper extremity extending from the shoulder to the elbow....

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