Just Ask the Expert: Advice on proper blood pressure cuff size and placement

Dr. Garcia welcomes internal medicine questions from veterinarians and veterinary technicians.

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Where do you recommend placing the blood pressure cuff on a hindlimb, and how important is the cuff width? We have seen different blood pressure measurements when using different cuff widths on the same patient: > 240 mm Hg with a size 2 cuff and 130 mm Hg with a size 2.5 cuff.

Jennifer L. Garcia

A. The size of the cuff is definitely important and should measure 40% of the appendage circumference in dogs and 30% in cats.1 Using a cuff that is too large will tend to give you falsely lower blood pressure readings, and vice versa. You can roughly gauge the size of the cuff by laying the long axis of the cuff along the limb and measuring the edge of the cuff against the circumference of the limb. The cuff should be less than 50% of the circumference but more than 25%.

As for where you put the cuff, the most important thing is that the limb you use is at heart level, so the patient should be in lateral or sternal recumbency, otherwise your blood pressure reading will be inaccurate. If you are using Doppler sphygmomanometry, place the cuff midradius on the forelimb and proximal to the hock on the hindlimb. The transducer is placed over the peripheral artery on the palmar surface—over the superficial palmar arterial arch for the forelimb and over the dorsal pedal artery in the hindlimb. For oscillometric techniques, place the cuff distal to the elbow on the forelimb and around the midmetatarsus on the hindlimb.

Jennifer L. Garcia, DVM, DACVIM, is a veterinary internal medicine consultant in Houston, Texas.

REFERENCE

1. Stepien RL. Diagnostic blood pressure measurement. In: Ettinger SJ, Feldman EC, eds. Textbook of veterinary internal medicine. 7th ed. St. Louis, Mo: Saunders, 2010;398-402.