What Are The Contraindications To Measuring BP in Arms And How To Measure BP In Legs?

Contraindications To Measuring BP in Arms

Although no absolute contraindications to obtaining a blood pressure exist, various relative contraindications exist in which caution should be used. Usually, one should avoid obtaining a blood pressure in the same arm in which an arteriovenous fistula (such as used in hemodialysis) is present, or where lymphadema exists. Furthermore, caution should be used if the patient is at high risk for developing lymphedema (such as after lymph node dissection for treatment of breast cancer), although evidence-based studies have not demonstrated an increased risk of lymphedema or arm swelling with blood pressure measurements taken on the ipsilateral arm after breast cancer surgery.





If possible, one should also avoid checking blood pressure in the extremity with intravenous access. In these instances, using the other arm is recommended; if bilateral arteriovenous fistulas or lymphedema exist, then obtaining a lower extremity blood pressure is recommended.



What is the proper technique for measuring blood pressure in the legs? How do standard readings in the legs compare with those obtained in the arms?


Blood pressure measurement in the legs is achieved with an appropriate-sized cuff, applied at the midthigh, and by listening over the popliteal artery. If possible, the patient should be in a prone position. The bladder of the cuff should be about 40% of the circumference of the thigh, and the length should be about 75% to 80% of this circumference.

Normally, the systolic blood pressure in the legs is usually 10% to 20% higher than the brachial artery pressure. Blood pressure readings that are lower in the legs as compared with the upper arms are considered abnormal and should prompt a work-up for peripheral vascular disease. All hypertensive patients should have comparisons of arm and leg blood pressures as well as volume and timing of the radial and femoral pulses at least once to rule out coarctation of the aorta.

OR you can measure blood pressure at the ankle level:

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