Wednesday, March 18, 2009

Sharing Our Blood Pressure Miscuffing Stories

The importance of using the correct-sized blood pressure cuff for people with larger arms has been established in the research for many years. You'd think this would be a moot point by now.

Yet many people of size report being miscuffed or having to argue about cuff size with their healthcare workers, even now. Why does this still happen?

For one thing, not all providers carry larger cuffs. Sometimes, clinics try to cut costs by not ordering larger cuffs, or they may not be aware just how strongly miscuffing can affect blood pressure.

Other times, larger cuffs are available but medical personnel simply do not want to go to the trouble of finding them.

This is actually distressingly common; I have had this happen to me numerous times in the last 15 years, and have heard from many other women of size who have experienced similar issues.

I have many stories about this, but let me just share a brief example of one here, and then I'd like to hear your stories.

A few years ago, I had gone to an urgent-care clinic for antibiotics for an ear and bronchial infection that had rapidly deteriorated; I wanted to get some quick antibiotics for it to keep it from getting worse before I could see my regular doctor.

While there, they of course wanted to take my BP. That's fine. As always I asked to make sure it was a large cuff; it was not. Therefore, I refused to have my BP taken.

I made sure they understood that the problem was not taking my blood pressure (which was usually normal); it was taking it with the wrong-sized cuff.

Didn't matter. They treated me like I had high BP and was just trying to avoid documenting that. (After all, I was fat and that means I probably had hypertension, right?) And oh, did the pressure ever start to just give in.

They told me the large cuff was "out for repair" and they had to use the regular one because they "had" to have something to write down in the records. I refused to have it done that way because I didn't want an artificially-inflated reading on my records.

They tried to tell me that the using the large cuff only made a few points' difference in BP and wasn't that important. I told them that it could make a very large difference indeed and continued to refuse.

They tried to tell me that as long as the cuff fit around my arm, it was fine. I pointed out that this was not true, that it was the size of the bladder inside proportionate to my arm size that was the real issue.

They tried to talk me into taking my BP on the forearm instead. I told them that this method was not that accurate and since it wasn't an emergency and my BP didn't have anything to do with why I was there (the ear/bronchial infection), I would not consent to that either.

Finally, in a stroke of genius, they appealed to my sense of science. They said, "Let's do an experiment and see just how much difference it makes. What's your normal BP; we'll compare that with the results we get from this regular cuff. Let's see whether it makes a lot of difference."

Being the foolishly gullible curious person that I am, I fell for it. (That was stupid. They weren't interested in the science at all, just in getting a reading that they could write down in my records.)

Long story short, my blood pressure was 50 points higher with the regular cuff; it was normal with the large cuff I had it taken with at another doctor's office the next day. But that inaccurately high reading is in my permanent record now, forever.

I have had several other experiences where healthcare workers tried to take my BP with the regular cuff. It's happened even in my regular doctor's office, which usually knows to use the large cuff with me. That's why it's so important to ask every time.

In addition, miscuffing was a problem for me in 3 of my 4 pregnancies. More on that soon....just want to point out that if it happened in THREE OF FOUR pregnancies (and fairly recent ones, too), it's a pretty darn common problem.

Research on the errors that miscuffing causes has been around for more than 25 years, and while miscuffing is less common than it used to be, it is still a distressingly frequent problem.

Healthcare workers get training in the importance of cuff size, but it routinely gets disregarded or forgotten over time. It is definitely something that people of size need to be on the alert for.

Do you have any stories of miscuffing? What happened? How did you handle it? If you complained, how did the authorities respond?

*Coming soon......miscuffing in pregnancy and why correct cuff size is even MORE important when you are pregnant.


Anonymous said...

I never really had a problem with cuffs. The nurse at my OB would take my blood pressure, look at the number, look at last week's number, look at me, and say "oh, I brought the wrong cuff". Matter of fact. Never a sneer- the fault was hers for bringing the small one, not mine for needing the big one.

So, yeah, a problem in that she used the wrong cuff frequently. But the way it was handled never made it feel like a problem. When my pressure was high, she went straight to questioning the equipment, rather than assuming I was about to keel over on the table.

Towards the end of both pregnancies, as BP crept up, they'd take a reading on arrival, and then again after I spoke with the doc. She'd ask if I'd taken the stairs (I often had).

I generally got the sense that they believed me when I said I felt great- and were working with me to get numbers that jived with my lived experience, rather than implying (or stating outright) that I must be lying, denying, or just plain unaware of what was going on in my own body.

Eema-le said...

I had the same problem when I was pregnant with my daughter. I'm eager to read about your experience. I am fairly certain that the miscuffing, and all of the insanity that followed it, was why I ended up with a c-section.

Unknown said...

You have it in one -- I do not even know how to count the number of incorrect bp entries there are in my medical records. There's the problem -- these incorrect readings are still part of the record.

Unknown said...

I just went to an oral surgeon the other day to get a tooth extracted and when they tried to take my BP the velcro started ripping apart. The nurse tried to hold the cuff closed around my arm--obviously that didn't work. They finally got a larger cuff and did it. Honestly I didn't realize until now that I should even be concerned about it.

Lindley said...

I recently wrote about my experience at an emergency clinic (same deal, bronchitis) where my blood pressure was dangerously high--or not, who knows? I asked about a larger cuff, they said I didn't need one, and I was too interested in getting something to stop the cough to argue.

I don't think I've ever had a large cuff used on me, only a regular one. After agonizing for weeks about hypertension, I posted on the blog about it and learned that I very well may not have high blood pressure at all. Now I'm just angry.

Unknown said...

While I was in my first trimester, I had a horrible case of bronchitis, which usually happens when I stop my allergy medicines. I went to my general GP for the bronchitis, and they used a regular cuff on my forearm. I had asked for a thigh cuff, knowing I needed it, and they refused to use one. My blood pressure measured as slightly elevated, but my GP was ready to start giving my BP meds immediately.

I knew it was probably incorrect, and made excuses, saying I had been eating and drinking things high in sodium. I was seeing my OB in a few days, and told her I'd consult her after getting another measurement. She was quite persistent, but let it go finally.

Two days later my blood pressure was 110/70 with a thigh cuff. I hate to think what her medicine would have done to me, and my baby.

Anonymous said...

I've had good luck with convincing medical professionals to use the correct cuff. I did have one incident when I was pregnant with my son when I walked to a prenatal exercise class (about a mile, mostly uphill, in the heat) and they didn't have a larger cuff and I ended up with a 140/90 reading. I usually have readings below 110/70. They freaked out and didn't want me to participate in the class. I had them call my awesome OB and she vouched for my good BP and I was allowed to participate. It makes a difference!

Brigid Keely said...

I always push for a large cuff and it's RARELY a problem, which I'm grateful for. However, when I was laboring prior to giving birth, I had a cuff on me the entire time so they could continually monitor me. I was so tethered down. Worse of all, it wasn't a large sized cuff, it was a THIGH sized cuff, so it kept sliding down my arm. Incredibly irritating, and I don't know how accurate the results were.

chavon said...

Does the temperature of the cuff and inflator and tubing have anything to do with accuracy my midwife kept her equipment in the back of her truck all during my last pregnancy in winter with snow and always said my numbers were high even though she always said it was hard to pump because it was cold?