Miscuffing: inappropriate blood pressure cuff application.

For the accurate indirect measurement of blood pressure (BP), the American Heart Association (AHA) now recommends that cuff size should be based solely on limb circumference. We studied prevailing cuffing habits and compared them with newly revised AHA guidelines. Monitoring our staff's cuff applications, we found that "miscuffing" occurred in 65 (32%) of 200 BP determinations on 167 unselected adult outpatients, including 61 (72%) of 85 readings taken on "nonstandard" size arms. Undercuffing large arms was the most frequent error, accounting for 84% of the miscuffings. Considering that miscuffing distorts BP readings by an average of 8.5 mm Hg systolic and 4.6 mm Hg diastolic, we can improve the accuracy of our BP determinations by remarking our cuffs and using the new AHA guidelines.