![]() As the pressure declines, the Korotkoff sounds are noted. With the stethoscope in place over the brachial artery in the antecubital fossa, the cuff is slowly deflated at a rate of 2 mm Hg per second. ![]() Pressure is then rapidly increased to at least 30 mm Hg higher than that which eliminates a palpable radial pulse. It should be high enough on the arm to allow the stethoscope to be placed in the antecubital fossa without touching the cuff. ![]() The patient should be comfortably seated and the deflated cuff applied with the bladder centered over the brachial artery. Cuffs that are too small give results erroneously high cuffs that are too large give results erroneously low. This ensures that the length is the recommended 80% of the limb circumference. Most standard cuffs have a bladder length that is twice its width. The width of the bladder ideally should be 40% of the circumference of the limb tested. The standard blood pressure cuff must be of the proper size to minimize errors in blood pressure determinations. Although these methods are necessary in some settings, sphygmomanometric measurements are much easier and safer, and are accurate enough for most clinical situations. The most accurate measurement of arterial blood pressure is obtained by direct methods that involve sophisticated and expensive equipment as well as cannulation of an artery.
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