f. Expose the Site. Have the patient expose the site to be used (upper arm or
thigh). Assist the patient as needed. The patient may need to remove a long sleeve
shirt or lower his pajama bottoms. The bladder must be placed over the patient's flesh,
not his clothing. Rolling a shirt-sleeve or pants leg up could create a tight area above
the site where the bladder is applied. This extra tightening could cause the blood
pressure readings to be inaccurate. Therefore, it is better to remove a long sleeve shirt
or pants rather than rolling them up.
g. Explain Procedure to Patient. Briefly tell the patient what you are going to
do. The explanation can be combined with instructing the patient to expose the site
where the bladder will be applied. Warn the patient that his arm (leg) may be
uncomfortable while the bag (bladder) around his arm (leg) is inflated, but reassure the
patient that the discomfort will only last 1 or 2 minutes.
h. Prepare Bladder. Make sure that the bladder is completely deflated. If air is
present in the bladder, open the release valve, force the air out of the bladder, and
close the valve.
i. Prepare Gauge. If a mercury gauge is being used, place the gauge where it
can easily read, yet not in the way. If an aneroid gauge is being used, attach it to the
j. Position Patient's Limb.
(1) If the bladder is to be applied to the patient's upper arm and there is a
support for the patient's arm (bed, table, ground, etc.), have the patient to extend his
arm in a palm up position. The arm should be about the same level as his heart.
(2) If the bladder is to be applied to the patient's upper arm but there is no
support for his arm, tuck his wrist under your arm so that you will be supporting his arm
and keeping it steady.
(3) If the bladder is to be applied to the patient's thigh, the patient should
remain lying on his abdomen or lying on his back with his knee flexed.
k. Wrap Bladder Around Limb.
(1) If the upper arm is being used, wrap the bladder around the upper arm.
The non-slip material or buckles of the bladder should be on the outside of the bladder,
not next to the patient's skin. The bottom edge of the bladder should be one to two
inches above the elbow (figure 5-6).
(2) If the thigh is being used, wrap the bladder around the middle of the
thigh (figure 5-7). A somewhat larger and longer bladder is normally used when the
blood pressure is taken in the thigh.