Blood pressure assessment is performed with the patient lying comfortably in the supine position. The cuff bladder is centered over the right brachial artery. If the arm is obese, a large adult or thigh cuff should be used. The arm should be slightly flexed, and it should be supported at approximately the level of the heart. To determine the systolic blood pressure adequately and to exclude an error as a result of an auscultatory gap, blood pressure is first assessed by palpation. In this procedure, the right brachial or right radial artery is palpated while the cuff is inflated above the pressure required to obliterate the pulse. The adjustable screw is opened slowly for deflation. The systolic pressure is identified by the reappearance of the brachial pulse. As soon as the pulse is felt, the adjustable screw is opened for rapid deflation. This assessment is demonstrated in Figure 14-20.
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