Where should blood pressure be measured in a dialysis patient?

• A. In the non-access arm if possible, away from the fistula or catheter; avoid using the access arm.
• B. In the arm with the fistula to monitor patency.
• C. On the patient’s leg.
• D. In either arm regardless of access status.

Answer: (A)

Protecting the vascular access is essential when taking blood pressure in dialysis patients. The blood pressure cuff temporarily compresses the arteries and veins. If you place the cuff on the arm with a fistula or catheter, this compression can reduce or disrupt flow through the access, increasing the risk of thrombosis or stenosis and potentially damaging the fistula or catheter. It can also cause pain or ischemia in that limb and may compromise the access’s function, jeopardizing the patient’s dialysis. Therefore, blood pressure should be measured on the arm without the access, away from the fistula or catheter. If neither arm is suitable, the leg can be used as a last resort, but the non-access arm is the preferred site whenever possible.