Q&A: BP cuff for vein distention

Q: I am a new RN and was always told that I can use a BP cuff to distend the veins for IV starts instead of a tourniquet. Can you tell me how high should I pump the cuff?

A:  BP cuff is one method that can be used for vein distention while assessing veins for venipuncture and during the actual venipuncture. There are various views on what the inflation pressure is best for this purpose  and the consensus opinion appears to indicate  just below diastolic pressure.  Here’s what the following infusion nursing/infusion therapy textbooks indicate:

1. Alexander et al:  Infusion nursing an evidence based approach 3rd edition 2009 states: You can inflate the cuff and release to just below the diastolic pressure.

2. Philips & Gorski Manual of IV Therapeutics 6th edition 2014:  You can apply the BP cuff on the patient’s arm, then slightly pump the cuff to about 30mmHg  The authors added this nursing fast fact: when using a blood pressure cuff, care must be exercised not to start the IV too close to the cuff, which causes excessive back pressure.

3.  Weinstein & Hagle Plumer’s Principles and Practice of Infusion Therapy 9th edition 2014. The patient’s blood pressure cuff may be used to distend the vein; inflate the cuff and then release it until the pressure drops to just below the diastolic pressure.

As an infusion nurse, I’ve only used a BP cuff in lieu of a tourniquet a few times when starting an IV.  I’ve found that inflating and releasing to about 30-40mm Hg provided sufficient distention without increased discomfort to the patient.

Good luck and thank you for your question.