An 85-year-old female with renal failure on hemodialysis has an AV fistula in the left arm. When measuring blood pressure, where should you place the cuff?

• A. Place the cuff on her right bicep, two to three inches above the elbow.
• B. Not assess the blood pressure of a patient who has an arterial-venous fistula.
• C. Place the cuff on her left bicep.
• D. Place the cuff on her thigh.

Answer: (A)

In a patient with an arteriovenous fistula for dialysis, the cuff should not be placed on the arm that has the fistula. The fistula is a delicate access point, and applying cuff pressure over that arm can injure the fistula, reduce blood flow, or lead to thrombosis or other access complications. To protect the dialysis access and to get an accurate reading, place the cuff on the arm without the fistula—in this case, the right arm. Position the cuff about two to three inches above the elbow to ensure proper encirclement and accurate measurement. The left arm, where the fistula is located, should be avoided for BP measurement; using the thigh is not standard practice for routine BP and can yield less reliable readings unless no other option exists.