1. The room should be quiet and the patient comfortable.
2. Position the patient's arm so the antecubital fold is level with the heart. (It is best that the arm be support by an armrest or your arm.)
3. Center the bladder of the cuff over the brachial artery approximately 2 cm above the antecubital fold. Position the patient's arm so it is slightly flexed at the elbow.
4. Proper cuff size is essential to obtain an accurate reading. Be sure the index line falls between the size marks when you apply the cuff.
5. Palpate the radial pulse and inflate the cuff until the pulse disappears. This is a rough estimate of the systolic pressure.
6. Place the stethoscope over the brachial artery.
7. Inflate the cuff 20 to 30 mmHg above the estimated systolic pressure.
8. Release the pressure slowly, no greater than 5 mmHg per second.
9. The level at which you begin to hear Korotkoff sounds is the systolic pressure.
10. Continue to lower the pressure until the sounds muffle and disappear. This is the diastolic pressure.
11. Blood pressure should be taken in both arms on the first encounter. If there is more than 10 mmHg difference between the two arms, make a note to always use the reading from the arm with the higher pressure.

In Children

Do not rely on pressures obtained using a cuff that is too small or too large. This is frequently a problem with obese or muscular adults for whom the regular cuff is too small. The pressure recorded will most often be 10, 20, even 50 mmHg too high! Finding a large cuff may be inconvenient, but you will also "cure" a lot of high blood pressure.

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