If a patient has an arteriovenous fistula in the arm used for BP measurement, where should BP be measured?

• A. On the contralateral arm or, if necessary, use a validated alternative site and document limitation; avoid the fistula arm.
• B. On the fistula arm.
• C. On the thigh.
• D. On the foot.

Answer: (A)

When a patient has an arteriovenous fistula in the arm used for dialysis, the cuff used for blood pressure measurement should not be placed on that arm because the inflation can compress the fistula and disturb its flow, risking access dysfunction or injury. The proper approach is to measure on the opposite arm, and if that isn’t possible, use a validated alternative site and clearly document any limitation. This keeps the fistula intact and provides the most reliable pressure reading. Using the fistula arm would endanger the access, while sites like the thigh or foot are not standard for routine BP and can give less accurate readings or introduce other risks.