If you are using a manual blood pressure monitor, it is sensible to position the tubes to the top of the cuff so that they don’t interfere with the stethoscope. If you are using an automatic device then it doesn’t matter which way up you use the cuff. Some cuffs are conically shaped i.e. larger at the top than the bottom to fit the shape of the upper arm. In this case there is only one way to fit with tubes downwards.
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