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DIFFERENT METHODS OF
MEASURING BLOOD
PRESSURE
Stephen Hales
• 1727- First Blood
Pressure measurements
by inserting glass tubes
inside arteries of a Mare
and recording p...
• Forssmann, Counard
and Richard
• Nobel Prize 1956
• Procedure of cardiac
catherisation
MEASURING BLOOD
PRESSURE
BP MEASUREMENT
DirectIndirect
TonometricUltrasonicOscillometricAuscultatory
HybridAneroidMercury
Palpatory
Palpatory Method
• Rough Estimation of Systolic Pressure
• Carotid Femoral radial >70 mm Hg
• Carotid and Femoral > 50 mm ...
Direct Method
• Direct Intra arterial Measurement of
Pressure using a pressure transducer
• Systolic is recorded 5-10 mm H...
Mercury Sphygmomanometer
• Samuel Siegfried Karl
Ritter von Basch
(1881)
• Riva Rocci (1896)
• Modern Version by
Harvey Cu...
Aneroid Sphygmomanometer
• No Mercury
• Metal Bellow and
Lever system
• Inaccurate if not
calibrated
.
Mion D, Pierin AM. ...
Hybrid BP monitors
• Combine features of mercury and aneroid
sphygmomanometers
• Mercury replaced by Electronic Pressure
G...
PHYSICS OF BP MEASUREMENT
• Reynolds number
Re = ρ D v
μ
ρ- Density of the fluid
D- Diameter of the vessel
V- Velocity of ...
Korotkoff Sounds
Phase 1 Phase 2 Phase 3 Phase 4 Phase 5
Silence Tapping Soft
Swishing
Crisp Blowing Silence
Cuff
pressure...
Oscillometric Sphygmomanometer
• Records Oscillations in BP
cuff
• Blood pressure determined
by an algorithm
• Calibration...
Auscultatory Vs Oscillatory
Other Techniques
• Ultrasonic probes under cuff
• Tonometry
• Doppler
HOW TO MEASURE
BLOOD PRESSURE IN
CLINICAL SETTING
Subject Position
• Quitely Seated atleast for 5 min in a chair
• Feet on the floor
• Arms at Level of Right Atrium (mid po...
Body Position
• Back supported
• Legs Uncrossed
• Arm supported
• Cuff at level of Right
Atrium- Midpoint of
the Sternum
• Arm to be at level of
right atrium even
when patient is
supine (P=hρg)
• Support with pillow
Cuff Size
• Length: Width ratio
ideally 2:1
• Tubing at least 70 cm
long
Approx Size of Cuff
Length Width
Arm
Circumference
Cuff Cuff Size
Upto 10 cm Newborn 4X8 cm
11-15 cm Infant 6X12 cm
16-21 cm Child 9X18 cm
22-26 cm Small A...
Cuff Placement
• Midline of bladder of
cuff over arterial
pulsation
• Lower end 2-3 cm
above cubital fossa
• Midthigh leve...
Instrument at Level of Cuff
Position of Eye of Observer
• Eye at level of
upper meniscus of
mercury column
Inflation and Deflation
• Initial Inflation atleast 30 mm above point
where radial pulse disappears
• Deflation at 2-3 mm ...
Number of Measurements
• Minimum of two readings at least
intervals of atleast one min
• Average of both readings to be ta...
Both Arm Measurements
• Ideally, first visit should include
measurement of blood pressure in both
arms
• If Consistent dif...
Blood Pressure in Paediatric Age
Group
• BP in all four limbs to be checked on first
visit
• Auscultatory method satisfact...
Self Monitoring at Home
• Useful in White Coat Hypertension
• Smokers
Continuous Ambulatory BP
• White Coat Hypertension
• Drug Resistance
• Hypotension with Anti hypertensive
therapy
• Episod...
TAKE HOME MESSAGE
• Comfortable Sitting position of Subject
• Appropriate Cuff Size
• Calibrated Instrument
• Proper Infla...
Blood Pressure Measurement
Blood Pressure Measurement
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Blood Pressure Measurement

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Different Methods of Measuring Blood Pressure
Based on AHA and JNC 7 guidelines on procedure for measuring blood pressure

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Blood Pressure Measurement

  1. 1. DIFFERENT METHODS OF MEASURING BLOOD PRESSURE
  2. 2. Stephen Hales • 1727- First Blood Pressure measurements by inserting glass tubes inside arteries of a Mare and recording pressure from the column of blood that rose
  3. 3. • Forssmann, Counard and Richard • Nobel Prize 1956 • Procedure of cardiac catherisation
  4. 4. MEASURING BLOOD PRESSURE
  5. 5. BP MEASUREMENT DirectIndirect TonometricUltrasonicOscillometricAuscultatory HybridAneroidMercury Palpatory
  6. 6. Palpatory Method • Rough Estimation of Systolic Pressure • Carotid Femoral radial >70 mm Hg • Carotid and Femoral > 50 mm Hg • Carotid >40 mm Hg Deakin CD, Low JL (September 2000). Accuracy of advanced trauma life support guidelines for predicting systolic blood pressure using carotid, femoral and radial pulses: Observational ; BMJ 321 (7262): 673–4.
  7. 7. Direct Method • Direct Intra arterial Measurement of Pressure using a pressure transducer • Systolic is recorded 5-10 mm Hg higher and Diastolic is 5-10 mm lower than non- invasive techniques • Gold Standard • Accurate beat-to-beat monitoring Matthew Ward, Jeremy A Langton, Disclosures Cont Edu Anaesth Crit Care and Pain. 2007;7(4):122-126.
  8. 8. Mercury Sphygmomanometer • Samuel Siegfried Karl Ritter von Basch (1881) • Riva Rocci (1896) • Modern Version by Harvey Cushing (1901) GOLD STANDARD IN CLINICAL PRACTICE
  9. 9. Aneroid Sphygmomanometer • No Mercury • Metal Bellow and Lever system • Inaccurate if not calibrated . Mion D, Pierin AM. How accurate are sphygmomanometers? J Hum Hypertens. 1998; 12: 245–248 Yarows SA, Qian K. Accuracy of aneroid sphygmomanometers in clinical usage: University of Michigan experience. Blood Press Monit. 2001; 6: 101–106.
  10. 10. Hybrid BP monitors • Combine features of mercury and aneroid sphygmomanometers • Mercury replaced by Electronic Pressure Gauge • Auscultatory method used
  11. 11. PHYSICS OF BP MEASUREMENT • Reynolds number Re = ρ D v μ ρ- Density of the fluid D- Diameter of the vessel V- Velocity of the fluid μ- Viscosity of the fluid Re < 2100 – Laminar flow Re > 4000- Turbulent flow
  12. 12. Korotkoff Sounds Phase 1 Phase 2 Phase 3 Phase 4 Phase 5 Silence Tapping Soft Swishing Crisp Blowing Silence Cuff pressure SYSTOLIC DIASTOLIC
  13. 13. Oscillometric Sphygmomanometer • Records Oscillations in BP cuff • Blood pressure determined by an algorithm • Calibration Must • Ambulatory and Home BP
  14. 14. Auscultatory Vs Oscillatory
  15. 15. Other Techniques • Ultrasonic probes under cuff • Tonometry • Doppler
  16. 16. HOW TO MEASURE BLOOD PRESSURE IN CLINICAL SETTING
  17. 17. Subject Position • Quitely Seated atleast for 5 min in a chair • Feet on the floor • Arms at Level of Right Atrium (mid point of sternum) • Avoid Caffeine, Exercise and Smoking 30 min prior to recording
  18. 18. Body Position • Back supported • Legs Uncrossed • Arm supported • Cuff at level of Right Atrium- Midpoint of the Sternum
  19. 19. • Arm to be at level of right atrium even when patient is supine (P=hρg) • Support with pillow
  20. 20. Cuff Size • Length: Width ratio ideally 2:1 • Tubing at least 70 cm long
  21. 21. Approx Size of Cuff Length Width
  22. 22. Arm Circumference Cuff Cuff Size Upto 10 cm Newborn 4X8 cm 11-15 cm Infant 6X12 cm 16-21 cm Child 9X18 cm 22-26 cm Small Adult 12 X22 cm 27-34 cm Adult 16X30 cm 35-44 cm Large Adult 16X36 cm 45-52 cm Adult Thigh 16X 42 cm
  23. 23. Cuff Placement • Midline of bladder of cuff over arterial pulsation • Lower end 2-3 cm above cubital fossa • Midthigh level in lower limb
  24. 24. Instrument at Level of Cuff
  25. 25. Position of Eye of Observer • Eye at level of upper meniscus of mercury column
  26. 26. Inflation and Deflation • Initial Inflation atleast 30 mm above point where radial pulse disappears • Deflation at 2-3 mm per second • First and Last sounds to be taken as systolic and Diastolic Pressures • Column to be read to nearest 2mm Hg
  27. 27. Number of Measurements • Minimum of two readings at least intervals of atleast one min • Average of both readings to be taken • If diff > 5 mm Hg, more readings to be taken and averaged out
  28. 28. Both Arm Measurements • Ideally, first visit should include measurement of blood pressure in both arms • If Consistent difference in measurements without identifiable cause, higher reading should be used as baseline
  29. 29. Blood Pressure in Paediatric Age Group • BP in all four limbs to be checked on first visit • Auscultatory method satisfactory • Doppler • Oscillometric Most accurate • Palpatory method for systolic pressure • Flush method for infants – Systolic only
  30. 30. Self Monitoring at Home • Useful in White Coat Hypertension • Smokers
  31. 31. Continuous Ambulatory BP • White Coat Hypertension • Drug Resistance • Hypotension with Anti hypertensive therapy • Episodic Hypertension • Autonomic Dysfunction
  32. 32. TAKE HOME MESSAGE • Comfortable Sitting position of Subject • Appropriate Cuff Size • Calibrated Instrument • Proper Inflation and Deflation Procedure • Average of Readings

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