how to measure bp

8/2/2019 How to Measure BP

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Blood Pressure How to

easure

Ahmed Khashaba, MD

Cardiology Department

Ain Shams University


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....


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considered routine and is often

performed by those with the least

training

Jones DW, et al:Hypertension 2001; 37:185


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Blood pressure of all adults should be measured by

any trained healthcare professional whenever its appropr a e.

medical visits

To determine cardiovascular risk

To monitor antihypertensive treatment


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E ui ment factors

Observer factors

Patient factors


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Sources of Error in BP Measurement

Single armSingle arm

Auscultatory gapAuscultatory gap

Conversation withConversation with

observersobservers

Quick deflationQuick deflationNo rest periodNo rest period

Atrial FibrillationAtrial Fibrillation

Korotkoff IVKorotkoff IV

Digit preferenceDigit preference

White coat effectWhite coat effect

Expectation biasExpectation bias

CaffeineCaffeinestract onsstract ons

Background noiseBackground noise

SmokingSmoking

Full bowel/bladderFull bowel/bladder

Hearing acuityHearing acuityCrossed legsCrossed legs


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Blood Pr essur e Assessm ent :

Pa t i en t p r epar a t i on and pos t u r e

St andard i zed t echn ique :

Pat ien t1. No caffeine in the preceding hour.2. No smoking or nicotine in the preceding 15-30 minutes.3. No use of substances containing adrenergic stimulants

such as phenylephrine or pseudoephedrine (may bepresent in nasal decongestants or ophthalmic drops).

4. Bladder and bowel comfortable.. u e env ronmen . om or a e room empera ure.

6. No tight clothing on arm or forearm.

7. No acute anxiety, stress or pain.. .


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Pa t i en t p r epar a t i on and post u r e

St andard i zed t echn ique :

Pos tu re

The atient should be calml seated for at least 5

minutes, with his or her back well supported andarm supported at the level of the heart. His or her

crossed.

and during the procedure.


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Recom m en ded Tech n i u e

fo r Measu r ing Blood Pr essu r e

Standardized technique:

Use a mercury manometer or a recently

electronic device.

Aneroid devices should only be used if

there is an established calibrationcheck every 6-12 months.


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Recom m ended Techn ique


Elec t r on ic osci l lom et r ic dev ices :

Use a validated electronic deviceaccording to BHS, AAMI or IPstandards.

Off ice

For self blood pressuremeasurement devices, a logo onthe packaging ensures that thistype of device and model meetsthe international standards for

accurate blood pressuremeasuremen .

AAMI=Association for the Advancement of Medical Instrumentation

H om e / Se lf

BHS=British Hypertension Society; IP: International Protocol.


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fo r Measu r ing Blood Pr essu r e ( con t .)

cuff with theappropriate size


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Ar m ci r cu m f er en ce ( cm ) Size o f Cu f f ( cm )

From 18 to 26 9 x 18 (child)

rom oadult model)

,

More than 41 18 x 36 (extra large,


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f o r Measu r ing Blood Pr essu r e ( con t .)

Locate brachial andradial pulse

Position cuff at the

heart level

Arm should besupported


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fo r Measu r ing Blood Pr essu r e ( con t . )

To exclude possibility of

auscultatory gap,ncrease cu pressurerapidly to 20-30 mmHgabove level of

disappearance of radialpulse

Place stethoscope overthe brachial artery


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Drop pressure by 2 mmHg /

Appearance of sound (phase IKorotkoff) = systolic pressure

Record measurement

Drop pressure by 2 mmHg /beat

Disa earance of sound hase VKorotkoff) = diastolic pressure

Record measurement

Take 2 blood pressuremeasurements, 1 minute apart


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S st o l i c BP

200

180

No sound

Koro tko f f sounds

160

140

Clear sou n d Ph ase 1

Muffling Phase 2

Auscultatory gapNo sound

120

100

Muffled sound

Muffled sound

Phase 3

Phase 4

Poss ib le read in gs :

80

60

40 No sou n d Ph ase 5 136 / 100184 / 86 = correct136 / 86

20

0

m m H g


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St andar d i zed t echn ique :

For initial readings, take the blood

pressure in both arms and subsequentlymeasure it in the arm with the highestrea ng.

erea er, a e wo measuremen s onthe side where BP is highest.


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Record the blood pressure to thec oses mm g on emanometer

as well as the arm used

and whether the patient wassupine, sitting or standing.


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Avoid digit

five (5) or zeros(0) by not

down.

Record the heartrate.


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to determine and monitor

to test for postural hypotension, if

present, which may modify thetreatment.


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Pa t i en t p r epar a t i on and post u r e

St and in g pos i t i on

or pa en s over age , a e cs anpatients being treated with

,

postural changes while taking bloodpressure reading, i.e. after one to fiveminutes in the standing position andunder circumstances when the patientscomp a ns o symp oms sugges ve ohypotension.


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Th r esh o l d f o r I n i t i a t i o n o f Tr e at m en t an d

Targ e t Values

Con d i t i on I n i t ia t ion

Target

m m H g

Diastolic systolic 140/90

160


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Blo od r essu r e m easu r em en t w i t h s eci f ic

dev ices

Mercury Blood Pressure Monitor

Electronic Blood Pressure Monitor


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Blood Pr essu r e Measu r em en t w i t h Aner o id

B lood Pr essur e Mon i t o r

no t be used

i f t he r e is no t

an es tab l i shedca l i b ra t i on check

ev er y 6 - 1 2 m o n t h s.


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BP measurement should not be erformed li htl .BP measurement should not be erformed li htl .

Use standardized protocolUse standardized protocol

The measurement of blood pressure through auscultation remains

the most widely accepted method in everyday practice.

The measurement of blood pressure through auscultation remains

the most widely accepted method in everyday practice.

Reliance on automated devices may lead to inaccurate readings inthe presence of arrhythmias.

Reliance on automated devices may lead to inaccurate readings inthe presence of arrhythmias.

Mercury sphyg. are still considered the gold-standard measuring

devices for indirect blood ressure determination

Mercury sphyg. are still considered the gold-standard measuring

devices for indirect blood ressure determination

Aneroid sphygmomanometers are considered accurate ifAneroid sphygmomanometers are considered accurate if

..

how to measure bp

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