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BP Measurement

The document outlines the process and considerations for measuring blood pressure using a sphygmomanometer, including the definitions of systolic and diastolic pressures, the Korotkoff sounds, and factors influencing blood pressure readings. It details the proper technique for measurement, including patient positioning, cuff placement, and the importance of environmental conditions. Additionally, it provides a classification of hypertension according to the JNC 7 guidelines and highlights common mistakes to avoid during the measurement process.

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21 views4 pages

BP Measurement

The document outlines the process and considerations for measuring blood pressure using a sphygmomanometer, including the definitions of systolic and diastolic pressures, the Korotkoff sounds, and factors influencing blood pressure readings. It details the proper technique for measurement, including patient positioning, cuff placement, and the importance of environmental conditions. Additionally, it provides a classification of hypertension according to the JNC 7 guidelines and highlights common mistakes to avoid during the measurement process.

Uploaded by

meharmakan777
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Aim: Blood pressure measurement using a sphygmomanometer.

Understanding blood pressure


Blood pressure is a measurement of the force of blood pushing against arterial walls. Blood pressure
is highest when the heart contracts or pumps blood and lowest when the heart relaxes or pauses
between beats. The measure of blood pressure during the point in the cardiac cycle when the heart
contracts is called systolic pressure, and the measure of blood pressure when the heart relaxes is
called diastolic pressure. Blood pressure is typically recorded using a sphygmomanometer, which
relies on the height of a column of mercury to represent arterial pressure in millimeters of mercury
(mmHg) or kilopascals (kPa). For example, adult blood pressure of 110/70 mmHg would be
considered within normal values, and blood pressure of 120/90 mmHg would be considered as high
blood pressure or hypertension.

Common factors that influence blood pressure are as follows:

 Age, gender, and body type


 Time of day
 Body position
 Activity and exercise
 Emotional status
 Medication
 Medical and family history
 Social habits (i.e., smoking and alcohol consumption)
 Disease (i.e., kidney, metabolic, or congestive heart failure)
 Pain
 Blood volume
 Blood thickness/viscosity
 Vessel resistance and size

Measuring blood pressure


The Korotkoff method typically includes the occlusion of the brachial artery by a cuff placed on the
upper arm and inflated to a pressure above systolic pressure. When the cuff is inflated above
systolic pressure, blood flow in the artery is completely occluded or stopped. The pressure is then
gradually lowered at 2-3 mmHg per second until pulsatile blood flow occurs. This will cause intra-
arterial sounds during auscultation over the brachial artery secondary to turbulent flow and
oscillations of the arterial wall. The sounds are described to have five phases, which are as follows:

 Phase I is the appearance of tapping sounds corresponding to the appearance of a palpable


pulse
 Phase II sounds become softer and longer
 Phase III sounds become crisper and louder
 Phase IV sounds become muffled and softer
 Phase V sounds disappear completely

The fifth phase is the recorded value of the last audible sound. There is agreement among
researchers that phase I corresponds to systolic pressure but tends to underestimate the systolic
pressure recorded by intra-arterial measurement.

There has been some debate in the past as to whether phase IV or V is the accepted value for
diastolic pressure, but both are felt to occur before diastolic pressure is determined by intra-arterial
recordings. Therefore, it is now accepted that phase V should be used, except when the
disappearance of the sounds cannot be reliably determined because the sounds are audible even
after complete deflation of the cuff. This situation can occur in pregnant women, patients with
arteriovenous fistulas, and patients with aortic insufficiency.

According to the Seventh Report of the Joint National Committee on the Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure (JNC 7), the classification of hypertension is
presented below:

JNC 7 Classification of blood pressure for adults


Blood pressure classification SBP mmHg DBP mmHg
Normal <120 <80
Prehypertension 120-139 80-89
Stage 1 Hypertension 140-159 90-99
Stage 2 Hypertension >160 >100
Effects of body position on blood pressure
Blood pressure is commonly measured in the seated or supine position; however, the two positions
give different measurement values. With that in mind, any time a value is recorded, body position
should also be recorded. It is widely accepted that diastolic pressures while sitting are higher than
when a patient is supine by as much as 5 mmHg. When the arm is at the level of the heart, systolic
pressure can be 8 mmHg higher, such as when a patient is in the supine position rather than sitting.
A patient supporting their own arm (isometric exercise) may increase the pressure readings. If the
patient’s back is not supported (i.e., when a patient is seated on an exam table instead of a chair)
the diastolic pressure may be increased by 6 mmHg. Crossing the legs also may raise systolic
pressure by 2-8 mmHg. Arm position plays a dramatic role in value errors as well. If the arm is below
the level of the heart, values will be too high; if the arm is above the level of the heart, values will be
underestimated. For every inch the arm is above or below the level of the heart, a 2 mmHg
difference will be found.
Stethoscope bell and sphygmomanometer cuff placement
The brachial artery is palpated on the anterior aspect of the elbow by gently pressing the artery
against the underlying bone with the middle and index fingers. The brachial artery pulse will be used
to measure blood pressure with a stethoscope and sphygmomanometer in the next demonstration.

The lower end of the blood pressure cuff is placed 2-3 cm above the antecubital fossa, which should
be at approximately the same vertical height as the heart while allowing room for the stethoscope.
The cuff should be placed snugly around the upper arm, and the bladder of the cuff should cover at
least 80% of the arm's circumference.

The bell of the stethoscope is placed over the brachial artery with a good seal using light pressure.
Applying too much pressure with the bell of the stethoscope will cause it to act like the diaphragm,
and high-pitched sounds will be heard better than low-pitched sounds. Blood pressure cuff and
stethoscope bell placement are pictured to the right.

Testing procedures
1. Place the patient in a quiet, well lit, warm, and comfortable room.
2. Have the patient remove all clothing that covers the location of the cuff placement. The sleeve
should not be rolled up because this can be restrictive or have a tourniquet effect on the artery.
3. Seat the patient with his or her legs uncrossed, feet on the floor, and back and upper arm
supported.
4. Place the arm being measured at the level of the heart or mid-point of the sternum.
5. Palpate the brachial artery in the antecubital fossa.
6. Place the middle of the bladder (commonly marked on the cuff) at this location.
7. Place the lower end of the cuff 2-3 cm above the antecubital fossa to allow room for the
stethoscope.
8. Place the bell of the stethoscope over the brachial artery with a good seal using light pressure.
9. Semi-rapidly inflate the cuff 30 mmHg greater than the estimated systolic value.
10. Deflate the cuff at 2-3 mmHg per second until pulsatile blood flow occurs.
11. Identify when the sounds first appear with two consecutive beats, and record this value as the
systolic pressure.
12. Continue to lower the pressure at a rate of 2-3 mmHg per second until the sounds are muffled
and disappear, and record this value as the diastolic pressure.
13. Confirm diastolic pressure by deflating the cuff for another 10-20 mmHg.
14. Deflate the cuff completely, wait 2 or more minutes, and repeat this procedure.
15. Take additional readings if the first two readings differ by more than 5mmHg, and document
your findings.
Special instructions

 The patient should not have consumed alcohol, tobacco, or caffeine or exercised for 30
minutes prior to the examination.
 It is best to complete a thorough history to allow the patient to relax and the effect of any of
the above to resolve.
 Avoid cuff over-inflation and subsequent patient discomfort.
 Do not allow the cuff to rub against the stethoscope because the extraneous noise can
complicate the auscultatory process.

Clinical notes

 Common mistakes include reading the manometer value without hearing the Korotkoff
sounds, taking BP through clothing, occluding the artery with restrictive clothing, improper
cuff sizing, holding the patient's arm in an incorrect position, and inappropriate environmental
conditions.

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