Blood pressure measurement using mercury sphygmomanometers and other auscultation based devices

Based on EHES Manual, Part B. Fieldwork Procedures, 2nd edition (2016) Available at: http://urn.fi/URN:ISBN:978-952-302-701-5 These slides can be used freely, translated and adapted to national use (e.g. concerning the equipment). However, it is important to keep in mind that no changes should be made to the measurement techniques, which need to be standardized.

Equipment Sphygmomanometer Stop watch An object to elevate the device Cuffs Watch and thermometer Stethoscope Measurement tape Stop watch An object to elevate the device

Checking the device weekly Test inflation system for air leaks Connect each cuff size to the inflation system Wrap around the corresponding calibration cylinder or a bottle Inflate to 250 mmHg Open valve and deflate to 200 mmHg and close valve Wait 10 sec If mercury column drops more than 10 mmHg, there is a leak

Checking the device daily Shape of the meniscus Rise of the mercury Zero level of the mercury No cracks in the glass tube Screw at the top of the calibrated glass tube Air tube: no cracks or tears Screw

Checking the cuffs weekly Material is clean and intact Rubber tubes and inflation bulb: no cracks or tears Pressure control valve opens and closes smoothly Pressure control valve

Checking stethoscopes No cracks in tubes Earpieces carefully attached Head of the stethoscope carefully attached to tubes No cracks in the diaphragm No cracks Attachment

Setting up the measurement site Requirements quiet, without disturbance comfortable temperature a comfortable chair for the participant, a desk for the devices and a level to support the participant’s arm Place the device so that you can see the mercury bar clearly the mercury bar is at your eye level the participant cannot see the mercury bar

Exclusion criteria Blood pressure is not measured If a participant has open wounds or sores, casts or severe rash on both arms malformation or amputation of both arms preventing to place the cuff properly severe swelling in both arms (lymph node malfunction) If the participant refuses

Instructions to the participants Before the blood pressure measurement, ask If the participant has abstained for one hour from heavy physical exercise smoking eating drinking (except water) and alcohol use If the participant needs to empty his/her bladder

Position of the participant Ask the participant to sit back supported feet resting firmly on the floor feet not crossed Check that the position does not change during the measurement Back supported Feet resting on the floor, not crossed

Position of the arm Take the measurement from the right arm Arm resting on the desk or arm rest elbow pit (antecubital fossa) at the level of the heart if needed, adjust the chair or use a pillow Palm facing up Help the participant to feel relaxed and comfortable Right arm, resting Palm facing up Level of the heart

Clothing Roll sleeve up, if not constrictive Undress constrictive sleeve

Measurement Ask the participant to sit still for 5 minutes not to talk or move during the measurement Explain that you will take three measurements and tell all results later Measure arm circumference and select the cuff

Select the cuff (1/2) Measure the greatest circumference of the upper arm

Select the cuff (2/2) Bladder length at least 80% of the arm circumference Bladder width at least 40% of the arm circumference

Place the cuff On the right arm about 2-3 cm above the elbow pit (antecubital fossa) Check that the top edge of the cuff is not restricted by clothing Check that the tubes of the cuff are not under the arm or otherwise tied up Check that the cuff is not too tight one finger fits between the cuff and the arm Cuff 2-3 cm above antecubital fossa

Measure pulse rate Palpate the radial pulse and count the pulse rate for 60 seconds Record 60 sec pulse rate and whether the pulse was regular or not

Use of the stethoscope Use the bell of the stethoscope Not touching the cuff, tubes or clothing Use the bell of the stethoscope Check that the bell is not touching any objects Place the bell inside the bicep tendon Inside the bicep tendon

Determine the peak inflation level Palpate the radial pulse Inflate the cuff to the level when the radial pulse disappears plus 30 mmHg

Measure blood pressure (1/3) Wait at least 30 seconds after determining the peak inflation level Locate the brachial pulse Place the bell of the stethoscope below the cuff at the point of maximal pulsation

Measure blood pressure (2/3) Rapidly inflate the cuff to the peak inflation level Deflate at the rate of 2 mmHg per second Determine blood pressure

Systolic bp: Diastolic bp: Korotkoff Phase I The first appearance of a clear repetitive tapping sound Diastolic bp: Korotkoff Phase V The disappearance of the repetitive sounds Image: topnews.in/usa/files/Blood%20Pressure.jpg

Measure blood pressure (3/3) Deflate the cuff rapidly by fully opening the valve of the inflation bulb Wait 1 minute Make the 2nd measurement Make the 3rd measurement

Record Recording form room temperature time of the blood pressure measurement used arm posture during the measurement arm circumference used cuff size pulse for 60 seconds results of the 3 blood pressure measurements all exceptions in the protocol Record the results also in the participant’s feedback form and explain the results to the participant

Acknowledgements Slides prepared by: Hanna Tolonen, Päivikki Koponen Photographs: Hanna Tolonen Measurement demonstrations by Liisa Saarikoski, Ulla Leskinen and voluntary participants Experiences and feedback from the EHES network have been utilized in the preparation of these slides Funding: Preparation of the slides is part of the activities of the EHES Coordinating Centre which has received funding from the EC/DG SANTÉ in 2009-2012 through SANCO/2008/C2/02-SI2.538318 EHES and Grand Agreement number 2009-23-01, and in 2015-2017 through Grand Agreement number 664691/BRIDGE Health

Disclaimer The views expressed here are those of the authors and they do not represent the Commission’s official position.