Blood pressure measurement Automated 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 Watch and thermometer Measurement device Cuffs Measurement tape Cuffs Measurement device

Checking the device daily AC adapter cord of the device carefully plugged in or battery power Check model specific instructions Rubber tubes not cracked and have no tears All tubes carefully attached Cuffs clean and intact

Checking the cuffs weekly Material is clean and intact Rubber tubes no cracks or tears

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 screen of the device clearly the participant cannot see the screen of the device

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 sleeves up, if not constrictive Undress constrictive sleeve

Measurement Ask the participant to sit still for 5 minutes not to talk or move during the measurements 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 (actecubital 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 Check device specific instructions 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

Measure blood pressure Follow instructions of the automated device Take the measurement 3 times, one minute between measurements

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: Hanna Tolonen, Päivikki Koponen Photographs: Hanna Tolonen Measurement demonstrations: Sanna Ahonen, Shadia Rask 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.