1. Blood pressure measurement using mercury sphygmomanometers and other auscultation based devices

2. Based on EHES Manual, Part B. Fieldwork Procedures, 2nd edition (2016)
Available at:
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.

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. Clothing Roll sleeve up, if not constrictive
Undress constrictive sleeve

14. 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

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

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

17. 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

18. 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

19. 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

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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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 through SANCO/2008/C2/02-SI EHES and Grand Agreement number , and in through Grand Agreement number /BRIDGE Health

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