1. Blood pressure - procudure

2. Equipment – mercury sphygmomanometer
Cuffs
Watch and thermometer
Stethoscope
Measurement tape
Stop watch
Something to elevate the device

3. Equipment – automated device
Watch and thermometer
Measurement tape
Cuffs
Measurement device

4. Exclusion criteria Blood pressure is not measured if a participant has
Both arms amputated
Cast on both arms
Open wounds/sores on both arms
Rash on both arms
Malformation on both arms preventing to place the cuff
Lymph node malfunction in both arms

5. Setting up the measurement site
Room should be
Quiet
Comfortable temperature
No disturbance
Measurement device placement
Measurer has clear view
Participant cannot see the results
If mercury sphygmomanometer is used, mercury column at the eye level of the measurer

6. Instruction to the participants
Before blood pressure measurement, participants should abstain from
Eating
Drinking (except water)
Smoking
Heavy exercise
Taking drugs that affect blood pressure for one hour before the measurement

7. Position of the subject
Back supported
Feet resting on the floor, not crossed

8. Position of the arm Right arm, resting on the desk Palm is facing up
In line with heart

9. Removal of clothing Remove constrictive sleeves
Sleeves rolled up, not constrictive

10. Selection of the cuff The bladder of the cuff should be
Width: At least 40% of the arm circumference
Length: At least 80% of the arm circumference

11. Measurement process Participant is asked to sit still for 5 minutes
Participant is asked not to talk during the measurement
Arm circumference is measured and cuff selected
Cuff is placed 2-3 cm above antecubital fossa

12. By automated device
After the cuff has been placed, follow the instructions of the used device
Measure blood pressure 3 times, one minutes between measurements

13. By mercury sphygmomanometer (1)
The radial pulse is palpatated and the pulse rate is counted for 60 seconds
Record 60 sec pulse count and whether or not the pulse was regular

14. By mercury sphygmomanometer (2)
Determine the peak inflation level
The brachial pulse is located and the bell of the stethoscope is placed
Not touching the cuff, rubber or clothing
Inside the bicep muscle tendon

15. By mercury sphygmomanometer (3)
Inflate the cuff rapidly to the peak inflation level
Deflate at the rate of 2 mmHg/second
Systolic blood pressure: Korotkoff Phase I
Diastolic blood pressure: Korotkoff Phase IV
Record measurement to the nearest 2 mmHg
Wait 1 minute
Repeat measurement two more times

16. Quality assurance – mercury sphygmomanometer
Daily
Shape of the meniscus
Rise of the mercury
Zero level of the mercury
Cracks in the glass tube
Screw at the tops of the calibrated glass tube
Air tube for cracks and tears
Weekly
Cuffs
Material
Condition
Stethoscopes
Device
Air leaks

17. Quality assurance –automated device
Daily
AC adapter cord of the device is securely plugged in or
Batteries have power
Air tubes for cracks and tears
Secure attachment of the tubes
Weekly
Under consideration