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Blood Pressure Measurement

Direct method:
Involves directly inserting a tube or catheter into a
blood vessel. The catheter is connected to a blood
pressure transducer, which generates an electrical
signal.

Indirect method:
Palpatory method: uses the sense of touch.
Auscultatory method: uses the sense of hearing.

Indirect Method of BP Measurement
Sphygmomanometer (BP cuff)
An instrument that measures pressure, is
needed in both methods.
Pneumatic cuff consist of:
Cuff: a rubber bag usually the adult size 13 by 23
cm.
Inflator: rubber bulb with two valves that let the
air move in one direction.
Pressure indicator: Hg manometer.


Systolic pressure:
The maximum pressure
in an artery during
ventricular contraction.

Diastolic pressure:
The lowest pressure in
an artery during ventricular
relaxation.

Systolic pressure could
be measured by two
methods:
Palpatory method
(measure systolic
pressure only)
Auscultatory
method ( measure
both systolic and
diastolic pressure)

Diastolic pressure could
be measured by two
methods:
Auscultatory
method
(measures both
systolic and
diastolic pressure)
Observation of
maximum
oscillation
(measure diastolic
pressure only)

Palpatory Method
Observer palpate radial
artery and inflate the cuff
until radial pulsation no
longer perceptible.
Pressure is then reduced
slowly until pulsation again
appear.
Manometer reading is
taken as systolic pressure.

Explanation
The cuff pressure constriction of the
artery is opposed by the blood
pressure.
Therefore, in order to completely
constrict the artery, the cuff pressure
must be
greater than the highest blood pressure,
the systolic pressure.

The cuff pressure is gradually decreased.
At the point where the cuff pressure drops
below the systolic pressure of the blood,
blood can pass through the constricted
opening of the artery and the pulse
will be felt. In other words, the systolic
pressure, the highest blood pressure
will be the point at which the cuff pressure is
first overcome.
The pulse will continue to be felt as the
pressure in the cuff falls from systolic all the
way down to zero.

Auscultatory method

Put the head of the stethoscope just under the edge of
the cuff a little above the crease of the persons elbow.
Hold it there firmly with your right hand.
Put the ear pieces of the stethoscope in your ears.
Inflate the cuff the cuff with brisk squeezes of the bulb.
Watch the pressure manometer as you do it.
For most adult people, you shouldnt need to go over 180
mmHg.
At 180 mmHg, slightly open the valve on the air pump.
Now pay attention very carefully to what you hear
through the stethoscope as the mercury column falls.

The first time you hear the sound, note what the
reading was on the pressure manometer. This value
represents the systolic blood pressure.

The sounds should continue and become louder in
intensity.

Note the pressure reading when you hear the
sound for the last time, or when the sound
disappears. This value represent the diastolic blood
pressure.

Afterward, open the air valve completely to release
any remaining pressure.

Automated Indirect Method
In this method the device uses a pressure transducer
connected to sphygmomanometer cuff, a microphone
placed beneath the cuff(over the artery) and a
standard physiological recording system on which cuff
pressure and Korotkoff sounds are recorded.

The pressure cuff is automatically inflated to about 220
mm Hg and allowed to deflate slowly.

The microphone picks up the Korotkoff sounds from
the artery near the surface , just bellow the
compression cuff.
The most electrical monitors now provide
both diagnostic Systolic/Diastolic waveform
information and added option of a single
value Mean arterial Pressure indication.
MAP = [Systolic Diastolic] + Diastolic.
Average blood pressure is:
120 / 80
The first sounds that are heard indicate
systolic pressure (top number).
When the sounds stop, diastolic pressure has
been reached (bottom number).

Direct Method of BP Measurement
Direct measurement of Blood Pressure is usually
obtained by one of three methods:
Percutaneous insertion
Catheterization (Vessel cut down)
Implantation of a transducer in a vessel or in
the heart.


Percutaneous Insertion

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