Principles and techniques of blood pressure measurement pdf

Posted on Thursday, April 1, 2021 9:13:41 AM Posted by Liane G. - 01.04.2021 and pdf, pdf free download 5 Comments

principles and techniques of blood pressure measurement pdf

File Name: principles and techniques of blood pressure measurement .zip

Size: 1777Kb

Published: 01.04.2021

Blood pressure measurement

Regret for the inconvenience: we are taking measures to prevent fraudulent form submissions by extractors and page crawlers. Received: April 05, Published: July 18, Citation: Kizilova N. Review of emerging methods and techniques for arterial pressure and flow waves acquisition and analyses. Int J Biosen Bioelectron. Download PDF.

Background: A brief review of the principles and tools for arterial pressure measurements is presented. The methods are based on compression of an artery like brachial, radial, digital or some other arteries, that go back to the pulse diagnostics of oriental medicine, decompression Riva-Rocci method and the first sphygmograph invented by E. Existing tools for the pulse palpation and arterial pressure auscultation are discussed from the point of view of their accuracy and reliability.

Applanation tonometry and light absorption methods and their implantation into the lightweight wearable devices are discussed. Advantages and disadvantages of different methods are formulated. It is shown the direct intra-arterial pressure measurements via a catheter remains the only reliable for anaesthetized, postoperative and patients of the cardiac intensive care unit, and persons with cardiovascular diseases, obesity, faint pulse, arrhythmia and some others.

Despite increased interest in non -invasive pressure monitoring, many commercially available tools have failed to satisfy the AAMI standards. The systems for continuous noninvasive arterial pressure monitoring based on photosensors are reviewed.

Accuracy and reliability of portable units for pulse oxymetry are discussed. The recently developed mobile apps technologies and microchips are promising future technologies for continuous health monitoring based on the multisensory design, though nowadays their accuracy is not satisfactory.

Arterial blood pressure AP is the physical parameter that, together with body temperature, is the most frequently measured parameter in hospitals and at home for medical diagnostics purposes. The principles of the AP measurements are based on the physical mechanisms and techniques that originated in ancient Oriental medicine, then in the medieval times, and have been reinvented and improved in XIX -XX centuries.

During the last decades the tendency to miniaturization, simplification, and automatization of the BP measurement devices with simultaneous rise in their sensitivity and reliability is observed. Both standard clinical and personal mobile techniques have been developed based on the models of a standard healthy human being. Therefore, the problem of sensitivity and reliability of the BP equipment and the physical principles used in them must be revisited and updated to satisfy more groups of patients and healthy individuals.

In this paper a brief historical review of existing methods and physical principles of AP estimation is presented. Modern techniques for noninvasive BP measurements based on palpation Riva-Rocci and auscultation Korotkoff methods, and continuous noninvasive arterial pressure CNAP measurements photoplethysmography PHP and applanation tonometry AT , their benefits and disadvantages are discussed.

The existing Mobile Apps technologies and the results of their testing studies are presented, and the perspectives of their future development are circumscribed. Famous Persian physician Avicenna , brilliant Roman physician Galen — AD and their followers were skillful in pulse diagnostics, among other techniques.

Ancient doctors estimated pulse strength, rate, and rhythm; they could diagnose the general state of the body and 12 internal organs Figure 1. The pulse strength corresponded to the AP, while pulse rate was estimated as number of pulses during one breathing cycle of the doctor.

In brilliant Italian scientist Galileo Galilei discovered the mathematical pendulum and the proportion between its length L and period T of oscillations. According to the biography composed by his student V. Viviani, Galileo used the pendulum with a permanent length for the arterial pulse measurements. He changed the length until the period of oscillations of the pendulum coincided to the frequency of the examined pulse. In that way, Galileo proposed the first quantitative measure of the pulse waves.

He inserted a vertical long fine tube into the incised artery of a horse and measured the height to which the column of blood rose. In that way, the first measurements have been done in cm or, as we could say now, in mm water column. Hales conducted the pressure measurements in different domestic and wild animals, calculated the stroke volume and blood flow velocity in larger arteries and capillaries.

He discovered the blood rose up to 8 feet 3 inches in the femoral artery of a mare, while it was 12 inches only in the femoral vein. The relationships between the AP and blood flow through the vessels have been studied some a hundred years later by famous French physicist Jean Marie Poiseuille.

In during the work over his doctoral thesis "The force of the aortic heart", Poiseuille invented the U-tube mercury manometer 29 and used it to decrease the volume of blood needed to fill in the measuring tube in comparison to the S. Therefore, Poiseuille measured pressures in the arteries of horses and dogs in mm Hg. The modified version of his manometer, named the Poiseuille-Ludwig hemodynamometer, was used in hospitals and medical institutions until the end of s and to this day the AP being measured in mm Hg by the mercury manometer, remains the golden standard for testing the new AP techniques and designs.

Poiseuille used his hemodynamometer in the detailed experiments on the fluid flows through fine tubes including the blood flow through metal, glass and other rigid tubes, and segments of blood vessels. The very first direct measurements of the AP in humans have been carried out in by French physician A. Lately the mercury-filled tube has been also used for indirect AP measurements.

The first non-invasive device called sphygmograph for the AP measurements has been designed in by German physiologist Karl von Vierordt.

In S. Von Bash proposed a compression method for quantitative AP estimations. He compressed the radial artery of human by an inextensible bag connected to the mercury manometer.

He filled in the bag by water until the pulse in the radial artery disappeared. Marey pioneered in long-time continuous measurements and recordings of the physiological signals by using the rotating cylinder drum with a stripe of paper wrapped around it. The ink pen attached via the lever to the counterforce system, left continuous pressure curves on the paper continuously unwrapped by the rotating drum.

In Marey designed a measuring tool, consisted of a rubber sleeve in a rigid cylinder, connected to a mercury manometer by one end and to a pump by another end. When a finger or wrist was inserted into the water-filled sleeve and sealed there by water pumping, weak pressure oscillations in the sleeve have been detected. Similar design is used in the modern AP measuring systems Figure 2B. The next essential improvement of the method was invention by Scipione Riva-Rocci in Italy and Hill and Barnard in England a cuff, which was attached around the upper arm and, being pressurized, occluded the brachial artery Figure 3A.

Riva-Rocci developed the decompression method for the diastolic arterial pressure DAP measurements. As it was shown in by German pathologist Von Recklinghausen, the cuffs used by Riva-Rocci were too narrow that introduced noticeable errors in the AP values.

First, the finger got anemic by an elastic bandage; then the narrow cuff was applied and inflated. Then the bandage was removed and the cuff was slowly deflated.

The cuff pressure at which the finger became flushed, was identified as SAP. Then the distance between the levels of palm and that of the atrium measured in millimeters, gave the venous pressure; thus the vein itself was used as a manometer. Korotkoff who discovered in appearance of sounds murmurs in the collapsed empty artery which he listened by a child stethoscope. Korotkoff carried out a series of AP measurements on animals using a Riva-Rocci sleeve, mercury manometer and child stethoscope for his MD thesis.

According to the Riva-Rocci method, he raised cuff pressure until it stopped the blood flow in the arm; the SAP was indicated by palpating the radial artery pulse. Then he slowly deflated the cuff and listened the radial artery pulse by the stethoscope placed on the arm beyond the cuff. He attributed the first audible signals to the DAP value. Korotkoff reported that the auscultatory method gave the DAP values by 10 mmHg before the pulse could be palpated on the radial artery.

In parallel to the auscultatory method, the oscillometric method of AP measurement has been developed starting from the pioneering work by E. In Erlanger modified the method by using the Riva-Rocci cuff around the upper arm instead of fingers Figure 3B. When the cuff is inflated above SAP, there are no pressure oscillations in the cuff. When during the slow cuff deflation the very first low amplitude oscillations are registered, the SAP is indicated.

During the unit was modified and improved; its validation has been carried out on persons. The measurement data have been compared to mercury sphigmomanometer and direct intra-arterial measurements. Figure 1 Pulse palpation on the radial arteries at the wrist A and six locations for superficial and deep compression of the arteries B. Figure 3 Sphygmomanometer by Riva-Rocci with narrow cuff a and explanation of the oscillometric method by B.

Based on the history of AP measurements and the techniques developed and validated, the following noninvasive methods are nowadays worldwide used for the patient care in hospitals and individually at home:. The golden standards for the new developed devises and approaches are mercury sphygmomanometer and direct invasive intra-vessel pressure measurements by pressure sensors installed into a catheter wire.

The standard Korotkoff auscultatory method is simple and cheap for everyday blood pressure measurements, but Widespread banning the use of mercury sphygmomanometers has led to diminishing the role of the method.

Therefore, the difference in the SAP and DAP measured by different sphygmomanometers can reach mm Hg even in healthy subjects, while in the patients with hypotension, depression, after anesthesia or uptake of some medicines, the difference might be even higher. The auscultatory signals are faint in patients with muscular atrophy and similar impairments. The rate at which AP can be recorded is restricted by the inflation and deflation rates of the cuff.

Consequently, true beat-to-beat continuous blood pressure monitoring is unlikely by means of this method. The Riva -Rocci method is helpful is estimation of the AP in noisy environment as far it is based on palpation technique, but only SAP can be measured and the technique does not give accurate results for infants and hypotensive patients.

There is no consensus whether the patient must be sitting or supine during the examination. The latter is essential for the supine patients with spine problems or after a surgery. In the most guidelines sitting is recommend. Although in most patients the dynamics of inflation of the sphygmomanometer cuff does not itself change the AP, as it was shown by direct 52 and indirect Finapress 53 measurements, the sudden inflation may produce an increase in AP up to 40mmHg in occasional patients.

The wrist cuff based wearable equipment become more popular during the last years due to improvements in the sensitivity of the sensors and novel mathematical approaches for the signal recognition, filtering and analysis.

Some types of the wrist tools are presented in Figure 4. The cuff is supplied by pressure sensors located distally along the radial artery.

When the cuff is pressurized over the SAP value, there are no oscillations of the air pressure in the cuff. During the slow automatic deflation the appearance of the oscillations and their changes in time are measure and analyzed by the software. Applanation tonometry AT is a method of the AP estimation by continuous measurements of changes in fluid volume due to the pulse wave propagation along a superficial artery like the radial artery Figure 5. The membrane directly contacts with the artery pressing it to a rigid surface radial bone.

The fluid volume is determined by electric resistivity of the fluid volume that is measured by electrodes. Before use, the tool must be calibrated on the direct or other indirect AP measurements. For reliability, the arm must be relaxed and the fingers can be fixed by special holders or by the hand of a doctor Figure 5A. The wearable modified AT could be very helpful in for fast and continuous AP measurement in hypertonic and postoperative patients, as well as for monitoring the AP during the physical training in elderly persons.

The method is based on compression of the radial artery by the hemispherical AT sensor Figure 5B and the source of mistakes, especially in the home use, could be in the incorrect determination of the artery location and direction of its compression towards the radial bone which are individual. Due to high importance and demand for easily applicable and accurate CNAP systems, many research groups, practitioners and manufacturers focus on development and validation of such systems.

General principles of blood pressure measurement

Measurement of blood pressure is an important diagnostic and monitoring procedure. Blood pressure measurement is a common diagnostic and monitoring procedure, and accuracy is essential if patients are to receive the appropriate treatment and care in a timely manner. This article, part 1 in a two-part series, discusses principles of blood pressure monitoring and the devices used. Part 2 will describe the procedures for monitoring blood pressure. Citation: Jevon P Blood pressure 1: key principles and types of measuring equipment.

Exploratory Study. METHODS: A questionnaire with 5 questions about practices and behaviors regarding blood pressure measurement and the diagnosis of hypertension was sent to 25, physicians in all Brazilian regions through a mailing list. The responses were compared with the recommendations of a specific consensus and descriptive analysis. The following items were reported: use of an aneroid device by For hypertension diagnosis, The results suggest that, to include the great majority of the medical professionals, disclosure of consensus statements and techniques for blood pressure measurement should go beyond the boundaries of medical events and specialized journals. Blood pressure measurement with the indirect method with the auscultatory technique is the most frequently used procedure in clinical practice for the diagnosis of arterial hypertension and assessment of the efficacy of treatment.


Basic techniques of blood pressure measurement. Location of measurement. The standard location for blood pressure measurement is the brachial artery. The auscultatory method. The oscillometric technique. Ultrasound techniques. The finger cuff method of Penaz.


Blood pressure measurement

This study aimed to quantify blood pressure BP measurement accuracy and variability with different techniques. Ten observers without receiving medical training were asked to determine BPs using a traditional manual auscultatory method and b visual auscultation method by visualizing the Korotkoff sound waveform, which was repeated three times on different days. The measurement error was calculated against the reference answers, and the measurement variability was calculated from the SD of the three repeats.

Regret for the inconvenience: we are taking measures to prevent fraudulent form submissions by extractors and page crawlers. Received: April 05, Published: July 18, Citation: Kizilova N. Review of emerging methods and techniques for arterial pressure and flow waves acquisition and analyses. Int J Biosen Bioelectron.

Either your web browser doesn't support Javascript or it is currently turned off. In the latter case, please turn on Javascript support in your web browser and reload this page. Read article at publisher's site DOI : Br Med J,

General principles of blood pressure measurement

Hales first measured blood pressure in by inserting tubes directly into the arteries of animals. Non-invasive techniques for the measurement of blood pressure have been in existence since the early s, although Riva Rocci, an Italian physician, is credited with developing the first conventional sphygmomanometer in In , Nicolai Korotkoff described various sounds while auscultating over the brachial artery during deflation of a Riva Rocci cuff.

COMMENT 5

  • Unlocking the power of opnet modeler pdf starting your day right joyce meyer pdf free Griselda T. - 02.04.2021 at 17:44
  • Metrics details. Didiane C. - 04.04.2021 at 17:56
  • Kambi kathakal download pdf file brendan mccarthy soup diet book pdf Channing E. - 06.04.2021 at 17:52
  • Literature for composition an introduction to literature 10th edition pdf a survey american history alan brinkley 12th edition pdf Emerio L. - 06.04.2021 at 23:13
  • Arterial blood pressure is most commonly measured via a sphygmomanometer , which historically used the height of a column of mercury to reflect the circulating pressure. Julie B. - 08.04.2021 at 21:17

LEAVE A COMMENT