Method of blood pressure measurement by Korotkoff

According to the WHO recommendations when measuring AP you must follow certain rules:

• Create comfortable conditions for a patient. The patient should be seated on the back of a chair (or lying down), the measurement is conducted at calm state, after 5-minute rest. In the absence of such support, figures obtained during the measurement will be 7/11 mm Hg. above the actual values.

· Patient’s legs should be uncrossed.

· It is desirable to exclude the use of coffee and strong tea (one hour before the test), smoking (within 30 minutes), and use of sympathomimetic (including nasal and eye drops).

· Before measuring the level of AP you must empty the bladder (urinate), since the pressure-filled bladder increases the blood pressure to 15/10 mm Hg.

• During the measurement, do not talk and perform any movement.

· The measurement must be taken on both hands. Subsequently, when the level of the working arterial pressure is selected, shall be carried out on the hand where the figures were higher.

• The cuff should not be short and/or narrow, as this can lead to a substantial increase of numbers of false blood pressure (fig. 51).

Figure 51.

BP measurement rules

The procedure:

· Patient’s hand should be removed from clothes (clothes cannot be rolled up - it causes compression of limbs and arteries!). Put the patient's arm on a stable surface (a table or at the edge of the bed) in a straightened position, palm up and in a relaxed state.

• Place the cuff on the arm, so that the middle cuff should be at about heart level (to exclude the influence of hydrostatic forces), and the bottom should be situated 2.5 cm above the elbow. Density overlay cuff: between the cuff and the surface of the patient’s shoulder must wedge a finger.

• Rubber tubes that connect the cuff to gauge and bulb must be held on the inner side of the forearm. The arrows must be at zero level.

• Detect pulse by palpation in the crook of patient’s elbow.

• Attach the membrane head phonendoscope at the brachial artery pulsation.

• Close the valve of the supercharger (bulb) and rapidly squeeze the pump the air in the cuff until the pulse and some more (on 20-30 mm Hg).

· Open the screw, slowly releasing air from the cuff, listen to and record the moments of appearance and disappearance of Korotkoff sounds

· Remember the figure of the first sound in the scale of the pressure gauge, this is the systolic pressure.

• Let the cuff deflate the air and continue up to the disappearance of the tones. The figure on the scale of a display, the last loud sound is diastolic pressure.

· Let the cuff completely deflate. Make sure that the gauge on zero.

· Sterilize phonendoscope bell with 70% alcohol twice.

· Note AP readings.

Repeated AP measurements takes after the ears the cuff completely deflates to 3-8 times on the same arm, with an interval of several minutes. Until the results start to more or less match, with minimal difference. Reliable result is the average value of the "similar" AP information.

Oscillometric measurement technique (electronic) AP in recent years is becoming increasingly popular (fig. 52).

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Figure 52.

Automatic blood-pressure measuring apparatus

The operating principle is in compression of hit arteries surface of the extremities (e.g. on the wrist) and registration by using tensometric lateral sensors, retransmits on them through the vessel wall. Oscillometric method is used in approximately 80% of all automatic and semi-automatic tonometer, which measure AP. These gauges with LCD display and automatic switch off are widely used by patients for self AP measurement.

The distinctive feature of this device is the cuff design with fixed phonendoscope head that when buckling the Velcro is sure to be the over artery protrudes in the elbow crook. To learn how to measure your blood pressure in the appliance can even a child or an elderly person, and results you can safely trust.

To obtain the most reliable result you need to measure the level of arterial pressure 2-3 times, with an interval between measurements 1-2 minutes. In most cases, the results of the first blood pressure monitor are overestimated because of the squeezing arm by cuff of tonometer is a defensive reaction of the body, which increases blood vessel tonus.

Arterial pressure level varies during the day: usually it is lowest during sleep and in the morning, reaching a maximum peak in hours of daytime activity. The difference between the highest and the lowest values of AP during the day in healthy people, as a rule, does not exceed: for a 30 mm Hg systolic and for diastolic 10-mm Hg.

It is important to know that in patients with arterial hypertension often nightly rates are above the daily AP. Therefore, for examination of such patients is important to daily monitoring ad (BPM - 24-hour blood pressure monitoring), which allow you to specify the time of the medication intake and to ensure full control of the efficiency of the treatment (fig. 53).

The method is based on the recording of blood pressure numbers. The measurement shall be carried out by the special device, which consists of a cuff, mini - compressor, readout and recording device, as well as a block of memory.

The device is fixed to the waist or hung up over his/her shoulder. Put a cuff on patient’s shoulder of "working" hand. The left-handers on the left hand, right-handers - on the right one.

In the protocol, you record installation and powering time of device.

The device is configured to the AP readings registration at intervals of 3, 5, 10 and 15 minutes, which is recorded in the memory unit and measuring time as well.

After the machine is turned on, a man can go and do the usual things.

The next day, the machine removes by staff. Data from a memory unit retrieves in the form of letter-digital record and doctor makes a conclusion.

Figure 53.

Application technique of 24-hour blood pressure monitoring

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