View
213
Download
0
Category
Preview:
Citation preview
Blood Pressure Training
Kidney Disease Screening and Awareness Program (KDSAP)
Susan Cheung, MD, MS
Renal Division, Department of Medicine,
Harvard Medical School, Harvard University
Objectives
By the end of this session, you will learn and
demonstrate adequate techniques to measure
blood pressure correctly
What is blood pressure (BP)?
• BP is the force of blood pushing
against the walls of arteries.
• BP is expressed as two numbers:
systolic/diastolic BP.
• Systolic BP: the pressure in the
blood vessel when the heart
beats
• Diastolic BP: the pressure in the
blood vessel when the heart is at
rest between beats
• Currently used in the Clinical setting:
– Normal BP: < 130/80 mmHg
• According to AHA ( American Heart Association):
Definition of Hypertension
Complications of Persistent High
Blood Pressure
• Hypertensive Heart Disease:
(Left ventricular hypertrophy and cardiomegaly)
Stethoscope Anatomy
1. Check the
tubing for holes
2. Clean any wax
from the ear tips
3. Point earpieces
forward when
ready to use
Choosing the right size cuff1. Use the “bladder” of a blood pressure
cuff
2. Measure the circumference of the arm
80%
40%
Distance around the arm Blood pressure cuff size
7 to 9 inches Small adult cuff
9 to 13 inches Standard adult cuff
13 to 17 inches Large adult cuff
Check:
1. Screw valve
2. Air leak
• You are indirectly measuring the pressure in the blood vessel
• When the pressure in that bladder exceeds the pressure of the artery, the artery is compressed and distal blood flow diminishes, then stops
• As you release the air in the cuff, the bladder deflates and cuff pressure falls
• Pressure in cuff reaches the pressure generated by the heart during contraction, blood begins to flow through the artery again
Mechanics Behind Measuring BP
• Blood flow produces
Korotkoff's sounds: these
sounds vary through 5 different
phases
• The cause of these sounds is still
debated: may be caused by
blood jetting through the partly
occluded vessel. The jetting
causes turbulence in the open
vessel beyond the cuff
Mechanics Behind Measuring BP
Korotkoff’s Sounds
• According to the American Heart Association,
Korotkoff's sounds occur in five phases:
• Check your equipment before you start
• Check the environment
– Make sure the environment is quiet and without disturbance
• Check your patient
– Make sure your patient is relaxed, if needed, have him sit or lie
down for 5 minutes.
– Ask your patient not to talk during measurement
– Remove all clothing from forearm
– Support your patient’s arm at heart level
– Ask about cigarettes, alcohol and caffeine intake in the last 15
minutes which may affect BP readings
• Check yourself
– Make sure the manometer is in your direct line of sight
– Make sure you are relaxed
– Keep your eyes not only on your equipment but also your
patients
– Deflate the cuff slowly, 2-3mmHg per sec, listen carefully for
the Korotkoff’s sounds
Accurate BP measurements
• Step 1: Always introduce yourself! And put the patient at ease.
• Step 2: Appropriately expose and position patient's arm at heart level on table or
cradle
• Step 3: Select the right size cuff
• Step 4: Place cuff appropriately around patient’s arm and make sure manometer is
readily in sight and feel for brachial/radial artery:
Look! Look! Look!
• Step 5: Estimate systolic blood pressure by inflating the cuff and palpating the
brachial/radial artery
Look! and Feel!
• Step 6: Proper placement of cuff and place stethoscope over brachial artery and make
sure all equipment is appropriately positioned.
Look! Look! Look!
• Step 7: Deflate cuff and take systolic blood pressure (Korotkoff phase 1)
and diastolic blood pressure (Korotkoff phase 5)
Look and Listen!
• Step 9: Remove equipment as appropriate and address the patient
Protocol for BP Measurement
Recommended