Blood pressure measurement

using mercury sphygmomanometers

EHES Training Material

Exclusion criteriaBlood pressure is not measured • If a participant has

• open wounds/sores on both arms• severe rash on both arms• both arms amputated• cast on both arms • malformation on both arms preventing to place

the cuff• lymph node malfunction in both arms

• If the participant refuses

Instruction to the participants

Before blood pressure measurement, ask • if the participant has abstained from recently

• eating• drinking (except water)• smoking• heavy exercise• alcohol use

• If the participant needs to empty bladder

Equipment

Sphygmomanometer

Cuffs

Watch and thermometer

Stethoscope Measurement tape

Stop watchSomething to elevate the device

Setting up the measurement site

• The room should be• quiet• comfortable temperature• no disturbance

• Place the device so that• you can see the mercury

bar clearly • the participant cannot see

the mercury bar• the mercury bar is at your

eye level

Position of the subject

• Participant is sitting• back supported • feet resting firmly on

the floor• feet not crossed

• Check that the position of the participant does not change during the measurement Feet resting

on the floor, not crossed

Back supported

Position of the arm• Take the measurement

from the right arm• Arm resting on the desk

or arm rest• antecubital fossa at the

level of the heart• if needed, adjust the

chair or use a pillow to elevate the arm

• Palm facing up

Right arm, resting on the deskPalm facing

up

In line with the heart

ClothingRoll sleeves up, if not constrictive

Undress constrictive sleeves

Measurement process• Ask the participant

• to sit still for 5 minutes • not to talk or move

during the measurement

• Explain that you will tell the measurement results after all 3 measurements are taken

• Measure arm circumference and select cuff

Selection of the cuff• Measure the greatest

circumference of the upper arm

• The bladder of the cuff should be• width: At least 40%

of the arm circumference

• length: At least 80% of the arm circumference

Placement of the cuff• Place the cuff on right

arm about 2-3 cm above the antecubital fossa

• Check that the top edge of the cuff is not restricted by clothing

• Check that the cuff is not too tide• one finger fits between

the cuff and the arm

Cuff 2-3 cm above antecubital fossa

Measurement of pulse rate • Palpate the radial

pulse and count the pulse rate for 60 seconds

• Record 60 sec pulse count and whether or not the pulse was regular

Use of the stethoscope

• Use the bell of the stethoscope

• Check that the bell is not touching the cuff, rubber or clothing

• Place inside the bicep muscle tendon

Inside the bicep muscle tendon

Not touching the cuff, rubber or clothing

Determination of the peak inflation level

• Palpate the radial pulse

• Inflate the cuff to the level when the radial pulse disappears plus 30 mmHg

Measurement of blood pressure (1/3)

• Wait at least 30 seconds after the determination of the peak inflation level

• Locate the brachial pulse

• Place the stethoscope immediately below the cuff at the point of maximal pulsation

Measurement of blood pressure (2/3)

• Rapidly inflate the cuff to the peak inflation level

• Deflate at the rate of 2 mmHg per second

• Determine blood pressure

• Systolic bp:• Korotkoff Phase I• The first appearance

of a clear repetitive tapping sound

• Diastolic bp:• Korotkoff Phase V• The disappearance

of the repetitive sounds

Measurement of blood pressure (3/3)

• Deflate the cuff rapidly by fully opening the valve of the inflation bulb

• Wait 1 minute• Make the 2nd

measurement• Wait 1 minute• Make the 3rd

measurement

Recording of the results• Record

• room temperature• time of the blood

pressure measurement• pulse for 60 seconds• results of the 3 blood

pressure measurements• all exceptions

• Record the results in the participant’s feedback form and explain the results to the participant

Acknowledgements• Slides

• Hanna Tolonen, Päivikki Koponen• Photographs

• Hanna Tolonen• Measurement demonstrations

• Liisa Saarikoski, Marika Strand, Anne Söderqvist, Kari Kuulasmaa, Ari Haukijärvi, Shadia Rask, Katri Kilpeläinen, Vesa Tanskanen, Ulla Leskinen, Marja Lampola