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