BLOOD PRESSURE MEASUREMENT

Ms. Divya Jenifar P

AP - BME
BLOOD PRESSURE
Blood pressure (BP) is the pressure (force per unit area) exerted by
circulating blood on the walls of blood vessels
The pressure of the circulating blood decreases as it moves away from
the heart through arteries and capillaries, and toward the heart through
veins
Blood Pressure is a measurement of the force against the walls of the
arteries as the heart pumps blood throughout the body
Blood pressure is measured in mmHg (millimeters of mercury)
Blood is pumped by the left side of the heart into the aorta, which
supplies it to the arterial circuit.
The right side of the heart pumps it to the pulmonary circuit, which
operates at a lower pressure
For each heartbeat, blood pressure varies between systolic and diastolic
pressures
SYSTOLIC AND DIASTOLIC PRESSURE
The systolic pressure is the maximum pressure in an artery at the
moment when the heart is beating and pumping blood through the
body.
The diastolic pressure is the lowest pressure in an artery in the
moments between beats when the heart is resting.
Both the systolic and diastolic pressure measurements are
important
If either one is raised, it means you have high blood pressure
(hypertension).
Pulse pressure is the difference between systolic and diastolic
pressure
Systolic and diastolic arterial blood pressures are not static but
undergo natural variations
They also change in response to stress, nutritional factors, drugs,
disease, exercise, and momentarily from standing up.
Hypertension refers to arterial pressure being abnormally high, as
opposed to hypotension, when it is abnormally low
A normal blood pressure would be recorded as 120/80 mm Hg.
The nominal values in the basic circulatory system
Arterial system-------30-300mmHg
Venous system--------5-15mmHg
Pulmonary system----6-25mmHg
BLOOD PRESSURE MEASUREMENT METHODS
Blood pressure measurement can be classified in to
1. Indirect
Auscultatory method
Oscillometric method
Ultrasonic method
2. Direct
The catheterization method involving the placement of the transducer
through a catheter at the actual site of measurement in the blood stream
or by mounting the transducer on the tip of the catheter.
Percutaneous methods in which the blood pressure is sensed in the
vessel just under the skin by the use of a needle or catheter.
Implantation techniques in which the transducer is more Permanently
placed in the blood vessel or the heart by surgical methods.
AUSCULTATORY METHOD (AUDITORY METHOD)
(BLOOD PRESSURE MEASUREMENTS USING SPHYGMOMANOMETER)

Auscultatory method uses aneroid sphygmomanometer with a

stethoscope.
The auscultatory method comes from the Latin word “listening”
Indirect method of measuring blood pressure involves the use of a
sphygmomanometer and a stethoscope.
The sphygmomanometer consists of an inflatable pressure cuff and
a mercury or aneroid manometer to measure the pressure in the
cuff.
The cuff consists of a rubber bladder inside an inelastic fabric
covering that can be wrapped around the upper arm and fastened
with either hooks or a Velcro fastener
The cuff is normally inflated manually with a rubber bulb and deflated
slowly through a needle valve
First, a cuff is placed around your arm and inflated with a pump until the
circulation is cut off.
The pressure in the cuff is then gradually reduced.
As soon as cuff pressure falls below systolic pressure, turbulence is
generated in the blood as it spurts through the tiny arterial opening.
The sounds generated by this turbulence, Korotkoff sound can be heard
through a stethoscope placed over the artery downstream from the cuff
The pressure of the cuff that is indicated on the manometer when the first
Korotkoff sound is heard is recorded as the systolic blood pressure
As the pressure in the cuff continues to drop, the Korotkoff sounds
continue until the cuff pressure is no longer sufficient to occlude the vessel
during any part of the cycle.
Below this pressure the Korotkoff sounds disappear, marking the value of
the diastolic pressure.
ADVANTAGES
Auscultatory technique is simple and does not require much
equipment.
DISADVANTAGES
Auscultatory technique cannot be used in noisy environment
The observations differ from observer to another
A mechanical error might be introduced into the system e.g. mercury
leakage, air leakage, obstruction in the cuff etc.
The observations do not always correspond with intra-arterial
pressure
The technique does not give accurate results for infants and
hypotensive patients
OSCILLOMETRIC MEASUREMENT METHOD
The oscillometric technique operates on the principle that as an
occluding cuff deflate from a level above the systolic pressure, the
artery walls begin to vibrate or oscillate as the blood flows
turbulently through the partially occluded artery and these
vibrations will be sensed in the transducer system monitoring cuff
pressure.
As the pressure in the cuff further decrease, the oscillations
increase to a maximum amplitude and then decrease until the cuff
fully deflates and blood flow returns to normal.
The cuff pressure at the point of maximum oscillations usually
corresponds to the mean arterial pressure.
The point at which the oscillations begin to rapidly increase in
amplitude correlates with the systolic pressure
Advantages
Sound is not used to measure blood pressure in the oscillometric
technique, high environmental noise levels such as those found in a
busy clinical or emergency room do not hamper the measurement
It does not require a microphone or transducer in the cuff, placement
of the cuff is not as critical as it is with the auscultatory or Doppler
methods.
The oscillometric method works without a significant loss
Accurate even when the cuff is placed over a light shirt sleeve.
Disadvantages
Excessive movement or vibration during the measurement can cause
inaccurate readings or failure to obtain any reading at all.
ULTRASONIC DOPPLER SHIFT METHOD
PRINCIPLE OF OPERATION
It is based on the Doppler phenomenon: The frequency of sound
waves varies depending on the speed of the sound transmitted in
relation to the sound receiver.
The Doppler apparatus consists basically of an ultrasound
oscillator and transducer which transmits and receives the
generated ultrasound.
If the ultrasound strikes an immobile structure such as the
compressed arterial wall, the ultrasound frequency is reflected
back unchanged.
If a moving structure (pulsating artery) is encountered, however,
the frequency is altered up or down (Doppler effect) and this is
detectable by an audible alteration of the reflected sound.
PERCUTANEOUS INSERTION (DIRECT METHOD)
Typically, for percutaneous insertion, a local anesthetic is injected near
the site of invasion.
The vessel is occluded and a hollow needle is inserted at a slight angle
towards the vessel.
When the needle is in place, a catheter is fed through the hollow needle,
usually with some sort of a guide.
When the catheter is securely place in the vessel, the needle and guide
are withdrawn
For some measurements, a type of needle attached to an airtight tube is
used, so that the needle can be left in the vessel and the blood pressure
sensed directly by attaching a transducer to the tube.
Other types have the transducer built in-the tip of the catheter.
This latter type is used in both percutaneous and catheterization
models.
CATHETERIZATION ( DIRECT METHOD)
Catheter is a long tube that is inserted in to the heart or major
vessels.
Sterilized catheters are used
Apart from obtaining blood pressures in the heart chamber and
great vessels, this technique is also used to obtain blood samples
from the heart for oxygen-content analysis and to detect the
location of abnormal blood flow pathways.
Measurement of blood pressure with a catheter can be achieved in
two ways.
1. Extra vascular pressure sensor
2. Intra vascular pressure sensor
EXTRA VASCULAR PRESSURE SENSOR
The catheter inserted to the human body by surgical cut down or
percutaneous insertion.
Blood pressure information transmitted via catheter fluid to the
sensor diaphragm.
A thin flexible metal diaphragm is stretched across the opening of
the transducer top.
Diaphragm is connected to an inductive bridge or Wheatstone
bridge strain gauge.
The strain gauge will move an amount which is proportional to the
applied pressure
INTRA VASCULAR PRESSURE SENSOR
Fibre bundle is connected to a light-emitting diode (LED) source
and to a photo detector.
The pressure sensor tip consists of a thin metal membrane
mounted at the common end of the mixed fibre bundle.
External pressure causes membrane deflection, varying the
coupling between the LED source and the photo detector.
It measures displacement of diaphragm optically by varying
reflection of light.
The size of the device is comparable to strain gauge and a lower
cost.
They have the advantage of keeping the transducer fixed in place
in the appropriate vessel for long periods of time.
To implant a transducer in an artery, a longitudinal incision is
made, the transducer is inserted with its housing in intimate
contact with the arterial walls.
The wound is closed with interrupted sutures.