UNIT-IV

MEASUREMENTS OF NON-ELECTRICAL PARAMETERS

MEASUREMENTS OF TEMPERATURE:
• Temperature measurement (also known as thermometry) describes the process of
measuring a current local temperature for immediate or later evaluation. Datasets
consisting of repeated standardized measurements can be used to assess temperature
trends.
• Many methods have been developed for measuring temperature. Most of these rely on
measuring some physical property of a working material that varies with temperature.
One of the most common devices for measuring temperature is the glass thermometer.
• This consists of a glass tube filled with mercury or some other liquid, which acts as the
working fluid. Temperature increase causes the fluid to expand, so the temperature can
be determined by measuring the volume of the fluid.
• Such thermometers are usually calibrated so that one can read the temperature simply
by observing the level of the fluid in the thermometer.
• Another type of thermometer that is not really used much in practice, but is important
from a theoretical standpoint, is the gas thermometer.
Other important devices for measuring temperature include:

• Thermocouples
• Thermistors
• Resistance temperature detector (RTD)
• Pyrometer
• Langmuir probes (for electron temperature of a plasma)
• Infrared thermometer
• Other thermometers

MEASUREMENTS OF RESPIRATION RATE:

• The respiration rate is the number of breaths a person takes per minute. The rate is
usually measured when a person is at rest and simply involves counting the number of
breaths for one minute by counting how many times the chest rises.
• Respiration rates may increase with fever, illness, and other medical conditions. When
checking respiration, it is important to also note whether a person has any difficulty
breathing.
• Normal respiration rates for an adult person at rest range from 12 to 16 breaths per
minute.
INDIRECT METHODS OF MEASUREMENTS OF BLOOD PRESSURE:
AUSCULTATORY TECHNIQUE:
• The “differential auscultatory technique” is a non-invasive method for accurately
measuring blood pressure.
• A special cuff-mounted sensor consisting of a pair of pressure sensitive elements,
isolates the signal created each time the artery is forced open. Figure 6.28 illustrates
how high frequency pulses are created each time, the intra-arterial pressure exceeds the
cuff pressure. As long as the cuff pressure exceeds the pressure in the artery, the artery
is held closed, and no pulse is generated.
• However, as soon as the intra-arterial pressure rises to a value, which momentarily
exceeds the cuff pressure, the artery “snaps” open; and a pulse is created.
• Once the artery is open, blood flows through it giving rise to the low frequency pressure
wave signal, which lasts until the arterial pressure again drops below the cuff pressure.
• This process is repeated until the cuff pressure drops to a value below the diastolic.
Figure 6.29 is a cut away view of an arm with a cuff partially occluding the brachial
artery. Each time the artery opens, the signal.
• Note that this signal consists of a slowly rising, low frequency component (in the
frequency range of 0.5–5 Hz) with a fast “pulse” (frequencies approximately 10–80 Hz)
superimposed on it. This signal is denoted by the arrows marked A transmitted from
the artery to both the sensor and the air bag in the cuff.
• The systolic pressure is determined as the pressure at which the first opening of the
artery occurs, as shown by the first pulse in Fig. 6.30(c), because this pulse is created
the first time the artery is forced open by intra-arterial pressure. Similarly, diastolic
value is determined as the pressure at which the differential signal essentially
disappears, because this corresponds to the last time the artery is forced open. The
differential sensor subtracts the side “B” signal from the side “A” signal, thereby
cancelling out the pressure wave component and the motion artefact signals, and the
higher frequency Korotkoff signals are isolated.

OSCILLOMETRIC METHOD:
• The automated oscillometric method of non-invasive blood pressure measurement has
distinct advantages over the auscultatory method. Since 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.
• In addition, because this technique 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 in accuracy even when the
cuff is placed over a light shirt sleeve.
• The appropriate size cuff can be used on the forearm, thigh, or calf as well as in the
traditional location of the upper arm.
• A disadvantage of the oscillometric method, as well as the auscultatory method, is that
excessive movement or vibration during the measurement can cause inaccurate
readings or failure to obtain any reading at all.
• The oscillometric technique operates on the principle that as an occluding cuff deflates
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 oscillometric method is based on oscillometric pulses (pressure pulses) generated

in the cuff during inflation or deflation.
• Blood pressure values are usually determined by the application of mathematical
criteria to the locus or envelope formed by plotting a certain characteristic, called the
oscillometric pulse index, of the oscillometric pulses against the baseline cuff pressure
(Fig. 6.32).
• The baseline-to-peak amplitude, peak-to-peak amplitude, or a quantity based on the
partial or full time-integral of the oscillometric pulse can be used as the oscillometric
pulse index. The baseline cuff pressure at which the envelope peaks (maximum height)
is generally regarded as the MAP (mean arterial pressure).
ELECTRONIC MANOMETER:
• A sphygmomanometer, also known as a blood pressure monitor, or blood pressure
gauge, is a device used to measure blood pressure, composed of an inflatable cuff to
collapse and then release the artery under the cuff in a controlled manner, and
a mercury or aneroid manometer to measure the pressure.
• Manual sphygmomanometers are used with a stethoscope when using the auscultatory
technique.
• It is intended to act as a replacement gauge for the mercury and aneroid manometers
used in conventional sphygmomanometers.
• It measures pressure in the range 0-300 mm Hg (0-40 kPa) with a resolution of 1 mm
Hg (0.13 kPa) and an accuracy of +/- 1 mm Hg (+/- 0.13 kPa) which is displayed on a
liquid crystal display. It operates from a 9 V PP3 battery over a temperature range of
10-50 degrees C.
• A sphygmomanometer consists of an inflatable cuff, a measuring unit (the mercury
manometer, or aneroid gauge), and a mechanism for inflation which may be a manually
operated bulb and valve or a pump operated electrically.
• A stethoscope is required for auscultation. Manual meters are best used by trained
practitioners, and, while it is possible to obtain a basic reading through palpation alone,
this yields only the systolic pressure.

• Mercury sphygmomanometers are considered the gold standard. They indicate pressure
with a column of mercury, which does not require recalibration.[2] Because of their
accuracy, they are often used in clinical trials of drugs and in clinical evaluations of
high-risk patients, including pregnant women.
• Measurement of blood pressure by the direct method, though an invasive technique,
gives not only the systolic, diastolic and mean pressures, but also a visualization of the
pulse contour and such information as stroke volume, duration of systole, ejection time
and other variables. Once an arterial catheter is in place, it is also convenient for
drawing blood samples to determine the cardiac output (by dye dilution curve method),
blood gases and other chemistries. Problems of catheter insertion have largely been
 eliminated and complications have been minimized. This has been due to the
development of a simple percutaneous cannulation technique; a continuous flush
system that causes minimal signal distortion and simple, stable electronics which the
paramedical staff can easily operate.

PRESSURE AMPLIFIERS:

• Air pressure amplifiers are also known as air boosters and air intensifiers and are used
for increasing or boosting existing plant air pressures.
• Each pressure amplifier comprises a spool valve that acts as a 4-way directional control
valve. The single acting compressed air boosters displace air once per full cycle.
• Regular plant air, normally at a range of 80 psig to 100 psig (5.5 bar to 6 bar) is supplied
to this spool valve, which automatically cycles back and forth.
 • The plant air fed into the spool valve is alternately directed, as the spool cycles to a
main air drive piston in the air drive cylinder. This makes the piston cycle back and
forth in the pressure multiplier.compressed air boosters displace air once per full
cycle.

SYSTOLIC AND DIASTOLIC MEASUREMENT:

• For a normal reading, your blood pressure needs to show a top number (systolic
pressure) that’s between 90 and less than 120 and a bottom number (diastolic pressure)
that’s between 60 and less than 80.
• Blood pressure readings are expressed in millimeters of mercury. This unit is
abbreviated as mm Hg. A normal reading would be any blood pressure below 120/80
mm Hg and above 90/60 mm Hg in an adult.

Numbers higher than 120/80 mm Hg are a red flag that you need to take on heart-healthy habits.

When your systolic pressure is between 120- and 129-mm Hg and your diastolic pressure is
less than 80 mm Hg, it means you have elevated blood pressure.

Although these numbers aren’t technically considered high blood pressure, you’ve moved out
of the normal range. Elevated blood pressure has a good chance of turning into actual high
blood pressure, which puts you at an increased risk of heart disease and stroke.

No medications are necessary for elevated blood pressure. But this is when you should adopt
healthier lifestyle choices. A balanced diet and regular exercise can help lower your blood
pressure to a healthy range and help prevent elevated blood pressure from developing into full-
fledged hypertension.

LOW BLOOD PRESSURE

Low blood pressure is known as hypotension. In adults, a blood pressure reading of 90/60 mm
Hg or below is often considered hypotension. This can be dangerous because blood pressure
that is too low doesn’t supply your body and heart with enough oxygenated blood.

CARDIAC OUTPUT:

Cardiac output (CO), also known as heart output denoted by the symbols or is a term used
in cardiac physiology that describes the volume of blood being pumped by the heart, by the left
and right ventricle, per unit time. Cardiac output (CO) is the product of the heart rate (HR), i.e.
the number of heartbeats per minute (bpm), and the stroke volume (SV), which is the volume
of blood pumped from the ventricle per beat; thus, CO = HR × SV. Values for cardiac output
are usually denoted as L/min. For a healthy person weighing 70 kg, the cardiac output at rest
averages about 5 L/min; assuming a heart rate of 70 beats/min, the stroke volume would be
approximately 70 ml.
Because cardiac output is related to the quantity of blood delivered to various parts of the body,
it is an important component of how efficiently the heart can meet the body's demands for the
maintenance of adequate tissue perfusion. Body tissues require continuous oxygen delivery
which requires the sustained transport of oxygen to the tissues by the systemic circulation of
oxygenated blood at an adequate pressure from the left ventricle of the heart via the aorta and
arteries.

INDICATOR DILUTION:
• Indicator dilution principle states that if we introduce into or remove from a stream of
fluid a known amount of indicator and measure the concentration difference upstream
and downstream of the injection (or withdrawal) site, we can estimate the volume flow
of the fluid.
• The method employs several different types of indicators. Two methods are generally
employed for introducing the indicator in the blood stream, viz: it may be injected at a
constant rate or as a bolus.
• The method of continuous infusion suffers from the disadvantage that most indicators
recirculate, and this prevents a maxima from being achieved.
• After passing through the right heart, lungs and the left heart, the indicator appears in
the arterial circulation.
• The presence of an indicator in the peripheral artery is detected by a suitable
(photoelectric) transducer and is displayed on a chart recorder. This way we get the
cardiac output curve. This is also called the dilution curve.

• The run of the dilution curve is self-explanatory. During the first circulation period, the
indicator would mix up with the blood and will dilute just a bit. When passing before
the transducer, it would reveal a big and rapid change of concentration.
• This is shown by the rising portion of the dilution curve. Had the circulation system
been an open one, the maximum concentration would have been followed by an
exponentially decreasing portion so as to cut the time axis as shown by the dotted line.
• The circulation system being a closed one, a fraction of the injected indicator would
once again pass through the heart and enter the arterial circulation.
• A second peak would then appear. When the indicator is completely mixed up with
blood, the curve becomes parallel with the time axis. The amplitude of this portion
depends upon the quantity of the injected indicator and on the total quantity of the
circulating blood.
For calculating the cardiac output from the dilution curve, assume that
M = quantity of the injected indicator in mg

Q = cardiac output

THERMAL DILUTION TECHNIQUE:

• A thermal indicator of known volume introduced into either the right or left atrium will
produce a resultant temperature change in the pulmonary artery or in the aorta
respectively, the integral of which is inversely proportional to the cardiac output.

• Although first reported by Fegler (1954), thermal dilution as a technique did not gain
clinical acceptance until Branthwaite and Bradley (1968) published their work showing
a good correlation between Fick and thermal measurement of cardiac output in man.
• However, the technique of cannulation of the internal jugular vein and the difficulty of
floating small catheters into the pulmonary artery prevented a rapid clinical acceptance
of the technique.
• In 1972, a report appeared in the American Heart Journal describing a multi-lumen
thermistor catheter, known today as the Swan-Ganz triple lumen balloon catheter (Ganz
and Swan, 1972).
• The balloon, located at or near the tip, is inflated during catheter insertion to carry the
tip through the heart and into the pulmonary artery. One lumen terminates at the tip and
is used to measure the pressure during catheter insertion.
• Later, it measures pulmonary artery pressure and intermittently, pulmonary–capillary
wedge pressure. A second lumen typically terminates in the right atrium and is used to
the monitor right atrial pressure (central venous pressure) and to inject the cold
solutions for thermal dilution.
• The thermistor is encapsulated in glass and coated with epoxy to insulate it electrically
from the blood.
• The wires connecting the thermistor are contained in a fourth lumen. This catheter
simplified the technique of cardiac cannulation making it feasible to do measurements
not only in the catheterization laboratory but also in the coronary care unit. The
acceptance of the thermal dilution technique over the past few years can only be
attributed to the development of this catheter.
 THERMAL DILUTION TECHNIQUE

ELECTROMAGNETIC BLOOD FLOW METERS

Electromagnetic Blood Flow Meters
• Measures instantaneous pulsatile flow of blood
• Works based on the principle of electromagnetic induction
• The voltage induced in a conductor moving in a magnetic field is proportional to the velocity
of the conductor
• The conductive blood is the moving conductor
PRINCIPLE OF ELECTROMAGNETIC BLOOD FLOW METERS:
• A permanent magnet or electromagnet positioned around the blood vessel generates a
magnetic field perpendicular to the direction of the flow of the blood. • Voltage induced in the
moving blood column is measured with stationary electrodes located on opposite sides of the
blood vessel and perpendicular to the direction of the magnetic field.

Principle of Electromagnetic Blood Flow Meters • The Induced emf • Where • B = magnetic
flux density, T • L = length between electrodes, m • u = instantaneous velocity of blood, m/s

Principle of Electromagnetic Blood Flow Meters • This method requires that the blood vessel
be exposed so that the flow head or the measuring probe can be put across it.