Lecture #3 - Blood Pressure Recording Procedure CKiD Blood Pressure Training Equipment Mabis Medic-Kit aneroid sphygmomanometer Mabis Medic-Kit assortment of cuff sizes Stethoscope with bell (pediatric head preferred) Table at heart level to support arm Accusplit Stopwatch (provided in CKiD starter package) Disposable tape measure (provided in CKiD starter package) Ball point pen Physical Exam (PE) form 1
Arm Measurement Right arm should be used unless there is a medical reason not tto use it. Indicate on form if left arm is used Participant in a standing poistion holding forearm at 90 degree angle Arm is bare from shoulder to elbow Arm Measurement Arm length is measured using a measuring tape in metric units Measure from the acromion or bony extremity of the shoulder girdle to the olecranon or the tip of the elbow 2
Arm Measurement The midpoint is marked on the dorsal surface of the arm Arm Measurement With participant s arm relaxed at their side, measure the arm circumference at the midpoint 3
Determination of Cuff Size Based on Arm Cm. Arm Circumference 90t 9.0 to 14.0cm 140 > 14.0 to 21.0cm > 21.0 to 29.0cm > 29.0 to 40.0cm > 40.0 to 52.0cm Cuff Size (Mabis ) infant child regular adult large adult thigh Measurement Procedures Seat the participant with right arm on a table Palpate the brachial artery and mark this location for placement of the center of the bladder and placement for the bell of the stethoscope 4
Measurement Procedures Appropriate cuff applied snugly and smoothly with the midpoint of the length over brachial artery Arm positioned with midpoint of cuff width at heart level Measurement Procedures Legs uncrossed and feet on the floor Back supported Allow a five minute wait before taking BP Give participant instructions to remain seated and do not talk until completion of measurement 5
Determining the Peak Inflation Return to room after 5 minute wait Connect tubing to cuff While palpating the radial pulse observe dial and inflate cuff rapidly to 60mmHg and then slowly in increments of 10mmHg until the pulse is no longer felt (pulse obliteration point) Cuff is quickly and completely deflated Add 30 to the pulse obliteration point to get the Peak Inflation Level(PIL) Blood Pressure Reading Wait 60 seconds before taking first BP reading Place the ear pieces of the stethoscope into the ears, with the tips turned forward Earpiece should be tight enough to exclude outside sound The valve between the bell and diaphragm should be turned in the direction of the bell 6
Blood Pressure Measurement Bell of stethoscope is lightly placed on the skin overlying the brachial artery Rapidly inflate to the determined PIL Deflate and maintain a constant rate of deflation at approximately 2mmHg/second Continue to deflate until 10mmHg below the level of the diastolic Blood Pressure Measurement Wait 30 seconds after each blood pressure reading Participant s arm should be passively raised for 15 seconds after each reading Wait an additional 15 seconds with arm resting on the table 7
Ways to Accentuate Korotkoff Sounds Using standard technique with rapid inflation of cuff to the PIL Rapidly inflate the cuff while participant s arm is elevated, then, bring arm back to heart level and proceed to take the reading After the cuff is rapidly inflated to PIL, have participant rapidly open and close his or her fist six to eight times. Have participant relax their fist and begin taking the reading Criteria for Systolic and Diastolic Blood Pressure Phase I ( systolic) identified as the pressure level l where the first of 2 or more consecutive beats is heard. Please Note: a single sound heard in isolation is note Phase I Phase V (diastolic) Disappearance of sounds 8
Please Note: A single sound heard in isolation (i.e., not rhythmic sequence) before the first of the rhythmic sounds (systolic) or following the last of the rhythmic sounds (diastolic) does not alter the interpretation of the blood pressure. Forgotten Blood pressure Readings If a blood pressure value is missed or forgotten, completely deflate the cuff and start over with a replacement reading after the 30 second wait. Do not re-inflate the blood pressure cuff during a reading. Do not redo a reading that looks unusual to you. 9