MTech. 1st stage Project Report, Dept.

of Electrical Engineering, IIT Bombay, October 2010

Arm Simulator for Blood Pressure Measurement

Pushpa Gothwal (09307054)
Supervisor: Prof. P.C. Pandey

Abstract: Arm simulator is a device for simulating behavior of the arm for testing and calibrating a noninvasive blood pressure meter. It can also be used as an instrument aid in teaching the healthcare professionals to correctly use a blood pressure meter. The objective of the project is to design and build a low cost artificial arm for BP measurement using Koroktoff sound as well as Ossilometric method. For generating Koroktoff sound or pressure pulses in arm, 8 bit PIC microcontroller is used. Theses sounds or pulses are generated based on the BP parameters set through an external control panel, and in response to time varying pressure under the cuff as dynamically sensed by a pressure sensor. Korotkoff sound is generated using a digital-to-analog convertor (DAC). In the first stage of the project, microcontroller based simulator circuit is bread-boarded and a program has been written which can be used for setting the values of systolic pressure, diastolic pressure, heart rate, arrhythmia, and pulse volume within their respective pre-specified ranges.

1. Introduction
Measurement of blood pressure (BP) is the most commonly used tool for assessing a patients cardiovascular system. It gives certain important information about patients abnormal blood pressure such as hypertension (high blood pressure) and hypotension (low blood pressure). Abnormal blood pressure is also known as a silent killer, because the condition generally does not have any symptoms. Therefore it is very important to regularly monitor the blood pressure. For accurate reading of blood pressure, the measuring instrument should be tested and calibrated. Testing of blood pressure instrument is very difficult with living subject because pressure level may become different at different times. Also, pressure reading varies depending upon the certain physiological factor such as sleep, body position, smoking, emotional state, etc. Taking multiple readings of the same subject to test the precision of the instrument or for comparing readings from two instruments may leads to change in the BP value. Hence, this method of calibration is tedious, time consuming, and unreliable. The purpose of this project is to develop a low cost microcontroller based arm simulator which

can be used for simulating blood pressure reading over full clinical range along with different types and rates of heart beat.

2. Physiology of the Heart

Cardiovascular system consists of the heart and the blood vessels that circulate blood throughout the body. The blood transports nutrients and oxygen to tissue and removes the carbon di oxide and waste product from it. Heart is a muscular organ which pumps the blood throughout the body. The heart consists of four chambers, left atrium, left ventricle, right atrium and right ventricle as shown in Fig. 2.1 [1]. Right atrium has sinoarterial node which generates the impulses and atrioventrical node (AV) conduct those impulses. Blood enters into the right atrium through two venacova, superior venacova (which leads from the bodys upper extremities such as head and neck) and inferior venacova (which leads from the bodys lower extremities). The incoming blood fills the right atrium and the coronary vein also gets emptied into the right atrium. When the right atrium is full, it contracts and forces blood through tricuspid valve into the right ventricle. When ventricular pressure exceeds atrial pressure the tricuspid valve closes and pressure in the ventricle forces to open the semilunar pulmonary valve. By opening the pulmonary valve, pulmonary artery circulate the deoxygenated blood into the lungs. In the lungs red blood cells are recharged with oxygen and give up carbon di oxide. The oxygenated blood enters into the left atrium through pulmonary vein and then it is pumped via mitral valve into the left ventricle by the contraction of arterial muscle. When the left ventricle muscle contracts, it closes the mitral valve. Build up of pressure in the ventricle forces the aortic valve to open. Then the blood flow in aorta from ventricle circulates inside the whole body .This cycle of blood circulation is repeated with beats of the heart [1]. Cardiac cycle is the sequence of coordinating events which take place during heart beat. Each cardiac cycle consists of two major periods- systolic and diastolic. Systolic is defined as the period of contraction of heart specifically ventricle muscle. Diastolic is the period of dilation of the heart chambers as they fill with blood. Various changes occur in different chamber of heart during each heart beat.

Fig.2.1 Labeled diagram of heart [1]

Fig.2.2 Various events during cardiac cycle [5]

3. Blood pressure measurement techniques

Blood pressure is measured either using invasive (direct) or non-invasive (indirect) methods. For routine clinical measurement, indirect method is preferred over direct method. It this method, The skin need not be punctured for taking the BP reading. It is a less accurate method because the pressure is measured indirectly and it also depends on patient position. It is generally measured with the patient sitting quietly and comfortably with the back support for five minutes and the arm is supported at the level of the heart. The patient should not take any caffeine or drugs or smoking before the readings. Direct method give accurate blood pressure measurement but it requires catheterization, hence it is not used for routine clinical measurement. This method is used in intensive care unit (ICU) and coronary care unit (CCU) for continuous monitoring of blood pressure. Noninvasive instrument includes the (i) auscultation method, (ii) ossilometric method, (iii) ultrasonic method, and (iv) tonometry method. 3.1. Invasive Method (Direct) For taking direct measurement, a catheter or a needle type probe is inserted directly into the area of interest through arteries or vein [3]. Two types of catheters are available. One of them is the catheter tip probe in which the sensor is mounted on the tip of the probe. In this pressure exerted on the sensor is converted into proportional electrical signal. The other one is fluid filled catheter probe where pressure is exerted by fluid filled column to the external transducer, which converts the pressure into the electrical signal. The electrical signal is then amplified and processed to give systolic, diastolic, and mean pressure value and visualization of pulse contour. 3.2. Noninvasive Method (Indirect) (i) Auscultation Method: This method is also known as sphygmomanometer method for indirect blood pressure measurement. The blood pressure is measured using an inflating cuff with squeeze bulb, mercury manometer, and stethoscope as shown in Fig. 3.2.[3]. The cuff is wound around the arm (which should be at about heart level) and a stethoscope is placed on the brachial artery. The cuff is inflated to a pressure above the systolic pressure so that flow of blood is occluded. The cuff is deflated slowly, and stethoscope is used to listen the sound from the artery. The
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point at which sound is heard known as the systolic pressure. This sound arises because the blood flow is converted from laminar to turbulent form. The pressure below the sounds disappear is the diastolic pressure. this sound arises because blood flow is converted into turbulent form to laminar form. When the pressure is below the systolic pressure, but above the diastolic pressure, a clear tapping sound is heard with the heart beat. The sounds are heard in five phase- (i) initial 'tapping' sound (cuff pressure = systolic pressure), (ii) sounds increase in intensity, (iii) sounds at maximum intensity, (iv) sounds become muffled, and (v) sounds disappear. This technique does not require any expense. However, it cannot be used in noisy environment. In this technique mechanical error can get introduced e.g. mercury leakage, air leakage, obstruction in the cuff etc. It does not give accurate results for infants and hypotensive patients.

Fig. 3.2 Auscultation method for indirect blood pressure measurement [3]
(ii) Oscillometric Method

The ossilometric method works on the same principle as the auscultator method but it does not use stethoscope as shown in Fig. 3.3. When the cuff pressure is in between the systolic and diastolic pressure, each cardiac cycle causes a small change in the cuff pressure, which has the appearance of oscillations. These oscillations, caused by the blood flow in artery below the cuff, are sensed using a pressure transducer. The appearance and end of the oscillation indicate the time at which the cuff pressure shows the systolic and diastolic pressure. The readings are not affected by high environment noise such as emergency and clinical room. The method can be used to reliably measure the mean arterial pressure. In this
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method, excessive movement of patient or vibration during measurement may result in inaccurate reading.

(a)

(b) Fig. 3.3 Oscillometric method of blood pressure measurement (a) Cuff placement (b) Oscillation in cuff pressure [3] Fig. 3.3 (b) shows that oscillation in cuff pressure. The point of maximum oscillation corresponds to the mean arterial pressure. The point at which oscillation begins to increase rapidly is known as the systolic pressure and the mean arterial pressure at which oscillation is decreasing rapidly is known as the diastolic pressure.

(iii) Tonometry Method As shown in Fig.3.4, this method uses a flat plate to compress the surface of the skin directly over a superficial artery, supported from below by a bone (radial artery). An arterial rider, cylindrical in shape, senses the radial stress of the artery by means of a sensor array. Effect of skin tension in vertical direction is set to zero by the side plate. The arterial rider strain gauge sensor detects the arterial pulsation. For estimating pressure, force is divided by contact area of arterial rider. This method is non-invasive and non-painful and can be used to monitor blood pressure continuously. It has relatively high cost and the wrist movement of patient may
gives inaccurate reading.

(iv) Ultrasonic Method (Doppler method) Doppler sensor is used to detect motion of the blood vessel to determine blood pressure as shown in Fig. 3.5. A compression cuff is placed over the arm with 8 MHz transmitting and receiving crystals [4]. Ultrasound source transmits signal on the blood vessel and the reflected signal is transduced by the receiving crystal, and then amplified. The reception of reflected signal indicates the closing and opening of artery. Frequency difference between transmitted and reflected signal is proportional to the blood velocity and velocity of wall motion. For the cuff pressure between diastolic and below systolic pressure, the blood vessels open and close with each heart beat, because artery pressure oscillates between cuff external pressure. As the cuff pressure further increases, the time between opening and closing artery

Fig.3.4 Tonometry method for blood pressure measurement [4]

Fig. 3.5 Ultrasonic method for indirect blood pressure measurement [4] decreases until they coincide. The reading at point is known as the systolic pressure. The cuff pressure futther decreases, the time between opening and closing artery increases until they coincide. The reading at point is known as the diastolic pressure. This method can be used in noisy environment and it can be used with infant and hypotensive subject. Movement by the patients change the alignment between the sensor and vessel thus the reflected signal does not give correct reading. 4. Blood pressure simulator A BP simulators is used to test and calibrate the BP monitor by assessing the repeatability and stability. In clinical environment, simulators are used as part of the quality assurance in for quick testing of BP monitors [8]. Two basic type of simulator have been developed, limb simulator and waveform simulator as shown in Fig. 4.1. A limb simulator models the artificial limb (arm). Waveform simulator generates pressure waveforms. Arm simulator is in the form of inner cylinder filled with water and K-sounds are generated by transducer. An outer layer of water is in flexible form that transmits the sound waves to pressure cuff and transducer. A waveform simulator generates Ossilometric waveform, which is fed into the cuff tubing of the tested monitor. The most commercial available simulators are BP Pump 2 and Cufflink by Fluke Biomedical, SmartArm and AccuPulse by Clinical Dynamics, QA1290 by Metron and SimCube SC-1 by Pronk Technologies. The simulators suffer from a
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number of disadvantages such as, large size, lack of flexibility in settings. Hence for the measurement of blood pressure under different cardiovascular condition, a compact portable BP simulator is needed.

4.1 Calibration
Accuracy of blood pressure measurements is dependent upon the deflation rate. For calibrating any instrument, pressure gauge reading is compared with a standard mercury sphygmomanometer and T connector is used between gauge and instrument. Any offset error if found should be corrected. For finding how much offset is needed, apply the cuff to the simulated arm. Set the simulator systolic pressure to 150 mmHg and set the diastolic pressure to 70 mmHg. Proceed with a simulated blood pressure measurement. Note the difference between the gauge and the simulator reading. Example, if the blood pressure reading was taken and the sound started at 148 mmHg, and then the offset is +2 mm. If the sound started at 152 mmHg, the offset is 2. For diastolic pressure if sound stopped at 72 mmHg, the offset is 2 or if the sound stopped at 68 mmHg, the offset is +2. [10]

Fig. 4.1 Two basic types of simulator for testing of BP measurement (a) limb simulator, (b) waveform simulator [8].

4.2 Earlier work

An arm simulator for blood pressure measurement was reported by Glover in [6]. It uses ossilometric method for blood pressure measurement. Generation of simulated pulse is shown in Fig. 4.2. Pulse rate, systolic pressure, and diastolic pressure for the simulator are selected by user. The cuff gets inflated by the pump in the monitor, till the brachial artery gets occluded. The cuff is deflated in steps by valve located in monitor. Applied cuff pressure is detected by transducer located in monitor. The transducer converts the pressure signal into
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electrical signal. This monitor contains the amplitudes of detected pulses and stores them along with corresponding value of cuff pressure. This data is then reviewed and the pressure level at which maximum pulse amplitude has occurred is determined. The cuff pressure is also applied on both side of a diaphragm located in pulse chamber. The cuff pressure is further applied on pressure transmitter of the simulator which converts it into electrical signal. This signal is then given to both procceser and control circuit which control the valve opening and closing. Output of the processer is fed to electrical pulse generator which produces pulses at selected rate and varying amplitude depending upon the cuff pressure created by monitor. In this way, blood pressure reading is simulated. When processer activates pulse geneartor, it supplies pulse signal to valve control circuit for closing the valve. Processor always gets current value of cuff pressure along with preset value of systoic, diastolic, and mean atrial pressure, then it computes the required pulse amplitude according to the line equation. Pulse rate genearted is determined by the set heart rate.

Fig. 4.2 Block diagram of blood pressure simulator arm [6]

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5. Design approach
In the block diagram as shown in Fig. 5.1 the microcontroller is the central control unit of the simulator. For a very compact design, the microcontroller should have sufficient programmable ROM, data RAM, parallel I/O ports, UART, and a programmable timer/counter for handling all the operations without requiring additional chips. Arm simulator will be in the form of a cylinder. The cuff containing the transducer is placed surrounding the cylinder and the transducer kept between cuff and cylinder converts pressure variations to voltage. The voltage corresponding to the pressure variation is given as input to the amplitude calculator, which also takes as input the following parameters systolic pressure (SP), diastolic pressure (DP), and the mean atrial pressure (MAP). These parameters are input through a keypad. The entire scheme can be implemented using microcontroller with on chip ADC and DAC. The pressure variations are given as input to the ADC of the microcontroller. The program converts these pressure variations into varying amplitude pulses which is converted to sound using an appropriate audio module.

Fig. 5.1 Block diagram of the arm simulator

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Fig. 5.2 K-sound amplitude as a function of cuff pressure

5.1 Hardware block of the simulator

In the first stage designed the simulator circuit, shown in Fig. 6.3, consists of keypad and LCD interfacing with the microcontroller. The microcontroller PIC16F1936 is used for processing purpose. It use has resulted in a simple circuit because it has on chip like DAC, timers, ADC, etc. Microcontroller uses timer to generate pulses which vary with the beat rate selected by user. Minimum beat rate is 20 beats/ minute and maximum beat rate is 150 beats/ minute and it varies in steps of 5 beats/ minute. Port pins PC.4PC.7 of microcontroller are connected to up, down, left, and right keys respectively.
ADC in Microcontroller Pulses

Pressure sensor

DAC out

Keypad

LCD

Fig. 5.3 Block diagram of simulator

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5.2 Pin assignment of the microcontroller

A 28 pin microcontroller IC (MCP16F1936) has been used for the testing of the simulator circuit. The user interface unit consists of four keys and a 16x2 LCD. The LCD is interfaced in four bit form to reduce the no. of port pins. The pin assignment is given in Table 4.1 and is also shown in Fig. 6.3. The display unit has option to change mode of operation, systolic pressure, diastolic pressure, heart rate, arrhythmia, and pulse volume. There are four keys increment, decrement, left and right. Key 1 and 2 are for selecting the parameter and key 3 and 4 are to change the selected parameter value. Choices available for the different parameters selection are listed below: Systolic pressure- 0230 mmHG, increase or decrease in step of 5, with default value as 120. Diastolic pressure- 0140 mmHG, increase or decrease in step of 5, with default value as 80. Heart rate- 20150 Beats/minute, increase or decrease in step of 5. Arrhythmia- 04, increase or decrease in step of 1. Pulse volume- 51, increase or decrease in step of 1.

Table 5.1 Assignment of pins for various functions on the microcontroller

Port Pin PA.1 PA.4 PA.5 PA.6 PA.7 PB.1 PB.2 PC.4 PC.5 PC.6 PC.7

Function LCD data pins Enable of LCD RS of LCD RW of LCD Square wave Non periodic pulse Increment key Decrement key Left key Right key

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C2 = 0.1 F PIC16F1936 8 VSS U2 VPP 19 VSS VDD 11 PC.0 PB.0 12 PC.1 PB.1 13 PC.2 PB.2 14 PC.3 PB.3 9 PA.7 PB.4 10 PA.6 PB.5 7 PA.5 PB.6 6 PA.4 PB.7 5 PA.3 PC.7 3 PC.6 PA.1 4 PC.5 PA.2 2 PC.4 PA.0

5V

JHD 162A

LCD DISPLAY

DB 2 9 DB 3 10 14 DB 7 13 DB 6 12 DB 5 DB 4 11 6 EN 4 RS 8 DB 1 DB 0 7 3 VEE 2 VCC 1 VSS 5 RW GND R1

NC NC

1 20 21 22 23 24 25 26 27 28 18 17 16 15 NC NC NC NC NC NC NC NC R3 R4 R5 R6 S4 S3 S2 S1 GND

GND

NC NC

NC NC NC NC DAC out ADC in

5V R2 330 R7 10 k

R3 = R4 = R5 = R6 = 10 k

10 k

GND

GND

Fig.5.4 LCD and Keypad interfacing with microcontroller

5.3 Software
The functioning of keys and LCD display are controlled by software. The simulator has two modes of operation: (i) Definition mode (ii) Operating mode. In definition mode all the keys are active and we can select and change all the five parameters. The user can select or change the mode and parameters following the algorithm as given below. 1. Start. 2. Default operation mode is definition mode; user can go to operation mode by pressing key1 or 3. 3. Check for key press. 4. In definition mode all the parameters can be incremented or decremented by pressing key 1 or 3. 5. In operating mode, key 1 and 3 will not work and it generates non periodic pulse wave according to heart beat. Check for key press.
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6. If key is pressed then do work accordingly. If left or right key is pressed then select the parameter, go to step 3. If up or down key is pressed then increment or decrement selected parameter respectively, go to step 3. 7. Display current setting on LCD for the user. 8. Go to step 3.

6. Summary and future work

We are designing a microcontroller based low cost portable arm simulator, which pressure pulses will simulate. First stage includes study of the earlier method of simulating pressure pulses, available products of arm blood pressure simulator. A designed is simulator in which user can select the specify parameter and change the parameter value by keypad and generate the varying amplitude of the K-sounds in response to variation in the sensed pressure. For testing purpose pulses are output in place of K-sound. The output of pressure sensor was simulated by a potentiometer.

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` Appendix: BP simulator
1. No 600 blood pressure simulator Arm [15] - This arm uses Auscultation method for measuring blood pressure. It also simulates the palpation of the radial pulse, and varies systolic and diastolic pressures from 0300 mm HG in two mm increments, variable amplitude of sound heard, sound jack for group listening, auscultatory gap setting, and heart rate settings. 2. (i) BPT-001 Blood Pressure Simulator [16] - This Blood Pressure Simulator simulates the five Korotkoff phases. It cost is 795$.It also provides the following features Systolic and diastolic settings On or off of ausculatory gap Adjust volume Adjust pulse rate (ii) BPK3-001 Blood Pressure Training Arm - This arm designed for training the procedure of NIBP measurement with an electronic trainer. Its cost is 940$. It also provides the following features Palpable antecubital pulse Blood Pressure Trainer with LCD guided operation Systolic, diastolic, heart rate, and auscultatory gap are programmable. Representation of both systolic and diastolic pressures Indication of gauge reading as pressure is increased or decreased Adjustable volume 3. NASCO Life/form Blood Pressure Simulator (lf03204) [11] - The NASCO Life/form Blood Pressure simulator is programmed to demonstrate the 5 Korotkoff phases, including an auscultatory gap, which can be heard during auscultation of a subject, while measuring the subjects blood pressure. This simulator digitally records the pressure sound by varied pulse rate and volume. It also provides the following features Calibration of simulator Setting of palpation Extra speaker to hear korotkoff sound

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 Setting of systolic pressure, diastolic pressure, pulse rate, and pulse volume. 4. SimCube NIBP Simulators [13] - Simcube NIBP Simulators are compact, handheld, affordable and easy to use. It simulates real-life oscillometric pulses by varying both the size and shape of the wave as cuff pressure changes. It also provides the following features It provides NIBP Simulations for Adult, Neonatal, hypertensive, and hypotensive subject. Digital Manometer 12-lead ECG: 10 different Heart Rates, synchronized with NIBP Respiration: 3 rates, plus a sequence of 7 different rates Pacer Simulation Peak Detect- For checking overpressure limits in 0.5 mmHg steps Leak Test Mode- It measures leak rate of a NIBP monitor, cuff, and hose Automated Alarm Test Mode- Tests heart rate alarms 5. Non-Invasive Blood Pressure Simulator (Rigel 311c) - It uses ossilometric waveforms for accurate calibration of NIBP monitors. It provides graphic representation of the inflation and deflation process. It displayed/ measured following parameters dynamic NIMP cuff pressure waveform, measurement time ( in seconds), maximum inflation Pressure (in mmHg typical), inflation time, inflation Rate (mmHg/sec), minimum Pressure, deflation time, deflation Rate. It also provides the following features It provides NIBP Simulations for Adult, Neonatal Digital Manometer, Leak Test 6. Non-Invasive Blood Pressure Simulators (1000 series) [13] - The Model NIBP-1000 Series is a family of Microprocessor based, High Precision Non-Invasive Blood Pressure (NIBP) Simulators. The units are small, easy to use and have multiple features to fit many different applications. The NIBP-1020, offers ECG waveforms that are full QRS and respiration waveforms that look real. The NIBP-1030 offers Invasive Blood Pressure, Temperature, Arrhythmias and a Leak Rate test mode. The graphics display not only provides multiple screens that give the pressure digitally in mmHg, but also offers views of the plot of the overall pressure or a close-up of the BP waveform. This model comes in different series with more features. The following are highlights of some of the main features NIBP(1010) Large graphics display with cursor selection of options and setup of parameters Full range manometer
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 Adult, neonatal, hypertensive and hypotensive modes Digital pressure envelope offset Optional peak pressure detect with simple reset Digital calibration no pots to turn Flash programmable NIBP(1020)- It provide all the basic model features plus: Ecg output with full nsr waveform Sinusoidal respiration simulation Ecg test waveforms Pace waveform Optional peak pressure detect with ecg alarm test Ecg syncronized with blood pressure NIBP (1030) - It has all the 1020 model features plus Synchronized invasive blood pressure output Static Invasive blood pressure simulation Leak rate test Ecg arrhythmia waveforms Ecg arrhythmia sequence

7. Cufflink Noninvasive blood pressure analyzer [10] - This Analyzer uses oscillometric

method for simulation and generate BP waveforms for seven adult, five neonate, and 5 arrhythmias. The different systolic/diastolic pressure gradients simulate a physiological range of normal, hypotensive, and hypertensive adult or neonate patients. An internal pump pressurizes the NIBP system under test. Use the Analyzers digital manometer instead of a mercury column for doing pressure measurements. The Analyzer facilitates overpressure testing of NIBP monitors by automatically detecting and displaying the overpressure point. The Analyzer has the following standard features: Dynamic oscillometric noninvasive blood pressure simulation Automated static pressure measurements, leakage testing, and relief-valve testing Five automated NIBP testing autosequences Five arrhythmia selections Adult and neonatal NIBP selections Adjustable heart rate values

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8. BP Pump 2 Non-Invasive Blood Pressure Simulator and tester [10] - This simulator include multi-purpose test instrument for use with oscillometric Non-Invasive Blood Pressure Monitors (NIBPMs). The Tester provides dynamic blood pressure simulations, static calibration, automated leak testing, and pressure relief valve testing. The following models are available: (i) BP Pump 2L (Basic Model) (ii) BP Pump 2M (High-Accuracy Model) The model has the following key features Pressure leak testing on cuff, tubing, and connections Relief valve testing on the patient monitor Pressure gauge measurements Pressure source capability NIBP simulations including adult, neonate, arrhythmias, and respiratory artifacts Auto sequences with optional reports Internal Adult and Neonatal Cuff simulation ECG synchronization with non-invasive output External wrist cuff simulations

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References
[1] K. Sembulingam and P. Sembulingam, Cardiovascular system, Essential of Medial Physiology, 5th ed., New Delhi: Jaypee, 2010, pp. 500-504. [2] C. Guyton, Physics of blood, blood flow, and pressure: Hemodynamics, Textbook of Medical Physiology, 7th ed., Philadelphia: saunders, 1986, pp. 206-209. [3] Handbook of Biomedical Instrumentation, 2nd ed., Tata McGraw Hill, New Delhi, 2009, pp. 218-227. [4] J. G. Webster,Blood pressure and sound, Medical Instrumentation Application and Design, 2nd ed., Boston, USA: Houghton Mifflin company, 1992, pp. 394-401. [5] J. J. Carr and J. M. Brown, Physiological pressure and other cardiovascular measurement, Introduction to Biomedical Equipment Technology, 4th ed., Delhi: Pearson Education, 2001, pp.234-245. [6] W.Glover and R. Medero,Arm Simulator for an Ossilometric blood pressure monitor, U.S. Patent 4,464,123, August 7, 1984. [7] K. Ruiter and W. W. Ruiter,Compact Ossilometric blood pressure simulator, U.S. Patent apl. 20100076713, 30 June, 2008. [8] G.Gersak, A. Zemva, and J. Drnovsek. (2009, October) A procedure for evaluation of non-invasive blood pressure simulators. Med Biol. Eng Comp.[online].47(12), pp.12211228,Available: http://www.springerlink.com/content/351052r33660n551/fulltext.pdf. [9] F. Leo and Jr. Costello,Ossilometric Noninvasive Blood Pressure Simulator, U.S. Patent 5,027, 641, July 2, 1991. [10] Fluke Biomedical, Cufflink NIBP analyzer Available online : http://assets.fluke.com.cn/evtmanuals/bppump2_omeng0000.pdf. [11] Nasco Life/form, LF03204U blood pressure simulator, Available online: http://www.enasco.com/pdfs/lf03204.pdf.
[12] Clinical Dynamics , AccuPulse NIBP Simulator Available online:

http://www.clinicaldynamics.com/pdfs/NIBP/AccuPulseSpecSheet.pdf. [13] Pronk Technologies Inc., Sim cube NIBP simulator, Available online: http://www.pronktech.com/simcube-nibp-simulator-pronk.htm. [14] Rigel medical, BP-SIM Handheld NIBP Simulator Available online: http://www.rigelmedical.com/products/nibp_simulators.asp. [15] Simulaids, No 600 Blood Pressure Simulator Arm Available online: http://www.simulaids.com/PDF/BloodPressureSimulatorArm.pdf.
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[16] Pinnacle technology group, BPT-001 Blood Pressure Simulator Available online: http://www.pinnacletec.com/pdf/pinnacle_catalog.pdf.

U3 LM7805
1 IN R2 100K 1 R2 2 0 0hm R2 10K C10 100uF C11 0.1uF OUT 3

D5V

U4 LM1117
3 IN Vout Vout

2 4

D3V3

GND

C12 0.1uF

C13 100uF

GND

C14 0.1uF

C15 100uF

CON3 J3

BAT U5 LM7805
1 IN OUT A5V 3 3

DGND

U6 LM1117
IN Vout

A3V3

1 2 CON3 J3 R2 0 ohm

GND

Vout 4 C18 0.1uF

1 GND

C16 100uF

C17 0.1uF

C19 100uF

C20 0.1uF

C21 100uF AGND

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