MEDICINE 1

BP Measurement Taking
BP Measurement Taking
Alfred Guzman, MD | 08 August 2017

1.01c
Selecting the Correct Size of the BP Cuff
It is important for clinicians and patients to use a cuff that fits
the patients arm.
I. Blood Pressure Follow the guidelines outlined below for selecting the correct
A. Aneroid Sphygmomanometer cuff size:
B. Selecting the Correct Size of BP Cuff o Width of the inflatable bladder of the cuff:
C. Ensuring Accurate BP Measurement Should be about 40% of upper arm circumference
D. AHA Guidelines for In-Clinic BP Measurement (about 12 to 14 cm in the average adult)
E. Steps in Taking the BP measurement o Length of the inflatable bladder: Should be
II. Heading 2 about 80% of upper arm circumference (almost
long enough to encircle the arm).
o The standard cuff size: 12 23 cm, appropriate
for arm circumferences up to 28 cm.
o Not in Bates but according to doc Height of the
bladder of the cuff: 50% of upper arm
circumference
BLOOD PRESSURE
The force exerted by the blood against the unit area of the
vessel wall.
It is measured in millimeters of mercury (mmHg) and
recorded as fraction: systolic blood pressure over the
diastolic blood pressure.
o Systolic blood pressure (SBP) the pressure of
the blood as a result of contraction of the venticles,
that is, the pressure of the height of the blood
waves.
o Diastolic blood pressure (DBP) the pressure Figure 2. Optimal relationships between the width (W), length (L) of the
when the ventricles are at rest. cuff bladder and the circumference (C) of the upper arm.
o Pulse pressure (PP) the difference between the
systolic and diastolic pressure readings. The table below is the recommended cuff size of American
SBP DBP = PP Heart Association (AHA).
It is measured with a blood pressure cuff, a
sphygmomanometer and a stethoscope. Patient Recommended Cuff Size
Some factors to consider in taking the BP measurement: Adults (by arm
o Instrument circumference)
o Technique
o Patient factor 22 to 26 cm 12 x 22 cm (small adult)
o Environment 27 to 34 cm 16 x 30 cm (adult)
35 to 44 cm 16 x 36 cm (large adult)
Aneroid Sphygmomanometer 45 to 52 cm 16 x 42 cm (adult thigh)
Is a calibrated dial with a needle that points to the Children (by age)
calibrations
An instrument for measuring the arterial blood pressure. Newborns & 4 x 8 cm
premature infants
Infants 6 x 12 cm
Other children 9 x 18 cm

Ensuring Accurate BP Measurement

1. The patient should avoid smoking, caffeine, or exercise for
30 minutes prior to measurement.
2. The examining room should be quiet and comfortably warm.
3. The patient should sit quietly for 5 minutes in a chair with
feet on the floor, rather than on the examining table.
4. The arm selected should be free of clothing, fistulas for
dialysis, scars from brachial artery cutdowns, or
lymphedema from axillary node dissection or radiation
therapy.
5. Palpate the brachial artery to confirm a viable pulse and
position the arm so that the brachial artery, at the antecubital
crease, is at heart level roughly level with the fourth
Figure 1. Parts of the Aneroid Sphygmomanometer. interspace at its junction with the sternum.
6. If the patient is seated, rest the arm on a table a little above
the patients waist; if standing, try to support the patients
arm at the midchest level.

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 MEDICINE 1
BP Measurement Taking
AHA Guidelines for In-Clinic BP Measurement o Note the pressure on the sphygmomanometer at
*AHA American Heart Association which pulse is no longer felt. Rationale: This gives
an estimation of the SBP.
Recommendation Rationale
o Release the pressure promptly and completely in
Patient should be seated Diastolic pressure is higher in the cuff, and wait 15 to 30 seconds before making
comfortably, with back supported, the seated position, whereas further measurements.
legs uncrossed, and upper arm systolic pressure is higher in 5. Position the stethoscope appropriately.
bared. the supine position. o Now place the bell of a stethoscope lightly over the
brachial artery, taking care to make an air seal
An unsupported back may with the full rim. Rationale: Because the sounds to
increase diastolic pressure; be heard, the Korotkoff sounds, are relatively low
crossing the legs may in pitch, they are generally better heard with the
increase systolic pressure. bell.
Patients arm should be supported If the upper arm is below the This is based on Bates although the
at heart level. level of the right atrium, the stethoscopes diaphragm is used
readings will be too high; if the more often in a clinical setting.
upper arm is above heart o Make sure to place the stethoscope directly on the
level, the readings will be too skin, not in clothing over the site.
low. 6. Auscultate the patients BP.
o Pump up the cuff until the sphygmomanometer
If the arm is unsupported and reads 30 mmHg above the point of the previously
held up by the patient, recorded palpatory reading. Rationale: Using this
pressure will be higher. sum for subsequent inflations prevents discomfort
Cuff bladder should encircle 80 An undersized cuff increases from unnecessarily high cuff pressures; it also
percent or more of the patients errors in measurement. avoids the occasional error caused by an
arm circumference. auscultatory gap a silent interval that may be
Mercury column should be Deflation rates greater than 2 present between the systolic and the diastolic
deflated at 2 to 3 mm per second. mm per second can cause the pressures.
systolic pressure to appear o Release the valve of the cuff carefully so that the
lower and the diastolic pressure decreases at the rate of 2 to 3 mmHg per
pressure to appear higher. second. Rationale: If the rate is faster or slower,
The first and last audible sounds an error measurement may occur.
should be recorded as systolic o As the pressure falls, identify the manometer
and diastolic pressure, reading based on the Korotkoff phases (will be
respectively. Measurements further explain later).
should be given to the nearest 2 o Deflate the cuff promptly and completely.
mm Hg. 7. Average two or more readings.
Neither the patient nor the person Talking during the procedure o Read both the systolic and the diastolic levels to
taking the measurement should may cause deviations in the the nearest 2 mm Hg.
talk during the procedure. measurement. o Wait 2 or more minutes and repeat.
o Average readings.
o If the first two readings differ by more than 5 mm
Steps in Taking the BP measurement Hg, take additional readings.
1. Position the patient appropriately.
o The adult patient should be sitting otherwise
specified. Both feet should be flat on the floor.
Rationale: Legs crossed at the knee result in an REFERENCES:
elevated SBP and DBP.
2. Position the cuff and arm. 1. Lecture Notes
o With the arm at heart level, center the inflatable 2. Bates Guide to Physical Exam and History Taking (12th Ed)
bladder over the brachial artery. 3. American Heart Association (AHA)
o The lower border of the cuff should be about 2.5
cm above the antecubital crease.
o Secure the cuff snugly.
o Slightly flex the patients arm at the elbow.
o Forearm should be supported at heart level.
3. Wrap the deflated cuff evenly around the upper arm.
4. Perform preliminary palpatory determination of the SBP.
o Rationale: The initial estimate tells the maximal
pressure to which the manometer needs to be
elevated in subsequent determinations. It also
prevents underestimation and overestimation of
the SBP should an auscultatory gap occurs.
o Palpate the radial or brachial artery with fingertips.
o Close the valve on the bulb.
o Pump up the cuff until radial or brachial pulse is no
longer felt. At that pressure, the blood cannot flow
through the artery.

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BP Measurement Taking

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