Blood pressure measurement technology algorithm. Correct measurement of blood pressure with a mechanical or automatic sphygmomanometer

Blood pressure is maintained at a relatively constant level and largely reflects the general condition of the body as a whole and the cardiovascular vascular system, in particular.

Measurement algorithm blood pressure it is not difficult, it is enough to study it once, and the acquired skill will remain in memory for many years.

A device for measuring blood pressure is called a sphygmomanometer.

Conditions for obtaining accurate values

At least half an hour before measuring blood pressure, as preparation, you should:

• refuse to eat, coffee or other tonic drinks;
• avoid smoking;
• avoid stress, do not physically overstrain;
• restrict reception medicines affecting blood pressure.

What else is important to know about how to properly carry out this procedure?

• If there was physical activity, then you should wait about 30 minutes.
• During the procedure, you can not speak and make sudden movements, this will distort the result.
• The cuff is put on the shoulder so that its lower edge is a few centimeters above the elbow.
• 2 fingers should pass into the space between the cuff and the shoulder (if this is a child - 1 finger).
• Ideally, several measurements are taken at once with a half-minute interval and the average value is taken as the result. Do not forget to deflate the tonometer cuff during the break between measurements!

Patient posture

Correct position of the patient when measuring pressure

The position in which the measurement takes place is important. If the patient is sitting, then his back should be straight, lean on the back, feet ─ stand flat on the floor, it is forbidden to cross your legs and cross your legs. The hand should lie relaxed on a support (for example, on a table).

If the patient is lying, then his arm is located along the body, while in order to raise it slightly, a small pillow can be placed under it.

Immediately before the manipulation, you need to sit for about 5 minutes in the position in which the examination will take place, try to relax.

If there is a need to measure pressure regularly, then it is better to do this every day at the same time, write down the results and show them to your doctor at the next appointment.

How is the tonometer arranged?

The standard apparatus that is used to monitor blood pressure consists of several parts.

• pear blower with valve;
• cuffs with pneumatic chamber. to select it, you need to measure the coverage of the shoulder of the subject using a centimeter tape. the middle shoulder cuff can only be used if its value is 23-33 cm;
• stethophonendoscope, with which Korotkoff's tones are heard;
• manometer showing the result.

Types of tonometers

Varieties of tonometers

All tonometers are divided into several groups depending on:

• places of application of the cuff: on the shoulder, on the wrist, on the finger;
• cuff inflation mechanism: mechanical, semi-automatic and automatic;
• ways to visualize the result: mechanical (show by the pressure gauge arrow), electronic (display numbers on the screen), mercury (pressure is shown by a mercury column).

It is believed that mechanical blood pressure monitors give the most accurate result, they are preferred by doctors.

Automatic and semi-automatic blood pressure monitors are easier to use; in order to take measurements with their help, you do not need to have acute hearing, which is often lost in the elderly. Such devices are easier to use, have a fairly large screen, but are inferior to mechanical ones in accuracy.

Tones N.S. Korotkov

N.S. Korotkov in the course of his research drew attention to the fact that when squeezing the main vessels, sounds are heard that can be used to judge the blood pressure in these vessels.

The sounds that are heard through the phonendoscope at the same time are called the tones of N. S. Korotkov. He singled out several phases of sounds that appear with a gradual decrease in pressure in the cuff worn on the patient's shoulder. The key is the appearance of sounds in the phonendoscope at the moment when the pressure in the cuff becomes close to systolic and their complete disappearance, occurring at a pressure equal to diastolic (the last clear tone).

Manipulation

The distal end of the cuff should be at a distance of 1-2 cm from the elbow

Technique for measuring blood pressure with a manual mechanical tonometer, performed by a doctor:

• The cuff is placed on the patient's shoulder in such a way that the middle of the pneumochamber is in the projection of the brachial artery. For convenience, there is a corresponding mark on the cuff. The doctor's fingers are on the wrist in the projection area radial artery, the doctor probes the pulse.
• With the help of a pear, air is quickly pumped into the cuff, while the doctor notes the value on the pressure gauge corresponding to the disappearance of the pulsation of the artery under the fingers and pumps air another 20 mm Hg. Art. (The value at which the pulse disappears corresponds to the systolic pressure). The membrane of the phonendoscope is superimposed on the projection of the brachial artery in the area of ​​the elbow bend.
• Next, the pressure in the cuff is slowly released, smoothly opening the valve on the pear-supercharger (approximately 2 mm Hg per 1 second), and note the exact value at which Korotkov's tones are heard. This is systolic pressure.
• The division corresponding to the disappearance of Korotkoff sounds indicates the value of diastolic blood pressure.

The algorithm for measuring blood pressure in babies does not have significant features and rules. If it becomes necessary to measure a newborn or baby, then tonometers with a special cuff are used for this. Otherwise, the algorithm of the procedure itself does not change.

In pregnant women, blood pressure is measured regularly, allowing you to control the general condition future mother Therefore, the correct technique for performing the manipulation is extremely important.

Measurement of blood pressure of a pregnant woman takes place at each visit to the gynecologist

Errors

The following errors should be avoided:

• It is not allowed to apply the cuff over clothing, it should not form folds that squeeze the arm.
• An error is the location of the phonendoscope membrane under the cuff. In this case, a distorted diastolic blood pressure value will be obtained.
• Using a cuff with the wrong diameter.
• Too rapid pressure reduction in the cuff.
• Peripheral pulsation (on the radial artery) is not evaluated at the first measurement.
• In older people, the vascular wall is no longer as elastic as in younger people, and in order to compress such an artery, a higher pressure in the cuff is required, which does not correspond to the level of pressure in the vessel. This explains the phenomenon of "pseudohypertension". The correct technique for performing the manipulation, namely, palpation of the pulse on the radial artery, helps to avoid mistakes.

Measurements on both hands

When measuring blood pressure, the algorithm includes its control on both arms and if the difference in values ​​is more than 10 mm Hg. Art., sometimes this may be the only sign of peripheral arterial disease. The child or young person in this case may have vascular anomaly, and in adults and elderly patients, different blood pressure on the extremities most often develops due to the progression of obliterating atherosclerosis.

In any case, it is necessary to seek help from a specialist as soon as possible.

Pressure above normal

Raise blood pressure is diagnosed when, subject to the correct algorithm and technique for its measurement, the level of blood pressure rises above 140/90 mm Hg. Art. Then they talk about the development of hypertension. Otherwise, the disease may be asymptomatic, especially on early stages. But even at the very beginning, the attention of the attending physician and following his recommendations are required.

Uncontrolled high blood pressure increases the risk of heart attacks and strokes

Only regular monitoring of blood pressure and keeping it within the normal range can help prevent many complications. hypertension. Therefore, absolutely everyone should own an algorithm of actions that will allow, if necessary, to measure blood pressure.

To determine the activity of the heart, vascular system and kidneys, it is necessary to measure blood pressure. The action algorithm for determining it must be followed in order to obtain the most accurate numbers.

It is known from medical practice that the timely determination of pressure helped a large number patients do not become disabled and saved the lives of many people.

The history of the creation of measuring devices

For the first time, blood pressure was measured in animals by Hales in 1728. To do this, he inserted a glass tube directly into the horse's artery. After that, Poiseuille added a mercury scale manometer to the glass tube, and subsequently Ludwig invented a float kymograph, which made it possible to record continuously. These devices are equipped with mechanical stress sensors and electronic systems. Direct blood pressure by vascular catheterization is used for scientific purposes in diagnostic laboratories.

How is blood pressure formed?

Rhythmic contractions of the heart include two phases: systole and diastole. The first phase - systole - is the contraction of the heart muscle, during which the heart pushes blood into the aorta and pulmonary artery. Diastole is the period during which the chambers of the heart expand and fill with blood. This is followed by systole and then diastole. Blood from the largest vessels: the aorta and pulmonary artery passes the way to the smallest - arterioles and capillaries, enriching all organs and tissues with oxygen and collecting carbon dioxide. Capillaries pass into venules, then - into small veins and into larger vessels, and finally - into veins that approach the heart.

Blood pressure and heart

When blood is ejected from the cavities of the heart, the pressure is 140-150 mm Hg. Art. In the aorta, it decreases to 130-140 mm Hg. Art. And the farther from the heart, the lower the pressure becomes: in the venules it is 10-20 mm Hg. Art., and blood in large veins - below atmospheric.

When blood is poured out of the heart, a pulse wave is recorded, which gradually fades away as it passes through all the vessels. The speed of its spread depends on the magnitude of blood pressure and the elasticity or elasticity of the vascular walls.

With age, blood pressure rises. In people from 16 to 50 years old, it is 110-130 mm Hg. Art., and after 60 years - 140 mm Hg. Art. and higher.

Ways to measure blood pressure

There are direct (invasive) and indirect methods. In the first method, a catheter with a transducer is inserted into the vessel and blood pressure is measured. The algorithm of this study is such that with the help of a computer, the signal control process is automated.

Indirect way

The technique of measuring blood pressure indirectly is possible by several methods: palpation, auscultation and oscillometric. The first method involves gradual squeezing and relaxation of the limb in the region of the artery and finger determination of its pulse below the place of compression. Rivva-Rocci at the end of the 19th century proposed the use of a 4-5 cm cuff and a mercury pressure gauge scale. However, such a narrow cuff overestimated the true data, so it was proposed to increase it to 12 cm in width. And at present, the technique for measuring blood pressure involves the use of this particular cuff.

The pressure in it is pumped up to the point where the pulse stops, and then slowly decreases. Systolic pressure is the moment when a pulsation appears, diastolic - when the pulse attenuates or noticeably accelerates.

In 1905 N.S. Korotkov proposed a method for measuring blood pressure through auscultation. A typical device for measuring blood pressure according to the Korotkov method is a tonometer. It consists of cuff, mercury scale. Air is pumped into the cuff with a pear, and then the air is gradually released through a special valve.

This auscultatory method has been the standard for measuring blood pressure for more than 50 years, but surveys show that physicians rarely follow the recommendations, and the technique for measuring blood pressure is violated.

The oscillometric method is used in automatic and semi-automatic devices in the wards intensive care, since the use of these devices does not require constant air injection into the cuff. Blood pressure is recorded on various stages reduction in air volume. Measurement of blood pressure is also possible with auscultatory dips and weak Korotkoff sounds. This method is least dependent on the elasticity of the walls of blood vessels and when they are affected by atherosclerosis. The oscillometric method made it possible to create devices for determining the upper and lower extremities. It allows you to make the process more accurate, reducing the influence of the human factor

Rules for measuring blood pressure

Step 1 - choose the right equipment.

What you will need:

1. Quality stethoscope

2. Correct cuff size.

3. Aneroid barometer or automated sphygmomanometer - a device with a manual inflation mode.

Step 2 - prepare the patient: make sure he is relaxed, give him 5 minutes of rest. For half an hour to determine blood pressure, smoking and drinking alcohol- and caffeinated drinks are not recommended. The patient should sit upright, free the upper part of the arm, position it comfortably for the patient (you can put it on a table or other support), feet should be on the floor. Remove any excess clothing that may interfere with airflow into the cuff or blood flow to the arm. You and the patient should refrain from talking during the measurement. If the patient is in the supine position, it is necessary to place the upper part of the arm at the level of the heart.

Step 3 - choose the correct cuff size depending on the volume of the arm: often errors occur due to incorrect selection of cuffs. Put the cuff on the patient's arm.

Step 4 - Place the stethoscope on the same arm where you placed the cuff, feel around the elbow to find the location of the strongest impulsive sounds, and position the stethoscope over the brachial artery at that location.

Step 5 - Inflate the cuff: Start inflating while listening to the pulse. When pulse waves disappear, you should not hear any sounds through the phonendoscope. If the pulse is not heard, then you need to inflate so that the pressure gauge needle is on the numbers above from 20 to 40 mm Hg. Art., than at the expected pressure. If this value is unknown, inflate the cuff to 160 - 180 mmHg. Art.

Step 6 - Slowly deflate the cuff: deflation begins. Cardiologists recommend slowly opening the valve so that the pressure in the cuff decreases by 2 to 3 mm Hg. Art. per second, otherwise a faster decrease may result in inaccurate measurements.

Step 7 - listening to systolic pressure - the first sounds of the pulse. This blood begins to flow through the patient's arteries.

Step 8 - listen to the pulse. Over time, as the pressure in the cuff decreases, the sounds disappear. This will be the diastolic, or lower pressure.

Checking indicators

It is necessary to check the accuracy of the indicators. To do this, measure the pressure on both hands to average the data. To check the pressure again for accuracy, you should wait about five minutes between measurements. As a rule, blood pressure is higher in the morning and lower in the evening. Sometimes the blood pressure figures are not reliable due to the patient's concern about people in white coats. In that case, use daily measurement HELL. The algorithm of action in this case is the determination of pressure during the day.

Disadvantages of the method

Currently, auscultatory method in any hospital or clinic is used to measure blood pressure. The action algorithm has disadvantages:

Lower SBP and higher DBP than those obtained with an invasive technique;

Susceptibility to noise in the room, various interference during movement;

Need correct location stethoscope;

Poor listening to low intensity tones;

The error of determination is 7-10 units.

This technique for measuring blood pressure is not suitable for a 24-hour monitoring procedure. To monitor the patient's condition in intensive care units, it is impossible to constantly inflate the cuff and create noise. This may negatively affect general condition the patient and cause him anxiety. The pressure readings will be unreliable. In the unconscious state of the patient and increased motor activity his hand cannot be laid at the level of the heart. An intense interference signal can also be created by uncontrolled actions of the patient, so the computer will fail, which will nullify the measurement of blood pressure, pulse.

Therefore, cuffless methods are used in intensive care units, which, although inferior in accuracy, are more reliable, efficient and convenient for constant monitoring of pressure.

How to measure blood pressure in pediatrics?

Measurement of blood pressure in children is no different from the technique for determining it in adults. Only an adult cuff will not fit. In this case, a cuff is required, the width of which should be three-quarters of the distance from the elbow to the armpit. Currently, there is a large selection of automatic and semi-automatic devices for measuring blood pressure in children.

Numbers normal pressure depend on age. To calculate the numbers of systolic pressure, you need to multiply the number of the child's age in years by 2 and increase by 80, the diastolic is 1/2 - 2/3 of the previous figure.

Blood pressure devices

Blood pressure monitors are also called blood pressure monitors. There are mechanical and digital are mercury and aneroid. Digital - automatic and semi-automatic. The most accurate and long-term device is a mercury tonometer, or sphygmomanometer. But digital ones are more convenient and easy to use, which allows them to be used at home.

As is known, normal level blood pressure is the most important physical health. If it is normal, it can be concluded that the person is experiencing serious problems with health. However, the slightest deviation up or down leads to the appearance severe symptoms. During the treatment of any cardiovascular diseases tonometer should be used regularly. Thanks to the use of this device, you can regularly obtain information about systolic and diastolic indicators, making a conclusion about the degree and stage of the disease, the rate of its progression.

Cardiovascular disorders

There is a special algorithm for measuring blood pressure. This figure can vary significantly depending on age. In the absence of any pathologies in a person, blood pressure is approximately at the same level, however, various factors can provoke an excess of the norm: unbalanced nutrition, stress, obesity, fatigue. During the day, slight drops in blood pressure are possible. If the jumps do not exceed 10 mm Hg. Art. for the bottom scores and 20 for the top scores, such changes should not be cause for concern.

People suffering from disorders of the cardiovascular system need to constantly monitor the slightest changes in their well-being. It is extremely important and also convenient to take measurements yourself at home. If you know the algorithm for measuring blood pressure, there should be no difficulties.

Types of instruments for measuring pressure

The first point that you should pay attention to is the choice of a tonometer. As you know, these devices are of two types:

• electronic;
• manual.

Relatively simple and easy to use is an automatic device. Even a child can cope with the instruction manual here. Before starting measurements, it is necessary to correctly position the cuff on the arm. In order for the device to show reliable results, it is important to place it above the elbow, leaving it at the same level as the heart. The remaining steps will be performed automatically by the electronic tonometer. As soon as the measurements are received, the device will transfer them to the screen.

How to use a mechanical device?

In comparison with an electronic device, a mechanical one requires additional effort from the application. However, this does not mean at all that not everyone can cope with a hand-held device at home. After the cuff is put on, it is necessary to pump air into it using a special pump attached to it. The rubber pear-shaped device is squeezed and unclenched in the hand until the device exceeds the expected results by several divisions (40-50 mm Hg). The algorithm of actions for measuring blood pressure in children and adults is practically the same. After the systolic and diastolic readings are obtained, the air from the cuff should be gradually released, which will restore blood circulation.

Algorithm of actions for measuring pressure

It is possible that the result will be above the norm or the expected level. You should not panic, since you can get optimal information only after the procedure has been carried out three times.

sticking to correct technique, an algorithm for measuring blood pressure in children and adults, it is advisable to repeat the process after 20 minutes, and after three hours - one more time:

• Blood pressure measurements should only be taken in a comfortable and comfortable posture. Sitting is considered ideal, in which the hand is placed on the table with the palm up. It is necessary to measure the pressure alternately on both hands.
• The elbow is placed in such a way that it ends up at the same level as the heart.
• The cuff wraps the arm three centimeters higher elbow joint. A stethoscope is applied under the cuff.
• During the procedure, you can not talk and move.
• After 5 minutes, it is advisable to re-measure.

What else needs to be taken into account?

Considering the above algorithm of actions for measuring blood pressure, it is necessary to remember the rules for preparing for the procedure. Reliable results can only be obtained if all the rules below are followed:

• Measure pressure on an empty stomach or a couple of hours after eating - this minimizes the likelihood of measurement errors.
• Do not drink drinks that increase blood pressure (coffee, alcohol) and smoke immediately before the procedure.
• The use of nasal or ocular vasoconstrictor drugs can distort the measurement data.
• The condition of the patient is also of great importance: before the procedure, it is important not to perform physical exertion, to play sports.

Norm of blood pressure in children: calculation formulas

As already mentioned, fundamental differences in the procedure and algorithm for measuring blood pressure in children and adults. However, it should be taken into account that for early age indicators 120/80 only in isolated cases can remain stable. In order to understand whether the results obtained are the norm, you must use the following formula for measuring blood pressure in children:

• In newborn babies, systolic pressure should be in the range of 74-76 mm Hg. Art. Based on this, diastolic can also be calculated, which, with a healthy cardiovascular system in babies, is 50-66% of the upper indicator.
• For children of 1 year of age, the optimal criterion for systolic pressure is an indicator equal to 76 + 2x, where x is the number of months from birth. Lower pressure (diastolic) is calculated according to the same principle (from half to two thirds of the upper value).
• According to the method of measuring blood pressure in children who have reached the age of one, the final indicators should average 90/60 mm Hg. Art.
• In the future, individual blood pressure indicators are determined by the formula 90 + 2x, where x is the number of full years. So the norm is calculated for the upper indicator, and for the lower one the calculation is somewhat different - 60 + x, where x is also the child's age.

These formulas are used to measure blood pressure in childhood all domestic pediatricians.

Choosing a cuff for a child

The technique for measuring blood pressure in children requires additional training. It is especially important to pay attention to the condition of the child: the baby should be extremely calm. After playing and running, it is necessary to wait about 20 minutes for the child's blood pressure to return to normal. In addition, it is desirable to make sure that the size of the cuff used is suitable for the volume of the child's arm. Yes, for kids. different ages produce products with different diameters:

• From birth to reaching the first year of life, babies wear a product that does not exceed 7 centimeters in volume;
• For children under two years old, cuffs are suitable, the diameter of which is from 4.5 to 9 cm.
• After two years - 5.5 - 11 centimeters.
• From four to seven years, the cuff is selected according to a diameter not exceeding 13 cm.
• After the age of seven - up to 15 cm.

Cuff standard sizes used for children over 10 years of age.

How to measure blood pressure in babies?

The algorithm for measuring blood pressure is simple:

1. In a sitting position (for babies - lying down) put left hand on the table, turning its inner surface up.
2. The cuff is superimposed on a couple of centimeters of the higher elbow joint. It is not necessary to pull it strongly on the child’s arm, therefore, free space should be left between the skin and the cuff, about one and a half centimeters.
3. The person performing the measurements needs to feel the place of the pulsation of the artery on the arm with his fingers and attach a stethoscope to it.

Technique for measuring blood pressure for children and adults

If the procedure is carried out using electronic tonometer, then there is nothing left but to wait for the results on the screen. If the device is mechanical, then first you have to inflate the cuff with air to a value of 150-160 mm Hg. Art. After that, carefully turn the valve in the opposite direction and release the air, watching the rate of pressure decrease - it should not be higher than 3-4 mm Hg. Art. in one second.

Systolic and diastolic indicators are determined in the same way in children and adults: when air is released from the cuff, it is important to listen and expect the appearance of a characteristic tapping pulsation. The numbers currently indicated by the needle of the sphygmomanometer are the upper indicator of blood pressure. By fixing the moment when the pulsation ends, you can determine the lower value - diastolic.

Blood pressure measurement - additional method diagnostics, which helps to make an accurate diagnosis and choose the best treatment tactics. To obtain reliable results, you must follow the rules and sequence of actions.

One of key indicators functional state human body is the pressure in large arteries, that is, the force with which blood presses on their walls during the work of the heart. It is measured at almost any visit to the general practitioner, whether it is a program of preventive examinations or treatment of complaints of well-being.

A word about pressure

The blood pressure level is expressed as two numbers written as a fraction. The numbers mean the following: at the top - systolic pressure, which is popularly called the top, at the bottom - diastolic, or bottom. Systolic is fixed when the heart contracts and pushes blood out, diastolic - when it is maximally relaxed. The unit of measurement is a millimeter of mercury. The optimal pressure level for adults is 120/80 mm Hg. pillar. Blood pressure is considered elevated if it is more than 139/89 mm Hg. pillar.

A condition in which its level remains consistently high is called hypertension, and a steady decrease is called hypotension. The difference between the upper and lower should be 40-50 mmHg. Blood pressure changes during the day in all people, but in hypertensive patients these fluctuations are much sharper.

Why you need to know your blood pressure

Even a slight increase in blood pressure increases the risk of heart attack, stroke, ischemia, cardiac and kidney failure. And the higher it is, the greater the risk. Very often, hypertension initial stage proceeds without symptoms, and the person does not even know about his condition.

Measurement of blood pressure is the first thing to do when complaining of frequent headaches, dizziness, weakness.

Hypertensive patients should measure blood pressure every day and monitor its level after taking the pills. People with high pressure can't be drastically reduced. medicines.

Methods for measuring blood pressure

You can determine the level of blood pressure in a direct and indirect way.

Straight

This invasive method is highly accurate, but it is traumatic, since it consists in the direct insertion of a needle into a vessel or cavity of the heart. The needle is connected to the manometer by a tube containing an anticoagulant. The result is a blood pressure fluctuation curve recorded by a scribe. This method is most often used in cardiac surgery.

indirect methods

Usually pressure is measured on peripheral vessels upper limbs, namely on the elbow bend of the arm.

Nowadays, two non-invasive methods are widely used: auscultatory and oscillometric.

First (auscultatory), proposed by the Russian surgeon N. S. Korotkov at the beginning of the 20th century, is based on clamping the shoulder artery with a cuff and listening to the tones that appear when air is slowly released from the cuff. Upper and lower pressures are determined by the appearance and disappearance of sounds that are characteristic of turbulent blood flow. Measurement of blood pressure according to this technique is carried out using a very simple device, consisting of a pressure gauge, a phonendoscope and a cuff with a pear-shaped balloon.

When measuring blood pressure in this way, a cuff is placed on the shoulder area, into which air is pumped until the pressure in it exceeds systolic. The artery at this moment is completely clamped, the blood flow in it stops, the tones are not heard. When air is released from the cuff, the pressure decreases. When the external pressure compares with systolic pressure, blood begins to flow through the squeezed area, noises appear that accompany the turbulent flow of blood. They are called Korotkov's tones, and they can be heard with a phonendoscope. At the moment when they occur, the value on the pressure gauge is equal to the systolic blood pressure. When the external pressure is compared with the arterial pressure, the tones disappear, and at this moment the diastolic pressure is determined by the manometer.

To measure blood pressure according to Korotkov, a mechanical tonometer is used.

The microphone of the measuring device picks up the Korotkov tones and converts them into electrical signals that are fed to the recording device, on the display of which the values ​​\u200b\u200bof the upper and lower blood pressure appear. There are other devices in which the emerging and disappearing characteristic noises are determined using ultrasound.

The method of measuring blood pressure according to Korotkov is officially considered the standard. It has both pros and cons. Among the advantages can be called high resistance to hand movement. There are a few more disadvantages:

• Sensitive to noise in the room where the measurement is taken.
• The accuracy of the result depends on whether the location of the phonendoscope head is correct and on the individual qualities of the person who measures blood pressure (hearing, vision, hands).
• Skin contact with the cuff and microphone head is required.
• It is technically complicated, which causes measurement errors.
• It requires special preparation.

Oscillometric
With this method, blood pressure is measured with an electronic tonometer. The principle of this method is that the device registers pulsations in the cuff that appear when blood passes through the squeezed portion of the vessel. The main disadvantage of this method is that the hand must be motionless during the measurement. There are quite a few advantages:

• For special training not required.
• The individual qualities of the measurer (vision, hands, hearing) do not matter.
• Resistant to indoor noise.
• Determines blood pressure with weak Korotkoff tones.
• The cuff can be put on a thin jacket, while this does not affect the accuracy of the result.

Types of tonometers

Today, aneroid (or mechanical) and electronic devices are used to determine blood pressure.

The former are used to measure pressure by the Korotkoff method in a medical institution, since for home use they are too complex, and untrained users receive measurement errors with errors.

The electronic device can be automatic and semi-automatic. These blood pressure monitors are designed for daily home use.

Everyone can measure their own blood pressure and pulse with an electronic tonometer

General rules for measuring blood pressure

Pressure is most often measured in a sitting position, but sometimes it is done in a standing and lying position.

Daily blood pressure in people is constantly changing. It increases with emotional and physical activity. It can be measured not only in calm state, but also during physical activity, as well as in between different types loads.

Since the pressure depends on the condition of the person, it is important to provide the patient with a comfortable environment. The patient himself needs not to eat, not to engage in physical labor, not to smoke, not to drink alcoholic beverages, not to be exposed to cold for half an hour before the procedure.

During the procedure, you can not make sudden movements and talk.

It is recommended to take measurements more than once. If a series of measurements is taken, a break of about one minute (at least 15 seconds) and a change of position are needed between each approach. During the break, it is recommended to loosen the cuff.

The pressure on different hands can vary significantly, in connection with this, it is better to take measurements on the one where the level is usually higher.

There are patients whose pressure in the clinic is always higher than when measured at home. This is due to the excitement that many experience at the sight of medical workers in white coats. For some, this can happen at home, this is a reaction to the measurement. In such cases, it is recommended to take measurements three times and calculate the average value.

The procedure for determining blood pressure in different categories of patients

In the elderly

In this category of persons, unstable blood pressure is more often observed, which is associated with disturbances in the blood flow regulation system, a decrease in vascular elasticity, and atherosclerosis. Therefore, elderly patients need to take a series of measurements and calculate the average value.

In addition, they need to have their blood pressure measured while standing and sitting, as they often experience sudden drops in blood pressure when changing positions, such as getting out of bed and sitting up.

In children

Children are recommended to measure blood pressure with a mechanical sphygmomanometer or an electronic semi-automatic device, while using a children's cuff. Before you measure your child's blood pressure yourself, you need to consult a pediatrician about the amount of air injected into the cuff and the time of measurement.

In pregnant women

By blood pressure, you can judge how well the pregnancy is proceeding. For expectant mothers, it is very important to constantly monitor blood pressure in order to start treatment on time and avoid severe complications at the fetus.

Blood pressure monitoring is essential during pregnancy

Pregnant women need to measure the pressure in a semi-recumbent state. If its level exceeds the norm or, conversely, is much lower, you should immediately contact your doctor.

With cardioarrhythmia

People who have a broken sequence, rhythm and heart rate need to measure blood pressure several times in a row, discard obviously incorrect results and calculate the average value. In this case, the air from the cuff must be released at a lower speed. The fact is that with cardioarrhythmia, its level can vary significantly from stroke to stroke.

Algorithm for measuring blood pressure

Measurement of blood pressure should take place in the following order:

1. The patient is seated comfortably on a chair so that his back is adjacent to the back, that is, he has support.
2. The hand is freed from clothing and laid on the table with the palm up, placing a towel roller or the patient's fist under the elbow.
3. A tonometer cuff is applied to the bare shoulder (two or three centimeters above the elbow, approximately at the level of the heart). Two fingers should pass between the arm and the cuff, its tubes pointing down.
4. The tonometer is at eye level, its arrow is at zero.
5. Find the pulse in the cubital fossa and apply a phonendoscope to this place with a slight pressure.
6. A valve is screwed on the pear of the tonometer.
7. The pear-shaped balloon is compressed and air is pumped into the cuff until the pulsation in the artery ceases to be heard. This occurs when the pressure in the cuff exceeds 20-30 mm Hg. pillar.
8. The valve is opened and air is released from the cuff at a rate of about 3 mmHg. pillar, while listening to Korotkov's tones.
9. When the first constant tones appear, the pressure gauge readings are recorded - this is the upper pressure.
10. Continue to release air. As soon as the weakening Korotkoff tones disappear, the readings of the pressure gauge are recorded - this is the lower pressure.
11. Release air from the cuff, listening to tones, until the pressure in it becomes equal to 0.
12. The patient is allowed to rest for about two minutes and the blood pressure is measured again.
13. The cuff is then removed and the results recorded in a diary.

Correct position of the patient during blood pressure measurement

Wrist Blood Pressure Technique

To measure blood pressure at the wrist with an electronic device with a cuff, you need to follow next instruction:

• Remove watches or bracelets from your arm, unbutton the sleeve and fold it back.
• Position the cuff of the tonometer above the hand by 1 centimeter with the display facing up.
• Place the arm with the cuff on the opposite shoulder, palm down.
• With the other hand, press the "Start" button and put it under the elbow of the arm with the cuff.
• Remain in this position until the air is automatically released from the cuff.

This method is not suitable for everyone. It is not recommended for people with diabetes, atherosclerosis and other circulatory disorders and changes in the vascular walls. Before using such a device, you need to measure the pressure with a tonometer with a cuff on the shoulder, then with a cuff on the wrist, compare the values ​​\u200b\u200band make sure that the difference is small.

The wrist tonometer has both advantages and disadvantages.

Possible errors in measuring blood pressure

• Mismatch between cuff size and arm circumference.
• Wrong hand position.
• Inflating the cuff too fast.

What to consider when measuring pressure

• Stress can significantly change the readings, so you need to measure it in a calm state.
• Blood pressure rises with constipation, immediately after eating, after smoking and drinking alcohol, with excitement, in a sleepy state.
• It is best to carry out the procedure one to two hours after eating.
• It is necessary to measure blood pressure immediately after urination, since it is elevated before urination.
• The pressure changes after taking a shower or bath.
• To change the readings of the tonometer can be located nearby mobile phone.
• Tea and coffee can change blood pressure.
• To stabilize it, you need to take five deep breaths.
• It increases when you are in a cold room.

Conclusion

Determination of blood pressure at home follows the same principle as in medical institution. The algorithm for measuring blood pressure remains approximately the same, but when using an electronic tonometer, the execution technique is noticeably simplified.

Equipment: tonometer, phonendoscope, guard temperature sheet, pen.

Algorithm for performing manipulation:

1. Establish a trusting relationship with the patient, explain the purpose and course of the manipulation, obtain his consent.

2. Wash, dry your hands.

3. Prepare everything you need.

4.Sit the patient to the table or give a comfortable position, lying on his back.

5. Place the patient's arm in an extended position, palm up.

6. Place the hand of his free hand clenched into a fist or a towel rolled into a roller under the elbow.

7. Release the patient's shoulder from the clothing sleeve.

8. Place the cuff of the tonometer on the bare shoulder 2-3 cm above the elbow (at the level of the heart) so that 1-2 fingers pass between it and the shoulder.

9. Point the cuff tubes down.

10. Check the position of the arrow of the tonometer (should coincide with the "0" mark), place it at eye level.

1. Palpate the pulse in the cubital fossa on the brachial or radial artery.

12. Attach a phonendoscope to the site of arterial pulsation, pressing lightly.

13. Close the valve on the pear-shaped balloon of the tonometer.

14. Inject air into the cuff (squeezing the pear-shaped balloon) until the pressure in the cuff, according to the pressure gauge, does not exceed 20-30 mm. rt. Art. the level at which the pulsation of the artery ceases to be determined (listened to).

15. Open the valve of the pear-shaped balloon and at a constant speed of 2-3 mm Hg. st let out air from the cuff, at the same time listen to Korotkov's tones (noises) with a phonendoscope.

16. Note the readings of the manometer at the time of the appearance of the first consecutive tones - this corresponds to the value of systolic blood pressure.

18. Note the moment of disappearance (and not their muting) of Korotkov's tones - this corresponds to the value of diastolic blood pressure.

19. Release air from the cuff, listening to Korotkoff's tones, to the level of pressure in the cuff equal to "0".

20. Allow the patient to rest for 1-2 minutes.

21. Measure blood pressure again.

22. Remove the cuff, give the patient a comfortable position (sitting or lying down).

23. Write down the data obtained in the sentry temperature sheet (fraction), inform the patient.

24. Wash, dry hands.