| Table
3: |
|
Proper
Measurement of Blood Pressure in the Office
|
Step 1
All measurements should be performed by individuals experienced in
the techniques of blood pressure assessment and using standardized
equipment. Measurements should be taken in a quiet, well-lit environment.
All measurements should occur at least 30 minutes after the last ingestion
of caffeine, alcohol, or nicotine. The patient should be allowed 3
to 5 minutes of rest before measurement. The observer must be able
to view the manometer at eye level. |
Step
2
The patient's upper arm is exposed and the patient is positioned in
the proper manner for the reading, with the arm supported at the level
of the heart. Seated patients may have their arms rest on a table,
with back support and feet flat on the floor. Supine patients' arms
may lie passively in extension, with a small pillow supporting the
arm and bringing the cuff to the level of the chest. Standing patients
require the arm be supported in such a manner as to eliminate exertion
and bring the cuff to the level of the chest. |
Step
3
The patient's bare upper arm is evaluated for the appropriate size
cuff (see Table 4).
No tight or constrictive clothing should be present on the limb, ie,
avoid rolling up a sleeve to expose the arm. |
Step
4
The cuff is placed on the patient's bare upper arm, with the lower
edge of the cuff 2.5 cm above the antecubital fossa. The midline of
the bladder of the cuff should lie over the path of the artery. |
Step
5
The cuff is rapidly inflated to 70 mm Hg and then steadily inflated
by 10-mm Hg increments while the examiner simultaneously palpates
the patient's brachial or radial artery pulsation. At the point at
which the pulse is no longer palpable, the cuff is deflated. Note
the pressures at which the pulse is obliterated on insufflation and
reappears on desufflation. This determines how high to inflate the
cuff on subsequent readings. |
Step
6
Wait 15 to 30 seconds, then place the bell head of the stethoscope
over the brachial artery. Inflate the cuff to a pressure 30 mm Hg
above the pressure noted in step 5. |
Step
7
Allow the cuff to slowly deflate at a rate of 2 mm Hg per second while
listening for repetitive sounds. |
Step
8
Record the pressure at which the first of at least two repetitive
sounds is heard. This is the systolic pressure (phase 1 sounds). Adjust
the valve such that the cuff deflates at a rate of 2 mm Hg per beat. |
Step
9
Record the
pressure at which the last regular sound is heard. This is the diastolic
pressure (phase 5 sounds). Continue to listen during full deflation
to confirm disappearance of the heart sounds. Record the pressures,
and round the systolic and diastolic pressures upward to the nearest
2 mm Hg if necessary. |
Step
10
Repeat the above steps to obtain blood pressure recordings in both
arms or in different positionsa. Allow 2 minutes of rest
between recordings. |
a
Generally, 2 or more readings are obtained and the average of the
two is used as the blood pressure for each limb tested. Both arms
should be tested, and the higher value considered as the blood pressure.
If the 2 readings in any limb differ by more than 5 mm Hg, additional
readings are suggested until this wide discrepancy is clarified.
Adapted from reference 4. |