Presentation on theme: "Blood Pressure Measurement Mini Course Blood Pressure Measurement Mini Course Based upon the BP measurement course created by the Virginia Department of."— Presentation transcript:
Blood Pressure Measurement Mini Course Blood Pressure Measurement Mini Course Based upon the BP measurement course created by the Virginia Department of Health’s Heart Disease and Stroke Prevention Branch “Miniaturized” by by: NC Department of Health’s Heart Disease and Stroke Prevention Branch and multiple partners.
Virginia BP Measurement Course (VA BPMC) The “VA Blood Pressure Training Classes for Health Care Professionals” course: An extensive review of Cardiovascular disease plus a clinical skills component. Information on the larger course is available at: Today’s DVD is available for free by calling sentara. CEU’s available by following the instructions provided with the DVD’s you can receive in the mail from Sentara.
NC BP “mini” Developed with feedback from NC’s public health and health care workforce. Need for a mini “lunch time” length course. Best to focus on how to accurately take a BP incorrect technique and inaccurate equipment results in over and under diagnosis of hypertension. How can we really address BP control, if we are not measuring it consistently?
But First……Where do you take BP’s and who is your patient population? Describe your clinical setting. Community Health Center Health Department Private Ambulatory Care Practice (or hospital or health system) Hospital (Inpatient, out reach, other) Emergency Service Provider (i.e. EMT) Worksite Community based organization (faith based, coalitions, etc) Other _______ Who are the patients you serve? (check all that apply) Over 20% minority populations Mainly Privately insured populations (BCBS, Tricare, Aetna, etc) Mainly Medicaid population Mainly Medicare population Mainly rural residents Mainly urban residents
How many patients or citizen encounters do you have PER MONTH in your setting? Less than 50 50- ≤ 100 More than 300 per month
Today we will…. Review different manometers. Review correct technique and patient positioning. Review Korotkoff sounds (DVD). Learn how to check your aneroid devices for accuracy.
Types of BP Measuring Devices Mercury-Gravity Manometer The Gold standard. Used less frequently due to safety concerns. Must inflate cuff and listen to Korotkoff sounds. Recalibration is unnecessary. Useful for checking accuracy of other BP devices.
Types of BP Measuring Devices Aneroid manometer Must inflate cuff and listen to Korotkoff sounds. Need to be checked for accuracy (every 6 months, can be checked against a mercury device). NOTE: The dial at the zero mark of an aneroid manometer under no pressure does not mean that the instrument is accurate, routine calibration is necessary.
Types of BP Measuring Devices Cont. Automated Electronic Devices Detects “oscillations” (pulsations) in the brachial artery. Proprietary mathematical algorithms are used to calculate the systolic and diastolic BP. Can be accurate and reliable. Need to be checked for accuracy as recommended by manufacturer (send out?). provides a grading scale for how well hundreds of BP devices have been validated.www.dableducational.org
Why might a BP reading not be reflective of a clients “true” BP? Errors
Physiological Variations Anxiety Stress Eating Full bladder Hot or cold environments Pain Nicotine Caffeinated beverages Over the counter and prescription medications
Errors Equipment: Wrong cuff size, equipment out of adjustment (especially aneroid gauges), cracks in tubing. Screener: Impaired eyesight and/or hearing, subconscious biases (previous reading bias, cut point bias, terminal digit preference). Poor technique. Client: Impact of positioning and/or conditions under which the BP is being measured.
Note bladder is smaller than surrounding material! bladder Anatomy of a BP cuff
picture from Find the bladder by feeling it or if possible pulling a little bit of the bladder out of the cuff!
For adults: The bladder of the cuff length must encircle at least 80% of the upper arm circumference (100% in children). The width of the bladder must encircle at least 40% of the arm circumference % of arm circumference 40%
Additional checks The lower edge of the cuff should be at least 1” (2-1/2 cm) above the bend in the elbow (antecubital fossa). Palpate brachial artery (you may need to straighten arm to feel the brachial pulse). Place the middle of the bladder over the brachial artery. Wrap the cuff smoothly and snugly around the arm. Test for proper cuff application by placing both thumbs under the applied cuff and tug gently; the cuff should not move. Are the ear pieces of your stethoscope pointed the right way?
Positioning Seated with feet on the floor and back well supported (no crossed legs!). An effort should be made to help the client relax. No smoking or caffeine for 30 minutes prior to the procedure. Sleeveless BP cuff applications are preferred. The arm should be slightly flexed, the palm of the hand up, with the entire forearm supported on a smooth, flat surface. The brachial artery must be at heart level.
Taking the BP
What is this person checking for?
Maximum Inflation Level (MIL) This technique can help you know how high to inflate the BP cuff! Determining the Maximum Inflation Level (MIL) Apply the pressure cuff. Locate the radial pulse. Palpate the radial pulse while steadily inflating cuff & watching the mercury column or aneroid gauge. Note the point on the mercury column or aneroid gauge at which the radial pulse disappears. The point at which the radial pulse disappeared is approximately the same as the client’s systolic BP. Rapidly deflate the cuff.
Taking the blood pressure After determining the MIL, wait 15 to 20 seconds before measuring BP with stethoscope. Before inflating the cuff, squeeze the bladder to release all air and thus ensure that the pressure level is at zero. After the 15 to 30 second wait, palpate the brachial pulse and place the stethoscope head directly over the brachial pulse make sure head of stethoscope is NOT touching the cuff or tubing.
How to Take an Accurate BP cont. With stethoscope in place, close valve and by rapidly & steadily squeezing the bulb, inflate the cuff mmHg above the point where the pulse disappeared in the MIL steps. Open the valve and begin deflation of the cuff. Maintain a constant deflation rate of 2-3 mmHg per second. Continue to listen to about 10 mm below where the last sound was heard.
Record the BP Systolic BP: the point at which the first of two or more continuous sounds are heard. Diastolic BP: recorded at the disappearance of sound (also called the onset of silence), not at the last sound. Subtract 2mmHg from the last sound you hear. (e.g. if the last sound is at 80mmHg, the diastolic BP is 78mmHg!) Read to the nearest even number. If the reading falls between two numbers, read the number above. We will practice this with the DVD!
*CLASS EXERCIZE 1* Review as a class how to check for the bladder size within BP cuffs, how to choose the right size cuff for each person and how to determine the MIL. This requires participants to be in groups of at least 2. Participants should practice sizing technique with at least 2 different sized cuffs.
*CLASS EXERCIZE 1* Measure a partners arm with 2 different cuffs. Determine your partners MIL.
Korotkoff sounds Phase 1: TAPPING, The first appearance of clear, tapping sounds that gradually become louder. Phase 2: SWISHING, The sounds change to a murmur and have a swishing sound. Phase 3: KNOCKING, The sounds have a loud, knocking quality, but are not quite as clear as those in Phase 1. Phase 4: MUFFLING, The sounds suddenly are muffled and again have a faint, swishing quality. Phase 5: NO SOUND, All sounds disappear (often referred to as the onset of silence).
Also available at Contact Hours on this material available! SENTARA *CLASS EXERCIZE 2* Korotkoff sounds and DVD. Practice determining the BP with a mercury and aneroid manometer.
A few more items Checking your own aneroid manometers for accuracy against a Mercury device. JNC – 7 BP categories BP stages BP Goals
Aneroid Check for Accuracy Technique Are your aneroid gauges accurate? See Appendix D: NC BP mini Manual
Normal blood pressure in adults (age 18 and older) is: less than 120 mmHg (systolic) and less than 80 mmHg (diastolic) Prehypertension is: mmHg (systolic) or mmHg (diastolic) Hypertension (high blood pressure) is: 140 or higher mmHg (systolic) or 90 or higher mmHg (diastolic) JNC 7
Definitions: Hypertension (HBP) stages (in mmHg): SystolicDiastolic Stage 1 HTN or Stage 2 HTN >160or >100
Other terms and issues Isolated systolic hypertension occurs when the systolic blood pressure is elevated 140 mmHg but the diastolic remains 90 mmHg (more common in the elderly). Importance of diastolic and systolic BP: It was thought that diastolic BP was the most important and many still believe this due to when they were trained. Recent research has determined that systolic BP is actually more important as it is a better predictor of future complications (especially in those aged 65 and over). Ref: Pastor-Barrluso Annals of Internal Medicine 2003.
Goals General Population (keep an eye out for JNC 8 !) less than 140 mmHg (systolic) and less than 90 mmHg diastolic Goal for diabetic adults, people w/ Chronic Kidney Disease less than 130 mmHg (systolic) and less than 80 mmHg (diastolic)
The END and The Challenge What changes can you make in your clinics to improve blood pressure measurement? How will you check to see if your efforts are sustained?
What items were helpful today? Learning/reviewing how to choose the appropriate cuff size. Learning/reviewing the different types of manometers. Learning/reviewing the MIL technique. Learning/reviewing the BP taking technique. Learning/reviewing Korotkoff sounds. Reviewing JNC – 7 definitions