1. Blood pressure measurement using mercury sphygmomanometers EHES Training Material

2. Exclusion criteria Blood pressure is not measured If a participant has open wounds/sores on both arms severe rash on both arms both arms amputated cast on both arms malformation on both arms preventing to place the cuff lymph node malfunction in both arms If the participant refuses

3. Instruction to the participants Before blood pressure measurement, ask if the participant has abstained from recently eating drinking (except water) smoking heavy exercise alcohol use If the participant needs to empty bladder

4. Equipment Sphygmomanometer Cuffs Watch and thermometer Stethoscope Measurement tape Stop watch Something to elevate the device

5. Setting up the measurement site The room should be quiet comfortable temperature no disturbance Place the device so that you can see the mercury bar clearly the participant cannot see the mercury bar the mercury bar is at your eye level

6. Position of the subject Participant is sitting back supported feet resting firmly on the floor feet not crossed Check that the position of the participant does not change during the measurement Feet resting on the floor, not crossed Back supported

7. Position of the arm Take the measurement from the right arm Arm resting on the desk or arm rest antecubital fossa at the level of the heart if needed, adjust the chair or use a pillow to elevate the arm Palm facing up Right arm, resting on the desk Palm facing up In line with the heart

8. Clothing Roll sleeves up, if not constrictive Undress constrictive sleeves

9. Measurement process Ask the participant to sit still for 5 minutes not to talk or move during the measurement Explain that you will tell the measurement results after all 3 measurements are taken Measure arm circumference and select cuff

10. Selection of the cuff Measure the greatest circumference of the upper arm The bladder of the cuff should be width: At least 40% of the arm circumference length: At least 80% of the arm circumference

11. Placement of the cuff Place the cuff on right arm about 2-3 cm above the antecubital fossa Check that the top edge of the cuff is not restricted by clothing Check that the cuff is not too tide one finger fits between the cuff and the arm Cuff 2-3 cm above antecubital fossa

12. Measurement of pulse rate Palpate the radial pulse and count the pulse rate for 60 seconds Record 60 sec pulse count and whether or not the pulse was regular

13. Use of the stethoscope Use the bell of the stethoscope Check that the bell is not touching the cuff, rubber or clothing Place inside the bicep muscle tendon Inside the bicep muscle tendon Not touching the cuff, rubber or clothing

14. Determination of the peak inflation level Palpate the radial pulse Inflate the cuff to the level when the radial pulse disappears plus 30 mmHg

15. Measurement of blood pressure (1/3) Wait at least 30 seconds after the determination of the peak inflation level Locate the brachial pulse Place the stethoscope immediately below the cuff at the point of maximal pulsation

16. Measurement of blood pressure (2/3) Rapidly inflate the cuff to the peak inflation level Deflate at the rate of 2 mmHg per second Determine blood pressure Systolic bp: Korotkoff Phase I The first appearance of a clear repetitive tapping sound Diastolic bp: Korotkoff Phase V The disappearance of the repetitive sounds

17. Measurement of blood pressure (3/3) Deflate the cuff rapidly by fully opening the valve of the inflation bulb Wait 1 minute Make the 2 nd measurement Wait 1 minute Make the 3 rd measurement

18. Recording of the results Record room temperature time of the blood pressure measurement pulse for 60 seconds results of the 3 blood pressure measurements all exceptions Record the results in the participant’s feedback form and explain the results to the participant

19. Acknowledgements Slides Hanna Tolonen, Päivikki Koponen Photographs Hanna Tolonen Measurement demonstrations Liisa Saarikoski, Marika Strand, Anne Söderqvist, Kari Kuulasmaa, Ari Haukijärvi, Shadia Rask, Katri Kilpeläinen, Vesa Tanskanen, Ulla Leskinen, Marja Lampola