01 Sphygmomanometry for alied health pptx

BP

1. CLINICAL OPTOMETRIC PROCEDURES 2 Sphygmomanometry (Blood pressure)

2. Authors Luigi Bilotto Brien Holden Vision Institute Peer Reviewer Dr Cédric Yansouni McGill University Editors Brien Holden Vision Institute, Public Health Division Brien Holden Vision Institute Foundation (formerly ICEE) is a Public Health division of Brien Holden Vision Institute COPYRIGHT © 2013 Brien Holden Vision Institute. All rights reserved. This publication is protected by laws relating to copyright. Except as permitted under applicable legislation, no part of this publication may be adapted, modified, stored in a retrieval system, transmitted or reproduced in any form or by any process, electronic or otherwise, without the Brien Holden Vision Institute’s (The institute) prior written permission. You may, especially if you are from a not-for-profit organisation, be eligible for a free license to use and make limited copies of parts of this manual in certain limited circumstances. To see if you are eligible for such a license, please visit http://education.brienholdenvision.org/ . DISCLAIMER The material and tools provided in this publication are provided for purposes of general information only. The Institute is not providing specific advice concerning the clinical management of any case or condition that may be mentioned in this publication, and the information must not be used as a substitute for specific advice from a qualified professional. The mention of specific companies or certain manufacturers’ products does not imply that those companies or products are endorsed or recommended by the Institute in preference to others of a similar nature that are not mentioned. The Institute makes no representation or warranty that the information contained in this publication is complete or free of omissions or errors.  To the extent permitted by law, the Institute excludes all implied warranties, including regarding merchantability and fitness for purpose, and disclaims any and all liability for any loss or damage incurred as a result of the use of the material and tools provided .

3. Sphygmomanometry The measurement of blood pressure (BP) A useful complementary test of an optometric assessment. Screening method for the patient with suspected or poorly controlled hypertension and cardiovascular disease.

4. Sphygmomanometry May also be valuable when pharmacological agents are used in eye care some medication may have potentially deleterious side effects in people with severe hypertension or cardiovascular problems. BP measurement is useful in the diagnosis and management of both ocular and systemic diseases, some of which can be sight-threatening or even fatal.

5. Sphygmomanometry Clinical conditions where BP Measurement complements the clinical diagnosis: Chronic open angle glaucoma Low tension glaucoma Repeated spontaneous subconjunctival hemorrhages Hypertensive retinopathy Retinal embolic phenomena Transient ischemic attacks Amaurosis fugax Headache Papilledema

6. THEORY Arterial pressure varies during the cardiac cycle. At the end of the ventricular contraction, when the ventricle finishes pumping blood into the aorta, the arterial pressure within the vascular system reaches the maximal systolic pressure. As the ejected blood is distributed throughout the vascular system during the relaxation phase of the ventricle, arterial pressure gradually decreases to reach the minimal diastolic pressure.

7. THEORY Systolic and diastolic pressure can be measured directly by inserting a catheter into a major artery that is connected to a manometer or electronic recording device. This is an invasive method used principally in critical care settings or in animals for experimental purposes.

8. THEORY 75 125 Systolic pressure Mean pressure Diastolic pressure mmHg Pressure in the arterial system during single cardiac cycle

9. THEORY Clinically, blood pressure is usually evaluated indirectly by wrapping an inflatable bladder around the arm to oppose the pressure in the brachial artery and listening to the resulting Korotkoff sounds.

10. THEORY Consider an air-filled bladder wrapped around the upper arm If the pressure in the bladder is increased until its pressure is higher than the highest arterial pressure (systolic pressure), the brachial artery will collapse and blood flow will cease. at which time no Korotkoff sound will be heard

11. THEORY As the bladder pressure is decreased by releasing air from an adjustable valve, blood in the brachial artery will first flow when the pressure within the artery is slightly greater than the pressure compressing it (systolic pressure  bladder pressure). At this point, a first Korotkoff sound will be heard.

12. THEORY

13. INSTRUMENTATION Using the above principle, the arterial pressure is measured with a sphygmomanometer and a stethoscope. The sphygmomanometer or blood pressure meter is a device composed of an inflatable bladder that can be wrapped and tied around the arm The bladder is connected to a measuring device Pressure cuffs are available in various sizes for the newborn, infant, child, adult, and large adult The stethoscope, an instrument used to amplify the Korotkoff sounds, generally consists of earpieces, binaural, rubber tubing and a chest piece.

14. PROCEDURE Clean earpieces of the stethoscope Ensure patient is rested Roll up sleeves The arm is then positioned with the palm facing upward Locate the brachial artery Wrap the cuff securely Insure proper alignment of the middle of the cuff

15. PROCEDURE Palpate the radial pulse with the index & middle fingers Make sure the cuff is approximately at the level of the heart. Inflate the cuff at ~ 20-30 mmHg above the point at which the radial pulse disappears Place the stethoscope diaphragm over the brachial artery Deflate the cuff by increments of 2-3 mmHg, listening for first (systolic) & last (diastolic) Korotkoff sounds Wait 1 minute and repeat the procedure

16. SOURCES OF ERRORS Sources of variability Diurnal Variation Interobserver variability Arm used Weak or inaudible Korotkoff sounds Orthostatic hypotension

17. SOURCES OF ERRORS Falsely Low or High Readings can be caused by the following: Cuff fitting Cuff deflation speed Arm position Patient anxiety, fear emotional distress

18. NORMAL BP RANGES - ADULTS < 95/60 Hypotension Diastolic < 85 85-89 90-104 105-115 > 115 Normal BP High-normal BP Light hypertension Moderate hypertension Severe hypertension Systolic < 140 140-159 > 160 > 200 (when diastolic < 90) Normal BP Borderline isolated systolic HTN Isolated systolic HTN None given

19. NORMAL BP RANGES - CHILDREN < 135/90 < 125/85 < 120/80 < 110/75 Ages 14-18 years Ages 10-14 years Ages 6-10 years Less than 6 years

20. REFERENCE Eskridge , J.B., Clinical Procedures in Optometry, Lippincott Williams & Wilkins, January 1991.