Blood pressure and heart rate monitoring is the most affordable and convenient way to determine the state of the cardiovascular system. And about how to measure the pressure with a mechanical tonometer, medical workers repeatedly tell. However, patients still make mistakes that guide their medication decisions.
Sequence of measurement steps
How to correctly measure pressure with a mechanical tonometer does not depend on the emotional mood of the patient, conditions and place of his stay. This is a set of rules, the violation of which directly affects the result. Before measuring, you need to rest from any load for 10-30 minutes and take a sitting position, stretching your legs forward and relaxing them, straightening your neck.
The cuff is applied to the middle third of the forearm in an extendedrelaxed limb, laid on the table with the palm up. The forearm is pushed forward so that the cubital fossa is at the level of the heart in height. From now on, the hand should not move anywhere, but lie relaxed in this position.
A stethoscope is put on the ears (not on the neck), and a pear is pumped up with the free hand with pulsation tracking on the wrist. After its termination, an additional 20 mmHg is injected and air is released, a tone is determined that will show the level of systolic pressure. As the air is slowly released, the tones, that is, the pulsation of the brachial artery, will increase and subside later.
The moment when the tones stop - the level of diastolic pressure (DBP). In the case of the phenomenon of infinite tones, the moment of significant subsidence of the 3rd tone, which occurs immediately after the increase in noise that arose after the appearance of the loudest pop - the 1st tone, is taken as the DBP level. It is necessary to fulfill all the specified conditions, since correctly measuring pressure with a mechanical tonometer means determining the average levels necessary for the selection and control of a treatment regimen.
Cuff inflation limit
Despite the extreme simplicity of the actions performed, when measuring blood pressure, patients make a huge number of errors. They affect the audibility of tones and the actual determination of pressure, and may cause discomfort during measurement. Most often, patients make a mistake in choosing the upper limit to which the cuff should be inflated.
According to WHO recommendations, itshould be determined by the presence of a pulse at the wrist. As soon as the pulsation on the radial artery has stopped when the cuff is inflated, another 20 mmHg should be pumped into the cuff, after which the air should be bled and the tones should be determined.
On the question of how to measure pressure with a mechanical tonometer, the photo clearly demonstrates the correct approach. Most patients try to measure according to the same principle as electronic devices. They inflate the cuff to high values, which affects the result due to the development of compensatory hypertension with prolonged and excessively strong compression of a large artery.
Inflation to high values also affects the comfort of measurement. Due to developing reflexes, the patient may have a headache, dizziness, pain in the shoulder and numbness of the fingers on the side of compression. These effects should be kept in mind, because the measurement of blood pressure with a mechanical sphygmomanometer helps to avoid them. And using common and cheap electronic blood pressure monitors, the patient is forced to put up with discomfort when measuring pressure and frequent errors in the development of arrhythmia.
Bleed speed
The second common mistake patients make is to deflate the cuff too fast. It leads to an incorrect definition of the first tone or its omission. The result is an incorrect determination of systolic pressure and a large difference between the values of adjacent measurements. How to measure correctlypressure with a mechanical sphygmomanometer yourself, at what speed should I bleed air from the cuff?
Having pumped it up to the level of cessation of pulsation on the radial artery, you need to pump about 20 mmHg more. If no tones are heard in the stethoscope, you can proceed to bleed the air. If there are tones, pump air until the audibility of the pulsation in the stethoscope stops completely and pump up about 20 mmHg more.
Bleeding air should be slow - 3-4 mmHg per second until the first loud tone appears. It is impossible to bleed air at a speed faster than 5 mmHg, as this can introduce an error of 10-15%. Considering that the heart rate is more than 1 time per second, the minimum error at high speed will be 5 mmHg, and the maximum, especially with an irregular pulse or bradycardia, will be 20 mmHg.
This explains why many people have too much variation between measurements. In addition, a high deflation rate also leads to another patient-favorite mistake - blaming a high diastolic pressure due to missing the last tone at a high cuff deflation rate.
Other mistakes
Without the presence of control from the he alth worker, the patient is prone to self-will and some kind of experiments, some of which are designed to refute this or that recommendation of the doctor. And the patient was repeatedly explained how to correctly measure the pressure with a mechanical tonometer to himself. But it is precisely without the supervision of a doctor andof proper discipline at home, he tends to do as he pleases, or as he is accustomed to, even if it is wrong. This is confirmed by the following list of measurement errors that are extremely common.
Preparation
The first mistake is the lack of preparation for measuring pressure. Forgetting the main recommendation on how to correctly measure blood pressure with a mechanical tonometer, patients often use devices, including electronic ones, without resting from the previous load. The correct pressure value will be the one measured at rest or after 10-30 minutes of rest after the cessation of physical activity. And immediately after its termination, the pressure indicators will be 20-30% higher than the average for this patient.
Hand movements
Mistake two - anxiety and hand movements when measuring pressure. Do not move your shoulder or rotate your forearm while measuring pressure. The arm should lie on the table in a relaxed position, palm up, and the cuff should be at the level of the heart. Stethoscope head on the lower border of the cuff. At the same time, the arm with the cuff applied cannot be inflated, which is why blood pressure monitors are better suited for self-measurement, in which the stethoscope is built into the cuff or does not require holding.
Uncomfortable posture
Third mistake - conscious or unintentional squeezing of large arteries. In the protocol of the Ministry of He alth, where they are paintedrules on how to correctly measure pressure with a mechanical tonometer, there are a number of requirements. It is indicated that the patient should sit relaxed, slightly leaning back, and look ahead. The legs should also be relaxed, stretched out in front of you, not crossed. In this position, squeezing of the vertebral and femoral arteries is excluded, which increases the value of predominantly diastolic pressure. It is necessary to comply with these requirements, otherwise the patient will often see inadequate pressure numbers.
