BP measurement

Procedure of the pulse rate and blood pressure measurement

1. The radial pulse is palpated and the pulse rate is counted for 30 seconds, measured by a digital wrist watch or one with second hand.Record 30-second pulse count and whether pulse was regular.
2. The manometer should be placed so that the scale is at eye level, and the column perfectly vertical. The subject should not be able to see the column of the manometer.
3. Determining the peak inflation level:
   The mercury column has to be at 0 level.
   The subject's radial pulse is again palpated.
4. The cuff is inflated and the level of the top of the meniscus of the mercury column is noted at the point when the radial pulse disappears. The cuff is immediately deflated by completely opening the valve.
5. The peak inflation level is determined by adding 30 mm to the pressure where the radial pulse disappeared.
   Venous blood pool in the forearm is normalized by waiting at least 30 seconds or by raising the arm for 5-6 seconds.
6. The brachial pulse is located and the bell of the stethoscope is placed immediately below the cuff at the point of maximal pulsation. If it is not possible to feel the brachial pulse, the bell of the stethoscope should be placed over the area of the upper arm immediately inside the biceps muscle tendon.
7. The bell should not touch the cuff, rubber or clothing.
8. The cuff is rapidly inflated to the peak inflation level and then deflated at a rate of 2 mmHg per second.
9. The pressure should be reduced steadily at this rate until the occurrence of the systolic level at the first appearance of a clear, repetitive tapping sound (Korotkoff Phase 1) and diastolic level at disappearance of repetitive sounds (Phase 5) have been observed.
10. Then the cuff should be rapidly deflated by fully opening the valve of the inflation bulb. Note: There may be a brief period (auscultatory gap) between systolic and diastolic pressure, when no Korotkoff sounds are heard. Therefore, the 2mmHg/second deflation should be continued until the diastolic blood pressure is definitely established. If Korotkoff sounds persist until the cuff is completely deflated, a diastolic blood pressure of 0 should be recorded.
11. The measurements should be recorded to the nearest 2 mmHg. If the top of the meniscus falls half way between two markings, the marking immediately above is chosen. The subject is not told the blood pressure values at this point.
12. After one minute of wait to allow redistribution of blood in the forearm a second measurement is made by repeating steps 7 to 9. The subject should not change position during the wait.
13. After another one minute a third measurement is made by repeating steps 7 to 9.
    The subject may now be told the measurement values.

*Before the blood pressure measurement begins the following conditions should be met:
Subjects should abstain from eating, drinking (anything else than water), smoking and taking drugs that affect the blood pressure one hour before measurement.
Because a full bladder affects the blood pressure it should have been emptied.
Painful procedures and exercise should not have occurred within one hour.
Subject should have been sitting quietly for about 5 minutes.
Subject should have removed outer garments and all other tight clothes. The sleeve of shirts, blouses, etc. should have been rolled up so that the upper right arm is bare. The remaining garments should not be constrictive and the blood pressure cuff should not be placed over the garment.
Blood pressure should be measured in a quiet room with comfortable temperature. The room temperature should have been recorded.
The time of day should have been recorded.
The blood pressure measurer should be identified on the blood pressure data recording form.
Position of the subject
Measurements should be taken in sitting position so that the arm and back are supported. Subject's feet should be resting firmly on the floor, not dangling. If the subject's feet do not reach the floor, a platform should be used to support them.