Sphygmomanometer

SOURAV MISHRA | ROLL no- 215BM1002 |

December 4, 2015

SPHYGMOMANOMETER PRODUCT DEVELOPMENT LABORATORY

PRODUCT DEVELOPMENT LAB

A

Product Report

Submitted as Part of Course

For

Completion of Semester

SPHYGMOMANOMETER

PROJECT GROUP

SI NO. NAME REGISTRATION NO.

1 SOURAV MISHRA 215BM1002

2 GAURAV MOHAN

SAKHARE

215BM1003

3 RAHUL SARKAR 215BM1443

4

VIVEK PRATAP SINGH

215BM1444

DEPARTMENT OF BIOTECHNOLOGY AND MEDICAL

ENGINEERING

NATIONAL INSTITUTE OF TECHNOLOGY

ROURKELA-769008

ODISHA

PRODUCT DEVELOPMENT LAB

TITLE: Sphygmomanometer

DEGREE: M.TECH 2015-16 (1st Semester)

SUBMITTED BY

DATE OF SUBMISION

04/12/2015

DEPARTMENT OF BIOTECHNOLOGY AND MEDICAL

ENGINEERING

NATIONAL INSTITUTE OF TECHNOLOGY

ROURKELA-769008

ODISHA

NAME REGISTRATION NO.

SOURAV MISHRA 215BM1002

Table of Contents

AIM OF THE EXPERIMENT ............................................................. 4

INTRODUCTION ............................................................................. 4

APPARATUS REQUIRED .................................................................. 5

PROCEDURE.................................................................................... 6

CARE AND MAINTAINANCE ........................................................... 9

CAUTION ......................................................................................... 11

REFERENCE ..................................................................................... 11

AIM OF THE EXPERIMENT:-

To develop a sphygmomanometer working model and test its functionality.

INTRODUCTION:-

The circulation of blood within the body has been a subject of study for many

thousands of years. In ancient times, the Chinese recognized the fact that

blood circulated through the blood vessels and developed theories on how

such systems worked. Evidence also suggests that scholars in India had

developed some knowledge of the circulatory system, with an emphasis on

the pulse and its dynamic nature.

A broader understanding of circulation and the circulatory system was

developed in the early 1600’s by a doctor named William Harvey. He began

teaching about circulation in 1615 and later published his work in 1628

entitled Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus

(On the Movement of the Heart and Blood in Animals). His work became a

foundation for the study of the circulatory system, and is still highly regarded

even to this day.

Once the correlation between heart rate and pulse was discovered, it was

possible to determine blood volume and blood pressure. In 1733 Reverend

Stephen Hales recorded the first blood pressure measurement on a horse. He

did this by inserting a long glass tube upright into an artery, observing the

increase in pressure as blood was forced up the tube.

In 1881, the first sphygmomanometer was invented by Samuel Siegfried Karl

Ritter von Basch. It consisted of a rubber bulb that was filled with water to

restrict blood flow in the artery. The bulb was then connected to a mercury

column, which would translate the pressure required to completely obscure

the pulse into millimeters of mercury.

In 1896, the device was further improved by Scipione Riva-Rocci.

Improvements included a cuff that could be affixed around the arm to apply

even pressure to the limb that would become the standard design for such

devices going forward.

Modern blood pressure measurement was not developed until 1905, when Dr.

Nikolai Korotkoff discovered the difference between systolic blood pressure

and diastolic blood pressure. These pressures corresponded to the appearance,

and disappearance of, sounds within the arteries as pressure was applied and

then released. Known as Korotkoff sounds, the use of systolic and diastolic

sounds is now standard in blood pressure measurement.

Since that time, further advances have been made to sphygmomanometers.

Now available in a variety of styles ranging from mercurial to aneroid and

electronic versions, blood pressure measurement has become more accurate

and widely accepted as an important vital sign when diagnosing a patient.

APPARATUS REQUIRED:-

I. MANOMETER

The portion of the sphygmomanometer that measures the air pressure

in mmHg. The aneroid contains a watch-like movement that measures

the air pressure applied to the cuff. Within the gauge is a series of

copper/berrylium diaphragms that expand when filled with air. Gears

convert the linear movement of the diaphragms, turning the needle on

a dial calibrated in mmHg.

II. BULB

The bulb pumps air into the cuff. An end (check) valve prevents air

from escaping. ADC’s latex-free bulbs are made from either spin cast

PVC or dip molded neoprene, Available in a large size for use with

bigger cuffs. ADLFOW filter screen-protected end valves provided an

additional dust barrier.

III. VALVE

The deflation valve allows for controlled deflations of the cuff-critical

for accurate measurement.

IV. CUFF

The cuff is design to hold the bladder around the limb during

measurement. A properly designed cuff will ensure proper placement

and positioning- essential for accurate measurement.

A cuff has following parts:

SHELL

The cuff is typically made from nylon and is design to secure the bladder

around the limb. They are made from patient- friendly 210 denier nylon and

sewn with nylon thread for easy cleaning. These are available in 6 sizes fitting

limb ranges from 9 to 66 cm, and in up to 12 colours for sizing, departmental

coding, or personal preferences.

GAUGE HANG TAB

A sewn strap that allows a pocket aneroid to be clipped to the cuff for

convenience. Some cuff brands don’t include a hang tab, making use with a

pocket-style aneroid more difficult.

HOOK AND LOOP ADHESIVE

Consist of the male and female components that engage to secure the cuff.

V. BLADDER

The bladder is the inflatable bag that, when filled, compresses the arm

to occlude the artery. Bladders should follow very specific sizing

parameters to ensure full arterial compression.

PROCEDURE :-

I. Assembly:-

Cuffs are made of two wholes each of which then fitted with two

pressure tubes.

One of the pressure tube is fitted with manometer and another via

deflation valve with the bulb to pump the air.

II. Testing for performance:-

Gauge Accuracy –

One of the most critical components of any sphygmomanometer is the

gauge. The accuracy of the gauge is a key factor in creating a quality

sphygmomanometer.

Gauge Durability-

It is not only the cuff that can wear out from repeated uses, gauges are

subjected to varying pressures regularly as the sphygmomanometers

are inflated to take measurements. Care should be taken to ensure its

durability.

Valve Leakage-

Preventing systems leakage is key to ensuring that a

sphygmomanometer gives reliable, accurate readings. When we close

the valve, air should not leak out.

Dimensions-

If the component parts of a sphygmomanometer do not fit properly, the

entire system can leak. Leakage can throw off your blood pressure

measurements through excessive deflation. This is why we use

calibrated calipers to inspect each and every component used in our

sphygmomanometer to ensure the best possible fit, and consistency, in

quality time after time.

III. Procedure to measure blood pressure:-

Patient Positioning:

The patient should sit or lie comfortably. The arm should be fully

supported on a flat surface at heart level. (If the arm’s position varies,

or is not level with the heart, measurement values obtained will not be

consistent with the patient’s true blood pressure). When seated, the

patient should have their back and arm supported, and their legs should

not be crossed. The patient should relax prior to measurement

comfortably for five minutes, and should refrain from talking or moving

during measurement. The observer should view the manometer in a

direct line to avoid “Parallax error”.

Application of the Cuff:

Range markings are part of the cuff system. Using an inappropriately

sized cuff can affect blood pressure readings.

Cuffs are specially designed to promote the precisely accurate

determination of blood pressure. Index and range markings ensure use

of the correct cuff size. The artery mark indicates proper cuff

positioning.

Place the cuff over the bare upper arm with the artery mark positioned

directly over the brachial artery. The bottom edge of the cuff should be

positioned approximately one inch (2-3cm) above the antecubital fold.

Wrap the end of the cuff not containing the bladder around the arm

snugly, and smoothly and engage adhesive strips. To verify a correct

fit, check that the Index Line falls between the two Range Lines.

Cuff Inflation:

Close the valve by turning thumbscrew clockwise. Palpate the radial

artery while inflating the cuff. Be sure to inflate cuff quickly by

squeezing bulb rapidly. Inflate cuff 20-30 mmHg above the point at

which the radial pulse disappears.

Positioning the Stethoscope:

The correct positioning of the cuff, as shown by the Artery Mark, and

stethoscope for optimal measurement.

Position the chestpiece in the antecubital space below the cuff, distal to

the brachium. Do not place chestpiece underneath the cuff, as this

impedes accurate measurement. Use the bell side of a combination

stethoscope for clearest detection of the low pitched Korotkoff (pulse)

sounds.

Deflate the cuff:

Open the valve to deflate the cuff gradually at a rate of 2-3 mmHg per

second. Record the onset of Korotkoff sounds as the systolic pressure,

and the disappearance of these sounds as diastolic pressure. (Some

healthcare professionals recommend recording diastolic 1 and diastolic

2. Diastolic one occurs at phase 4).

NOTE: It is recommended that K4 be used in children aged 3 to 12, and

K5 should be used for pregnant female patients unless sounds are

audible with the cuff deflated, in which case K4 should be used. K5

should be used for all other adult patients.

After measurement is completed, open valve fully to release any

remaining air in the cuff and remove the cuff. Do not leave the cuff on

the patient for an extended period of time.

Factors Affecting Measurements:

When taking blood pressure, it is vital that all of the steps involved in

the process are properly observed. Small variations in technique can

cause large variances in measurements, even on the same patient. The

chart below shows some common issues that could affect readings:

CARE AND MAINTAINANCE:-

STORAGE:

After measurement, fully exhaust cuff, then wrap cuff around gauge

and bulb and store in zippered carrying case.

In order to ensure that we have the best experience with your

sphygmomanometer, it is stored at temperatures ranging from 50°F to

104°F (10°C to 40°C) at a relative humidity level of 15% to 85%.

Manometer: The manometer (gauge) attached to your

sphygmomanometer requires minimal care and maintenance. The

manometer may be cleaned with a soft cloth, but should not be

dismantled under any circumstances. Gauge accuracy can be checked

visually; simply be certain the needle rests within the printed oval when

the unit is fully deflated.

Should the indicator needle of the manometer rest outside of this

calibration mark, then the manometer must be re-calibrated to within

±3 mmHg when compared to a reference device that has been certified

to national or international measurement standards. A manometer

whose indicator needle is resting outside of this mark, is NOT

acceptable for use.

Cuff Cleaning and Disinfecting:

Use one or more of the following methods and allow to air dry:

Wipe with mild detergent and water solution (1:9 solution).

Rinse.

Wipe with Enzol per manufacturer’s instructions. Rinse.

Wipe with .5% bleach and water solution. Rinse.

Wipe with 70% isopropyl alcohol.

Launder with mild detergent in warm water, normal wash cycle.

(Note: Remove bladder first. Cuff is compatible with 5 wash

cycles).

Low Level Disinfection:

Remove the bladder from the cuff. Prepare Enzol enzymatic detergent

according to the manufacturer’s instructions. Spray detergent solution

liberally onto cuff and use a sterile brush to agitate the detergent

solution over entire cuff surface for five minutes. Rinse continuously

with distilled water for five minutes. To disinfect, first follow the

cleaning steps above, then spray cuff with 10% bleach solution until

saturated, agitate with a sterile brush over entire cuff surface for five

minutes. Rinse continuously with distilled water for five minutes. Wipe

off excess water with sterile cloth and allow cuff to air dry.

CAUTION:

I. Do not iron cuff.

II. Do not heat or steam sterilize cuff.

REFERENCES:-

1. William H. McMicken, M.D. (n.d.). Hardening of the Arteries,

Inevitable or Preventable? Retrieved from

http://familydoc.tripod.com/ascvd1.htm

2. (n.d.) The History of Blood Pressure Monitoring. Retrieved from:

http://www.healthperfect.co.uk/Index/dphistry.htm

3. Georgia Alton. (n.d.) The History of Sphygmomanometers. Retrieved

from: http://www.ehow.com/about_5339926_history-

sphygmomanometers.html

4. 4. Sphygmomanometer. (8 January 2013 at 15:32). Retrieved from

Wikipedia: http://en.wikipedia.org/wiki/Sphygmomanometer

5. Adiyaman Ahmet, Tosun Nevin, Elving LammyD, Deinum Jaap, Lenders JacquesWM, Thien Theo. The effect of crossing legs on blood pressure. Blood Press Monit June 2007; 12:3: 189-193.

6. Campbell NormanRC, McKay DonaldW. Accurate blood pressure measurement: Why does it matter? CMAJ 1999; 161(3): 277-278.

7. Cushman WilliamC, Cooper KarenM, Horne RichardA, Meydrech EdwardF. Effect of back support and stethoscope head on seated blood pressure determinations. Am J Hypertens 1990; 3: 240-241.

8. Fonseca-Reyes Salvador, Garcia de Alba-Garcia Javier, Parra-Carrillo JoseZ, Paczka-Zapata Jose Antonio. Effect of standard cuff on blood pressure readings in patients with obese arms. How frequent are arms of a ‘large circumference’? Blood Press Monit 2003 8:3: 101-106.

http://familydoc.tripod.com/ascvd1.htm

http://www.healthperfect.co.uk/Index/dphistry.htm

http://www.ehow.com/about_5339926_history-sphygmomanometers.html

http://www.ehow.com/about_5339926_history-sphygmomanometers.html

http://en.wikipedia.org/wiki/Sphygmomanometer

9. Foster-Fitzpatrick Lucille, Ortiz Anna, Sibilano Helena, Marcantonio Richard, Braun LynneT. The effects of crossed leg on blood pressure measurement. Nursing Research Mar/Apr 1999; 48:2: 105-108.

10. Geddes LA, Whistler SJ. The error in indirect blood pressure measurement with the incorrect size cuff. Amer Heart J July 1978; 96:1: 4-8.

11. Gomez-Marin O, Prineas RJ, Rastam L. Cuff bladder width and blood pressure measurement in children adolescents. J of Hypertens Oct 1992; 10:10: 1235-1241.

12. Iyriboz Y, Hearon CM, Edwards K. Agreement between large and small cuffs in sphygmomanometry: A quantitative assessment. J of Clin Monitoring Mar 1994; 10:2:127-133.

13. Keele-Smith Rebecca, Price-Daniel CeCilia. Effects of crossing legs on blood pressure measurement (Research Data). Virginia Henderson Internat Nurs Lib Aug 2007.

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