1. Blood pressure can be measured directly using a pressure transducer connected to an artery or indirectly using a sphygmomanometer.
2. Modern devices use oscillometric or ultrasonic methods to indirectly and automatically measure blood pressure without a stethoscope.
3. Direct electronic manometry involves a pressure transducer connected to a patient's blood vessel via a saline-filled catheter to directly measure pressures like arterial, venous, and pulmonary pressures.
1. Blood pressure can be measured directly using a pressure transducer connected to an artery or indirectly using a sphygmomanometer.
2. Modern devices use oscillometric or ultrasonic methods to indirectly and automatically measure blood pressure without a stethoscope.
3. Direct electronic manometry involves a pressure transducer connected to a patient's blood vessel via a saline-filled catheter to directly measure pressures like arterial, venous, and pulmonary pressures.
1. Blood pressure can be measured directly using a pressure transducer connected to an artery or indirectly using a sphygmomanometer.
2. Modern devices use oscillometric or ultrasonic methods to indirectly and automatically measure blood pressure without a stethoscope.
3. Direct electronic manometry involves a pressure transducer connected to a patient's blood vessel via a saline-filled catheter to directly measure pressures like arterial, venous, and pulmonary pressures.
measurements and devices The nominal values of haemodynamic pressure in the basic circulatory system are as follows: basic circulatory system are as follows: Arterial system: 30 ‐‐ 300 mmHg Venous system: 5 – 15 mmHg Pulmonary system: 6 – 25 mmHg Blood pressure measurements Blood pressure measurements • Ph Physiological fluid pressures: cardiovascular system (Liquid), i l i l fl id di l t (Li id) pulmonary system (gas) • Arterial blood pressure, central venous pressure (CVP), p , p ( ), Intracardiac blood pressures, spinal fluid pressures • Stephen Hales (1773): Used an oen ended tube inserted directly into an artery in the neck of an unanesthetized directly into an artery in the neck of an unanesthetized horse: direct measurement of blood pressure • Indirect method of measurement: Sphygmomanometer p yg • Direct method of measurement: Pressure transducer that is coupled to the patient’s artery or vein through a saline‐ filled catheter or needle or using Hale’ss method (to filled catheter or needle, or using Hale method (to measure spinal fluid pressure and CVP. • Features: • Accurate enough for ordinary clinical use • Simple enough so that even nonprofessional personnel can be rapidly trained personnel can be rapidly trained • Limitation on the ausculatory method include the hearing acuity of the operator f • Several modern instruments are available for Several modern instruments are available for the indirect measurement of blood pressure in by replacement of the stethoscope with an by replacement of the stethoscope with an electronic transducer Pulpation method (indirect method) • Uses the sense of touch to detect the patient’s pulse in the radial artery (wrist) pulse in the radial artery (wrist) • The cuff is inflated until the radial pulse disappears • The operator then slowly releases the pressure in th the cuff until a pulse becomes palpable in the ff til l b l bl i th radial artery. The pressure at which this occurs is th the systolic blood pressure t li bl d • The method can detect only the systolic pressure b because no known palpable change occurs at the k l bl h h diastolic pressure. Flush method (indirect method) • Flush technique requires two cuffs and two operators • The cuffs are placed on the arm and are inflated. • The blood in the section between the two cuffs is h bl d h b h ff massaged out, leaving the lower arm pale and bl h d blanched. • The pressure in the upper cuff is then released slowly. • The pressure at which a sudden red flush is noted in the blanched skin is recorded as the mean arterial pressure (MAP) Limitations of sphygmomanometer b d based ausculatory l measurements • Measurement is intermittent because it takes time. • The Korotkoff sounds are normally in the range (less than 200 Hz) where human hearing range (less than 200 Hz) where human hearing is not very accurate. A piezo‐resistive pressure transducer is connected to the cuff. Features • Since sound is not used, environmental noise do not hamper the measurement h h • As it does not require a microphone in the cuff, placement of the cuff is not critical. • Oscillometric technique is used extensively when q y monitoring is needed but it is not desirable when direct pressure measurements are needed. • Microprocessor‐controlled approach and design with periodically inflate and slowly deflate the p y y cuff. Ultrasonic pressure measurements • A piezoelectric transmitting signal sends a sine‐ wave beam (ultrasound > 20 kHz) into the tissue wave beam (ultrasound, > 20 kHz) into the tissue • When it encounters a fluctuating vessel wall, some of its energy is reflected back some of its energy is reflected back (backscattered) to the receive (sensing) crystal • F F F( h F (where Fi h D F is the Doppler shift) describes l hif ) d ib the frequency content of the backscattered wave • The existence of the F component alers the circuit in the turbulent flow that corresponds to Korotkoff k ff sounds, and it diminishes when near‐ d d i di i i h h laminar flow resumes (P<Pdiastolic) Ultrasonic Doppler shift method If the artery wall is moving towards the transmitter, the apparent frequency f1 is given by: (C v) f1 f C where f =transmitted frequency (carrier frequency in the medium) C =velocity of sound in tissue v =velocity of vibrating vessel wall C f2 f1 C v The resultant Doppler shift C (C v) C f f f2 f f1 f f C v C C v 2 fv f C OR 2v f c where c wavelength of the carrier frequency in the medium Direct method: electronic manometry • An electronic pressure transducer can be connected to the patient through a thin piece d h i h h hi i of tubing called a catheter • The catheter is introduced into the vessel through a thin hollow tube called a cannula through a thin, hollow tube called a cannula • The transducer’s pressure diaphragm is coupled to the patient’s bloodstream by a column of saline solution that fills the catheter How to measure blood pressure p • Transducer: a thin, flexible metal diaphragm is stretched across an opening at one of the transducer bodyy • Strain gauges are connected to the diaphragm • A clear plastic pressure dome fits over the l l d f h diaphragm to contain the fluid and provide hydraulic connection to the catheter Systolic, diastolic and mean detector circuit • The pressure amplifier produces an analog waveform with a peak amplitude representing waveform with a peak amplitude representing systolic pressure and a minimum or valley that represents the diastolic pressure that represents the diastolic pressure • Additional circuitry is required that recognizes these points and from them produces a these points, and from them produces a steady voltage or current that can be used to drive a display meter drive a display meter • The MAP (mean arterial pressure) is found by taking the time average i.e., integrating of the pressure waveform Practical problems in pressure monitoring p p g • Hydrostatic pressure: The liquid in the transducer plumbing system has mass, so its weight can apply a force to the transducer diaphragm that is also interpreted as a pressure • Positive hydrostatic pressure head caused by the weight of the fluid in the tubing brought to the transducer from the fluid in the tubing brought to the transducer from above • Negative hydrostatic pressure is obtained when the tubing i is predominantly below the level of the transducer d i tl b l th l l f th t d diaphragm • Balancing method the tubing should have approximately Balancing method the tubing should have approximately equal lengths above and below the level of the diaphragm • The diaphragm should be level and at a height equal to the height from the floor to the catheter tip (not the point height from the floor to the catheter tip (not the point where the catheter is inserted