Laboratory Manual for measuring blood pressure

Measurement of blood pressure in man

Introduction
The heart contracts and relaxes more then 60 times per minute. It sets up
a pressure which drives blood through the blood vessels. The pressure of blood
in the circulatory system is depend on several factors, i.e. pumping action of the
heart, the resistance in the vessels that must be overcome by the blood, the
elasticity of the blood vessel walls, the viscosity of the blood, and the quantity of
blood in the arterial system.
The pressure which is developed in the arterial system as the product of
pumping action of the heart are varies from maximum pressure (or systolic
pressure because contraction of the heart is called systole) to minimum pressure
(or diastolic pressure)
We measure the pressure of the blood in the artery indirectly by using a
mercury sphygmomanometer (sphygmos (G) = the pulse; manometer = pressure
meter). The gold standard of equipment for measuring the blood pressure is
mercury thermometer, and the other equipment for measuring the blood pressure
must be calibrated using the mercury sphygmomanometer.
In this exercise, students measure the blood pressure in several different
positions and conditions of the subject.
Objectives
1.

To measure human arterial blood pressure and to understand the

basis for this measurement.

2.

To bring about cardiovascular changes by changes in posture,

exercise, Valsalva maneuver and cold stress, and measure changes
in blood pressure.

3.

To understand the reflex

control

illustrated by this experiment.

of arterial blood pressure as

Equipment
1. The gold standard device for measuring blood pressure is mercury
sphygmomanometer. Beside the mercury manometer it self, the device is
equipped with a cuff, which has a rubber bladder (rubber bulb) inside.
The length of the bladder is about 80% and its width at least is 40% of forearm
circumference. Determined by this provision, the width of the cuff for adult usually
is 14 to 15 cm. The bladder is equipped with a pump and is connected to the
manometer.
2.

Stethoscopes.

3.

Small pillows

4.

Washbasin for each group and

ice water

5.

Metronome

Subject preparation
A number of factors related to the subject can cause significant deviation
in measured blood pressure. These include room temperature, exercise, alcohol
or nicotine consumption, positioning of the arm, muscle tension, bladder
distension, talking, and background noise. The patient should be asked to
remove all clothing that covers the location of cuff placement. In every
measurement, the position of the arm should be at the level of right atrium.
The procedure of measuring the blood pressure
1. Cuff placement must be preceded by selection of the appropriate cuff size for
the subject's arm circumference.
2. The observer must first palpate the brachial artery in the antecubital fossa and
place the midline of the bladder of the cuff so that it is over the arterial
pulsation over the patient's bare upper arm.

3. The sleeve should not be rolled up such that it has a tourniquet effect above
the blood pressure cuff.
4. The lower end of the cuff should be 2 to 3 cm above the antecubital fossa to
allow room for placement of stethoscope.
5. Occlusion of the brachial artery must be produced by gradual inflation of the
cuff. While palpating the radial artery, the cuff is inflated until the radial pulse
disappears. The pressure of the cuff which is seen in the manometer than
allowed to fall at the rate of 2 - 3 mm per second. Note the pressure at which
the radial pulse returns. This is the systolic blood pressure measured using
palpatory methode.
6. The bell of the stethoscope than is placed over the palpated brachial artery in
the antecubital fossa.
7. The cuff should initially be inflated to at least 30 mmHg above the point
(pressure) at which the radial pulse disappears.
8. While the cuff is deflated at the rate of 2 - 3 mmHg per second, the Korotkoff
sound is heard using the stethoscope.
9. There are 5 phase of Korotkoff. Phase 1, appearance of clear tapping sounds
corresponding to the appearance of palpable pulse. Phase 2, sounds become
softer and longer. Phase 3, sounds become crisper and louder. Phase 4,
sounds become muffled and softer. Phase 5, sounds disappear completely
(the fifth phase is thus recorded as the last audible sound).
10. The manometer reading at the time when the first sound can be heard (the
first Krorotkoff sound) is taken as the systolic pressure, and the
disappearance of the sound is taken as diastolic pressure.
Note:
1. In placing the bell of the stethoscope over the brachial artery, the pressure
on the bell of the stethoscope should not to high so that the bell does not
make the brachial artery deflated. If it is happened, the Korotkoff sound
will be heard even until the manometer indicate o mmHg,

2. In making the determination of blood pressure, do not arrest the circulation

longer than 3 minutes, and allow the veins to empty before attempting
another determination.
3. The palpatory systolic blood pressure must be obtained first before
auscultatory blood pressure measurement for every new subject.
4. Required competencies:
a.

Vision. The observer must be able to see the meniscus of mercury

column at eye level without straining or stretching, and must be
able to read well enough to see the sphygmomanometer or digital
display no further than 3 feet (90 cm) away.

b.

Hearing. The observer must be able to hear the appearance and

disappearance Korotkoff sound.

c.

Eye/hand/ear coordination. This is required for the use of mercury

or aneroid sphygmomanometers but not for the newer electronic
technologies.

Experimental procedures
Students should work in a group of eight to ten for the experimental procedures.
1.

The effect of position on blood pressure.

One student will be the subject for this experiment. One student will
determine the frequency of the radial pulse at the subjects left wrist, and act
as timekeeper and scribe. One student will determine the blood pressure,
using the subjects right arm.
a.

With the subject in the recumbent position, determine the

palpatory systolic blood pressure. To confirm that the middle of the cuff
on the upper arm is at the level of the right atrium, the back and the arm
are supported using a small pillow.

b.

The radial artery is palpated at the wrist. The cuff pressure is

then increased until the radial pulse disappears. The pressure is then

allowed to fall at the rate of 2 3 mm per second. Note the pressure at

which the radial pulse returns as the palpatory systolic pressure.
c.

Then, determine the arterial pulse, and auscultatory systolic

and diastolic pressure using a stethoscope. The pressure of the cuff is
raised to about 30 mmHg above the systolic pressure which is obtained
by palpatory method. Repeat these observations five minutes after the
initials measurements. Record the results.

d.

With the subject in the sitting position, repeat these

observations.

e.

Repeat these observations at 3 minute intervals with the

subject standing stiffly at attention. Draw a chart of systoloic and
diastolic blood pressure values plotting blood pressures against time.

f.

Answer the following questions:

1.Does gravity affect the blood pressure in the arteries above the heart?
2.How is the pressure maintained at a relatively constant level in these
vessels? Of what importance is this?
3.Discuss the concept of postural hypotension and give examples of
situations under which it may occur.

2.

Effect of sustained intrathoracic pressure (Valsalva maoeuvre)

Choose another subject.
a.

The subject takes a deep breath and then expires against a

pressure (Valsalva Manoeuvre).and hold this manoeuvre.

b.

Throughout the test and for one minute after, count the radial
pulse every 10 seconds. Also note the character of the pulse, i.e.
whether it is full and strong, or weak and difficult to detect.

c.

Determine blood pressure every 20 seconds throughout the

test and for one minute thereafter (one minute after breaking point). Note
the character of the respirations that follow the breaking point.

Describe the results of this test. How do you explain the results?

3.

Cold pressor test

With the subject recumbent, measure blood pressure every minute for 5
minutes. Immerse the subjects left hand and wrist in a bucket of water at 4 0C
(use ice-water with nearly all the ice melted) for 3 minutes. Record blood
pressure and pulse rate every minute during the 3 minutes, and at minute
intervals afterwards until the measurements come back to normal.
A rise of about 10 mmHg in both systolic and diastolic pressure is to be
expected, while a of 20 mmHg or more in systoleic and of 15 mmHg or more
in diaqwtolic is said to be indicative of an individual with a hyper-reactive
vasomotor system.

4. Effects of psychological stress

Use a different subject.
Measure blood pressure and pulse rate of the sitting subject every minute for
5 minutes.. Have the subject count backwards by 7s from 666 as fast as
possible, continuing for 2 minutes. Give 1 mark for each correct answer, and
deduct 10 marks for each wrong answer.
Record the subjects blood pressure and pulse rate each minute during the
test, and each minute afterwards until the measurements come back to
normal.
5. Effect of exercise on blood pressure and heart rate.
Choose another subject.
Measure the subjects blood pressure and pulse rate in resting condition in
sitting position. Have two measurements.
Have the subject run stationary with high speed for 2 minutes. As soon as
possible after the exercise stops, and every 2 minutes for at least 6 minutes
after stopping, record blood pressure (systolic and diastolic) and pulse rate in
sitting position. Continue until heart rate and blood pressure return to normal.
On a graph, plot systolic and diastolic blood pressure and heart rate against
time, indicating the resting value as a baseline.