it is so sad that most of the health professionals do not know exactly how the BP should be recorded?

1. STANDARD OPERATING PROCEDURE
FOR
RECORDING BLOOD PRESSURE
by
Dr D.S.Chandel
Former director health services
Shimla (H.P.) INDIA

2. Mercury -desk type
Aneroid palm type
Non-mercury Digital
column type with LCD
display
Non mercury
Digital fully auto
with LCD display-
desk type
Types of
sphygmomanometers
Aneroid desk type Aneroid gauge type
Aneroid stand
type
Mercury-stand type

3. Maintenance of mercury
sphygmomanometer—Phase it out…..
 Mercury apparatuses are still considered as the best to
record most accurate BP.
 It should be calibrated/ standardized, at least once in
every 2 months or SOS. Any error displayed on the
apparatus itself.
Check if the mercury liquid is clean; black discoloration
due to mercuric oxide may require cleaning of the
column & the reservoir.
Check the angle of the column.
Check that the reading is at zero mark, when the cuff is
completely deflated.

4. Maintenance contd.
Test the cuff and tubing for air leaks or blockage;
Test the column and reservoir for mercury leaks.
Any spillage/leaks-follow the guidelines of BMWM.
Check that during inflation of the cuff, the mercury
rises smoothly.
Check that when inflation is stopped, mercury rise
stops immediately.
Clean and disinfect the device, every 6 months
according to the manufacturer’s specifications.

6. Some do’s!
1.Ask the patient to empty bladder, before recording BP.
2.Let the patient relax for 30 minutes, before recording, if
patient comes on foot from a distance.
3.Let the patient warm up, if it is cold outside.
4.Counsel the patient, make him comfortable & ask him to
remain calm, during the procedure.
5. Make the patient sit, with straight back (affects DP-
high), like sitting on a dinning chair with arm supported
on the table, with both feet resting on the ground (affects
SP-high).
6.Support the arm on table, on which the apparatus has
been placed.

7. Some do’s!
7. Best position, for the procedure, is the sitting
position. If it is being recorded in the lying down
position, then rest the arm on a pillow to bring it
to the level of heart.
8.Recording should be at the same time, on the
same limb & in the same posture every time, to get
correct reading.
9.Cuff should be of proper size. The bladder of the
cuff should cover 40% of the circumference of the
arm and 2/3 of the length of the arm.
10.Ensure there is no zero error in the apparatus.

8. Some don’ts
 For monitoring BP, patient should not suffer from
any illness at that time.
Patient should not take alcohol/caffeine, at least
30 minutes before recording the BP.
Patient should not talk, laugh, sneeze, cry, weep
and should breath smoothly, during the procedure.
Patient should not eat/take anything orally, at
least 30 minutes, before recording the BP.
Patient should not sit with legs crossed.

9. Some don’ts
There should be no medical problem in that
arm.
Patient should not smoke, within 30 minutes of
the procedure.
Patient should not do any exercise, within 30
minutes of the procedure.
The cuff should not be applied over the clothes.
The clothes should not be folded up to expose
the arm, if unavoidable then ensure that these
should not be constricting on the arm.

11. Procedure to record blood pressure
• Ask the patient to loosen any tight clothing or
remove long-sleeved garments, so that it is
possible to access the upper arm.
• Switch the apparatus on.
• Place the cuff around the upper arm, directly
over the skin, 1"-2" above the elbow and secure it
tight to the extent to allow two fingers between
the arm & cuff.
• The position of the arm should be such that the
cuff and the heart are at the same level.

15. Procedure contd.
• The tubes of the cuff should be on the inner side
of the upper arm, along the course of brachial
artery.
• Connect the cuff tubing to sphygmomanometer
tubing and secure it tight.
• Rest the patient's arm on a surface of the table if
patient is sitting and on a pillow if s/he is lying
on the bed.
• The cuff, heart and the apparatus should be at
the same level.

16. Procedure contd.
• The column of mercury should be at the level of
doctor’s eyes. The horizontal & vertical parts of
the apparatus should be at right angle to each
other . The BP apparatus should be kept on the
even surface to avoid any tilt.
• Place the stethoscope in the cubital fossa, over
the brachial artery and listen for the pulse beat.
• Inflate the cuff slowly and listen for the pulse,
when it disappears. This is an indication to stop
inflating the cuff.

17. Procedure contd.
• Wait for a moment, to ensure that the pulse is not
audible & start to deflate the cuff slowly, while watching
the mercury level in the sphygmomanometer.
• Note the sphygmomanometer reading, when the pulse
reappears: record this as the systolic pressure.
• Deflate the cuff further, until the pulse disappears:
record this reading as the diastolic pressure.
• Record these two measurements, first the systolic and
then the diastolic ,in the patient's notes.
• Deflate the cuff completely. Take at least two readings at
1-2 minutes interval

18. Procedure contd.
• Best position, for the procedure, is the sitting
position. If it is being recorded in the lying down
position, then rest the arm on a pillow to bring it
to the level of heart.
• Tell the patient, the blood pressure reading.
• Decontaminate chest piece and ear pieces of the
stethoscope with the alcohol wipe.
• Wash/sanitize and dry your hands.
• If there is extremely low or high reading of BP,
then ask the patient to consult medical specialist.

19. Other recommended sites to record BP

23. Mercury sphygmomanometer: desk type

24. Mercury apparatus: stand type

25. Aneroid- Palm type

26. Aneroid-stand type

27. Aneroid-desk type

28. Aneroid- arm type

29. Non-mercury sphygmomanometer
column type with LCD display

30. Digital fully auto
sphygmomanometer: LCD display

31. Digital sphygmomanometer: LCD monitor
type