Chapter 27

Noninvasive Blood Pressure Monitors

Introduction
Frequent bl ood pressure det ermi nat i ons duri ng anesthesi a aid drug t i t rat i on and
f lui d management and provi de warni ng of condi ti ons that coul d af fect pati ent saf ety
(1,2). There are a number of devices that automati cal l y measure bl ood pressure
noninvasivel y (i ndi rectl y). The ori gi nal aut omated devices were stand-al one
moni tors. Now, t he maj ori t y of bl ood pressure moni tors for operat ing room use are
i ncorporated i nto a physi ol ogi c moni tor or anesthesi a workstati on.
Intermittent Blood Pressure Monitors
I ntermi tt ent noni nvasi ve measurement of blood pressure requi res a di stensible cuff
or bladder encl osed i n an unyi el di ng cover. The cuff i s i nf l at ed, and bl ood f l ow
t hrough the underl yi ng art ery is obstructed. The cuff i s then def lated i n a cont rol l ed
manner, causing the pressure appl ied t o the art ery to decrease. Pul sati ons are
detected, and the resul ts are di spl ayed or recorded as bl ood pressure. Most
devices al so di spl ay pulse rate.
Standards
An American standard on aut omat ed sphygmomanometers was publi shed i n 2002
(3). I t st at es t hat bl ood
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pressure measurements det ermi ned by the devi ce must be equi val ent to t hose
obtai ned by a t rained observer usi ng the auscul tatory method or by di rect
moni tori ng using an i nt ra-arteri al catheter wi t hi n the l i mi ts of the standard.
An i nternati onal st andard was publ ished in 1999 (4). I t l i mi ts the maxi mum cuf f
pressure obtai nabl e duri ng normal use to 300 mm Hg for equi pment speci fi ed for
adul ts and 150 mm Hg f or equi pment speci f i ed for neonat es. I n addi ti on, means
must be present to prevent t he cuf f f rom remai ni ng i nf lated f or l ong peri ods of t i me.
Operating Principles
The maj ori t y of automated noni nvasive moni tors empl oy osci ll omet ry (5, 6). The cuf f
i s i nf l ated above the poi nt where pressure osci l lati ons are present. As t he cuf f i s
defl ated, pressure pulsat ions (osci l l at ions) caused by movement of the arteri al wal l
are transmi t ted t o the cuff . The magni tude of these osci l l at ions i ncreases to a
maxi mum, t hen decreases (Fi g. 27.1). The moni tor measures these osci ll ati ons.
Af ter the determi nat ion i s complete, t he remai ni ng ai r in t he cuf f i s rapi dl y
exhausted.
During the f i rst cycl e, t he cuf f i s inf l at ed to a predetermined pressure that i s hel d
const ant whi l e the moni t or t ri es to detect osci l l at i ons. I f si gnif icant pul sat ions are
st i l l present , the cuf f is i nf lated f urther. When f i rst turned ON, most automat i c blood
pressure moni tors stop i nf lati on at 160 torr or l ess (7). On pedi at ri c uni ts, a lower
pressure i s used. If the i ni ti al cuf f pressure i s greater than necessary to determi ne
systoli c pressure, the moni tor may decrease t hi s pressure during the next cycl e. If
t he i ni t i al pressure i s too l ow, t he moni tor wi l l i ncrease i t duri ng t he next cycle.
When no osci l l at ions are detected, t he pressure i n t he cuff i s decreased i n a
stepwi se or l i near manner (Fi g. 27.1).
Noninvasi ve bl ood pressure (NIBP) moni tors rel y on measurement, extrapolati ons.
and cl i ni cal l y t ested al gori thms to arri ve at values f or mean, syst ol ic, and di astol i c
pressures (6,7,8). The poi nt of maxi mum ampl i tude corresponds t o the mean
pressure (5,9,10,11). Systol ic and diastol i c bl ood pressures are then calculated
f rom the i ncreasi ng and decreasi ng magni tude of t he oscil l at ions accordi ng to an
empi ricall y deri ved al gori t hm. These al gori thms are propri etary and vary f rom
manuf acturer t o manufacturer and somet i mes f rom devi ce to devi ce (10).
Consequent l y, di ff erent devi ces do not al ways yi el d the same pressures (12).
Wi th osci l l omet ry, accurate bl adder pl acement i s not necessary, and t he ri sk t hat
t he cuf f bl adder wi l l become di sl odged is mi ni mal . These moni tors do not requi re a
l ow-noi se envi ronment, are not sensi t ive to el ect rosurgi cal i nt erf erence, and work
wel l when there i s peri pheral vasoconst ri ct ion. Venous engorgement has li t tl e eff ect
on accuracy (7). These moni t ors can reject most art i f acts caused by pat ient
movement or external i nt erf erence, based on anal ysis of the shape of the
osci l l omet ri c pul se waveform and the ti ming of the osci l l ometric pulses (5).

View Figure

Figure 27.1 A, B: Sequence of oscillometric blood pressure
determination. Cuff deflation may be linear (A) or in steps
(B). Pressure oscillations increase in magnitude, then
decrease. The oscillations are analyzed to determine
systolic, mean, and diastolic pressures. (Reprinted with
permission from Nellcor Puritan Bennett, Pleasanton, CA.)

Equipment
These moni tors use el ectri ci ty, ei ther l i ne or batt ery, as the power source. Many
uni ts are equi pped wi th a connecti on for a pri nt er or data management system.
Some can displ ay trends. Many manufacturers of f er di ff erent models f or di f ferent -
si ze pati ents.
Inflatabl e Cuff
Cuf fs come in di f ferent si zes. Di sposable and l atex-f ree cuff s are avai labl e. Some
have an ant imi crobi al agent
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on the cuf f f abric to hel p prevent bacteri al growth and mi l dew. Some cuff s are col or
coded by si ze. The i nternati onal st andard requi res t hat cuf fs are marked wi th an
i ndi cat i on of the l i mb ci rcumference f or whi ch t hey are appropri at e (4).
Pressure Tubi ng(s)
One or t wo tubi ngs serve as a means to i nfl at e the cuff and sense the pressure
wi thi n t he cuf f . A Y-pi ece near the cuf f can be used to mi x si ngl e- and t wo-hose
systems (13). Bl ood pressure tubings should not have Luer connecti ons, because
t hese may al l ow a pressure tube to be connected to anot her devi ce such as an
i ntravenous l i ne (14).
Cuff Inflati on and Deflati on Mechanism
The cuff i nf l ati on mechani sm consi sts of a pump and a reservoi r t hat hol ds a
quant i t y of ai r t hat can be qui ckl y released i nt o the cuff . A bl eed val ve def l ates the
cuff . The speed and manner of def lati on vary f rom manuf acturer t o manuf acturer.
Some adj ust the rat e as a funct ion of pressure.
Sensing Mechanism
A pressure transducer det ects t he pressure i n the cuf f and t ransduces i t i nto an
el ect rical current t hat can be measured. The pressure-sensi ng mechani sm is buil t
i nto t he cuf f i n most moni t ors. An aut ozero valve that peri odical l y opens t he
t ransducer t o atmosphere, automati cal l y establ i shi ng zero pressure, may be
present (7).
Timing Circuitry
The t i mi ng ci rcui try regul ates the f requency of bl ood pressure determi nati ons. Most
i nst ruments also al l ow manual cycl i ng. Most off er a short -t erm automati c (STAT)
mode t hat al l ows a number of determi nat ions to be made i n qui ck successi on.
Control Circuitry
The cont rol ci rcui t ry determi nes such paramet ers as t he maxi mum pressure i n t he
cuff , arti f act reject ion, el ect rosurgi cal i nt erference suppressi on, def l at ion rat e, and
automati c cut of f . The overpressure swi t ch may be set dif f erentl y for adul t and
pediatric model s. Some machines have automati c cuff defl at i on when the cycl e ti me
exceeds a predetermi ned l i mi t.
Alarms
Moni tors vary accordi ng to whi ch parameter(s) wi l l t ri gger an al arm. Some moni tors
automati cal l y set al arms around the i ni t ial val ues. Some have def aul t al arm l i mi ts
t hat can be changed by the operat or. Some moni tors acti vate an al arm when t hey
are unable t o determi ne the blood pressure.
Accuracy
Factors Affecting Bl ood Pressure Determi nations
Cuff/Arm Relationship
Accurate bl ood pressure measurement depends on t he rel at i onship between arm
ci rcumf erence and cuf f wi dt h (10). Typi cal l y, a cuf f that i s too smal l f or the pati ent' s
arm ci rcumf erence wi l l overesti mate bl ood pressure, whereas a cuf f that i s t oo
l arge wi l l underesti mate bl ood pressure (10,15,16). I t i s i mportant that di f ferent
si zes cuf fs are readi l y avail abl e. If a suff icientl y l arge cuff is not avai l abl e, i t may
be possi bl e to pl ace a cuff more di stal l y on t he l i mb. Current recommendati ons are
t hat a cuff 's wi dt h shoul d be approxi matel y 40% t o 50% of the ci rcumf erence (125%
t o 150% of the diameter) of the l i mb on whi ch i t i s used at the l i mb's mi dpoint
(17,18,19). Cuf f length has l i t tl e ef fect as l ong as the bl adder enci rcl es at l east
50% of the arm's ci rcumf erence (17).
I n t he past, i t was the practi ce in pedi atri c pati ents to use a cuf f that was t wo thi rds
t o t hree f ourt hs of t he upper arm l ength. Thi s resul ted i n underesti mati on of bl ood
pressure (20).
Another misleadi ng cri teri on f or determining proper cuff si ze i s a l abel such as
i nfant , chi l d, pedi at ric, smal l adul t , adul t , and l arge adul t . These terms are open to
i nterpretat ion by the user and can lead to i nappropri at e cuff sel ect i on (20).
Site
The si te where t he cuf f i s pl aced wi l l af fect t he measured pressure. As the si te
moves more peri pheral l y, t he systol i c pressure tends to i ncrease and di astol ic
pressure to decrease (21). I ncreased vascul ar t one may resul t i n an increase i n
pulse pressure. Vascul ar di sease and peri pheral vasoconstri cti on may cause
reduced pressures at distal locat ions.
The f orearm or wri st may be used when t he upper arm i s i naccessi bl e and/ or a
standard bl ood pressure cuf f does not f i t (22, 23,24,25). The ankl e may al so be
used (26,27). The mean and di astol i c pressures measured at the ankl e are
comparabl e wi t h those measured i n the arm but the systol i c pressure i s hi gher. A
poor correlati on was f ound between blood pressures measures on the arm and calf
of women who were undergoi ng cesarean secti on (28).
Arm Position
I f the cuf f and t he pat ient' s heart are not at the same l evel , a correcti on must be
made. For each 10 cm of vert ical height, 7.5 mm Hg (f or every i nch 1. 80 mm Hg)
above or bel ow t he heart l evel shoul d be added to or subtracted f rom the pressures
measured (21).
Arrhythmias
The osci ll omet ric t echnique is vul nerable t o error i n pat ients wi t h arrhyt hmi as
(29,30,31, 32).
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Improper Calibration and Maintenance
St udi es perf ormed wi t h i nstruments in common use have shown problems wi t h
cali brati on, mai ntenance, and accuracy (10). Errors in t he al gori thm may occur
(33,34).
Correlation with Other Methods of Blood Pressure
Determination
Many f eel that the standard of compari son should be t he pressure measured
di rectl y i n an art ery, most commonl y the radi al . However, i ndi rect pressure readings
wi l l never exactl y match invasive pressures. One reason is that si mul taneous
measurements of t en cannot be made. Anot her reason i s t hat di rect and indi rect
moni tors measure di f f erent physi cal properti es. The di rect method measures both
t he systol i c and di astol ic pressures and calculates t he mean. Osci l l ometry
measures the mean and cal culates t he systol i c and di astol ic pressures.
Many studies have compared pressures obtai ned wi t h NIBP moni tors wi th t hose
obtai ned di rect l y (16,35,36, 37,38,39,40,41,42,43,44,45,46, 47,48,49, 50,51,52). I n
general , correl at ion of di rectl y measured blood pressures wi th i ndi rect l y measured
bl ood pressures is best i n normal heal t hy pati ents and l east accurate at the
extremes of blood pressure. Al though errors can occur in ei t her di rect ion,
osci l l omet ri c devices tend to overesti mat e low pressures and underesti mate hi gh
pressures. The STAT mode does not deni grat e val ues and is subj ect to the same
vari ati ons as measurements taken under normal ci rcumst ances (53).
Most studi es have concl uded that an NIBP moni tor i s not suf f i ci ent l y accurate if
vasoacti ve drugs are bei ng admi ni st ered or i n cri ti call y i l l pati ents al though i t may
be useful f or trendi ng purposes. Another probl em i s that wi th moderat e to severe
hypotensi on, the automated machi ne of ten cycl es repeatedl y before indicat ing a
f ai l ure to measure (2).
Proper Use
I f possi ble, the cuf f shoul d not be appli ed to t he l i mb i n which an int ravenous
i nfusi on is pl aced because i nf usi on of f luids and drugs wi l l be sl owed or bl ocked
and the i ncreased pressure may cause bl ood to f low ret rograde i nto the i nf usi on set
t ubi ng or extravasat ion (7). Check val ves i n the i nt ravenous tubing between the
f lui d bag and the pati ent usual l y prevent backfl ow i nto the tubing. A si mple method
t o avoi d, or at l east reduce, t hi s probl em i s t o route the i nf usi on t ubi ng under or
t hrough the blood pressure cuf f (54). Other means t o prevent this probl em have
been suggested (55,56,57). In some cases, i t may be possible t o place the cuf f
di stal to the i nf usi on si te.
I f used on the arm, the cuf f should be placed as hi gh as possi bl e, and the i nfl ati on
t ubes shoul d exi t proxi mal l y (58, 59). I f the upper arm is very l arge or conical l y
shaped, i t may be bet ter to measure bl ood pressure at another l ocat ion such as the
ankle, thigh, or f orearm. The cuf f shoul d not be appl ied over a superfi ci al nerve,
bony prominence, or j oint.
Paddi ng should be pl aced around t he ski n under the cuff to prevent ski n creasing,
petechi ae, bl i steri ng, nerve damage, and probl ems f rom resi dual cl eani ng materi al s
(60).
Pri or to appl ying t he cuf f , al l resi dual ai r shoul d be expel l ed. The cuff shoul d be
appli ed snugl y enough to al l ow onl y one f i nger to be sl i pped under i t . Too t ight a
cuff may cause di scomf ort and venous di stent ion. Too l oose a cuff may cause
f alsel y elevat ed readi ngs and may prevent the moni t or f rom det ermi ni ng the bl ood
pressure. The cuff shoul d be pl aced and several i nfl at ions made whi l e the pat i ent i s
awake to el i ci t compl ai nts. Nothi ng shoul d be al l owed t o press agai nst the cuf f
duri ng measurements.
Bl ood pressure measurements shoul d be made no more f requentl y than cli ni cal l y
necessary. In one study, i t was shown t hat except when rapi d changes i n blood
pressure are ant icipated, a one- or t wo-mi nut e cycle t i me of f ers no advantage over
a fi ve-mi nut e cycl e ti me, but the short er ti me may i ncrease t he compl i cat i on rat e
(61).
The cuff si t e and extremi ty shoul d be inspected peri odi cal l y during prol onged
appli cati ons. It i s good practi ce i s to occasi onall y swi t ch the cuff to another si te, if
possi bl e.
Complications
Damage to Underl ying Tissues
Pet echiae, erythema, edema, t hrombophl ebi ti s, and ski n avulsion at the cuff si te
have been report ed (62,63,64,65,66,67,68,69). Predisposing f actors to t he
devel opment of petechi al hemorrhages include pati ents taking anti -i nf l ammatory
drugs, st eroids, or anti coagul ants and pati ents wi t h thin or redundant ski n (70).
Pet echia of t en occur under folds i n t he cuf f . Wrappi ng the space under the cuf f wi t h
cott on may avoid t hese problems.
Neuropathies
Neuropathies of the median, ul nar, and radi al nerves have been reported f ol l owi ng
use of an aut omat i c NIBP moni tor (58,59,69,71,72). Al l resol ved spontaneousl y.
Locati ng t he cuff close to the axi l l a and away f rom the el bow wi l l hel p to prevent
radi al nerve i nj ury. Excessive movement makes i t di ff i cul t f or the devi ce to
determine pressures, so i t wi l l cycl e more of ten, possi bl y to hi gher pressures. Thi s
can cont ri bute to nerve i nj uri es.
Compartment Syndrome
Cases of compartment syndrome associated wi t h prol onged use have been report ed
(73,74,75). In one case, the pati ent had hyperact ivit y and t remor. I n another case,
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t he bl ood pressure was l abi l e, causi ng the moni tor t o cycl e l onger and wi th hi gher
pressures than usual . I n a t hi rd case, the cuf f was appl i ed across the ant ecubi tal
f ossa.
Mechani cal Problems
Fai l ure of an NIBP moni t or i s not uncommon and may be associ ated wi t h seri ous
morbi di t y or mortal i t y (2,76). A common probl em is a l eaki ng cuf f , hose, or
connector (7, 76, 77).
Artifacts
Osci l l ometri c devi ces are sensi ti ve t o bot h i nt ri nsi c and extri nsi c moti ons (79).
I ntri nsi c moti on arti f acts are caused by movements such as del i berate pati ent
moti on, shiveri ng, tremors, convul si ons, rest l essness, or vi gorous skin preparat ion
(79,80). Ext ri nsi c mot ion art if acts are caused by act i ons that compress the cuf f ,
such as bumpi ng by personnel or equi pment (7) or massaging the arm where the
bl ood pressure cuf f is l ocated (81). Synchroni zat i on wi t h the electrocardi ogram can
reduce art if acts (82).
Bl ood pressure readi ngs were reported i n a pati ent where t he cuf f was under t he
pati ent 's head (83). It i s surmised that head movements caused enough mot i on i n
t he cuf f to produce the art i factual readi ngs. In another case, a cuff became
unfastened, but the bladder remai ned between the arm and the thorax (84). I t was
st i l l abl e to detect osci l l ati ons and displayed a f i cti ti ous pressure.
Air Embolism
I f the l i ne used to infl at e the cuff i s connected to an i nt ravenous l ine, a seri ous ai r
embolus can resul t (85).
Advantages
Automaticity
A maj or advantage of NIBP devices is that they can determi ne pressures regul arl y
and f requentl y on an automat i c basi s. Duri ng busy t i mes, t hi s is very helpf ul , savi ng
t i me and al l owi ng cl inicians to perf orm other t asks.
Aut omat i c devi ces el i minate most of t he f act ors that cause errors when bl ood
pressures are determined manuall y, such as vari abl e concent rati on, reacti on t i mes,
heari ng acui t y, ambient noise, confusi on of audi tory and vi sual cues, vari abl e
defl ati on rates, background noi se, variable i nt erpret ati on of sounds, preference f or
cert ai n digi ts, and bias due to knowl edge of previ ous readi ngs. They may eli mi nate
some of the mi st rust that some i ndividual s have when others measure the bl ood
pressure manual l y.
Simpli city
Aut omat i c NIBP moni tors are si mple t o use. They do not requi re extensi ve trai ni ng
t o set up or maintai n.
Noninvasiveness
I n compari son wi th di rect measurements, NI BP moni tors are l ess expensi ve,
si mpl er, and avoid t he ri sks (i schemic damage, embol i ) associ ated wi t h di rect
t echni ques.
Reliability
NI BP moni tors are rel iable devi ces that general l y do not requi re a l ot of
mai ntenance or experience a lot of downti me.
Usefulness
Some NIBP devi ces wi l l work in certai n pati ents (such as those wi t h obesi t y or
scl erosis and i nf ants), i n whom an accurate pressure cannot be obtained manuall y.
They wi l l read accuratel y t hrough bul ky dressi ngs (86). Pul se rates between 40 and
200 beats per mi nute usuall y do not hinder readi ngs (78).
Versati lity
Osci l l ometri c blood pressure measurements can be made on a vari et y of si tes.
Monitor Integrati on
NI BP moni tors can be i ntegrated wi t h other moni tors. Thi s integrati on may al l ow t he
number of f al se al arms to be reduced. For exampl e, i t may be possibl e to set the
pulse oxi meter so that i t does not al arm f or a certain peri od of t i me af ter the NIBP
cuff i s inf l ated.
Disadvantages
Unsuitable Situati ons
Whi le non-cont inuous bl ood pressure moni tori ng is helpf ul in establ i shing t rends, i t
i s unsui tabl e for det ecti ng rapi d changes i n bl ood pressure (87). If rapid changes
are ant icipated, a conti nuous method should be used.
Patient Di scomfort
Pat i ent di scomf ort i s of ten associated wi t h a prol onged cycl e t ime. Cycl e ti me wi l l
be prol onged wi t h a l arge cuf f , hypertensive pati ents, poor peri pheral ci rculati on, a
l eak i n t he moni tor, l ow bl ood pressure, dysrhyt hmias, or moti on arti f acts.
Cli nical Limitations
Aut omat ed bl ood pressure devi ces do not work wel l wi t h ext reme heart rates and
pressures. In ext reme condi ti ons, even mean pressure may not be measurabl e.
St udi es i nvolvi ng ambulance and heli copter transport have shown t hat t hese
moni tors are not as rel i abl e as needed (88,89,90).
Noncontinuous Measurements
Af ter a blood pressure measurement has been made, the val ue is usual l y displayed
unti l the next measurement.
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Most moni tors gi ve some i ndi cati on of t he age of t he di splayed val ue. Some
cl i nicians do not set the bl ood pressure moni tor t o automat ic unti l af ter induct i on is
compl ete. On occasi on, t here i s a prolonged peri od unt i l the aut omati c mode i s
used (91,92). Duri ng this t ime, the ori gi nal blood pressure wi l l be di splayed.
Continuous Noninvasive Blood Pressure Instruments
Conti nuous or near-conti nuous blood pressure moni tori ng i s desi rabl e i n pati ents
wi th cardi ac or cerebrovascul ar di sease, in cri t i cal l y i l l pat i ents, and i n surgi cal
procedures in whi ch peri ods of hemodynami c instabi li ty are ant i ci pat ed.
Vasotrac
The Vasot rac consi sts of a wri st modul e and a moni t or/ di spl ay connected by a
cable (93). The sensor is pl aced over t he radi al art ery at the wri st. A pressure-
sensi ng mechani sm appl i es variable pressure di rectl y above t he artery. The
counterpressure i n the art ery produces a pressure wavef orm. Anal ysis of the
waveform is used to calcul ate the systol i c, diastol i c, and mean arteri al pressures.
Bl ood pressure measurements, pul se rate, and an art erial waveform displ ay are
updat ed several ti mes a minute and displ ayed on a moni t or. It i s avail abl e in a
handhel d versi on.
When t he Vasotrac was compared wi t h di rect art eri al pressure, good correl ati on
was f ound (93, 94,95,96, 97,98). I t was f ound t o be accurate when del i berate
hypotensi on was used (98,99). However, i n l iver transpl antati on pati ents, t he
Vasotrac was not suff ici entl y accurate t o substi tute f or di rect arteri al bl ood
pressure moni toring (100).
Bl ood pressure can be det ected down t o 40 mm Hg and up t o 240 mm Hg. It is
accurate wi t h arrhyt hmi as. The Vasot rac system is suscepti bl e to pati ent arm
movement , but the wavef orm can al ert t he caregi ver to arti facts.
Al though t he Vasotrac does not provi de cont i nuous bl ood pressure measurement, i t
provi des much more f requent measurements (3 to 4 ti mes per mi nute) t han t he
i ntermi ttent method. This may decrease the need f or i nt ra-arteri al cannul at ion.
T-Line Tensymeter
The T-Li ne Tensymeter uti li zes art eri al tonomet ry, in whi ch a peri pheral art ery i s
sl i ght ly compressed and the pulse wave i s sensed by a transducer pl aced over i t. I t
consi sts of three part s: A di sposabl e wri st spl int, a di sposable radi al art ery sensor,
and a reusabl e bracel et. The pat ient 's hei ght and wei ght must be entered i nt o the
moni tor.
Fi rst, the wri st restrai nt i s appl i ed. The radi al pul se is pal pated and marked. The
sensor i s al i gned over the poi nt of maxi mum pulsati on. Then, the bracel et i s
connected over thi s. The devi ce then automat ical ly and cont inuousl y determi nes t he
poi nt of maxi mum pul sat i on and exerts sl ight pressure on the artery. Once the
opti mum si te is l ocated, the system does a dynami c pressure search to determi ne
t he mean arteri al pressure. The pulsati on i s convert ed i nto a di splayed wavef orm,
and systol ic and diast ol i c bl ood pressures are computed by usi ng t he wavef orm, the
pati ent 's body mass i ndex, and an algori t hm. Thi s provi des cont inuous, beat -t o-beat
NI BP measurements.
Thi s device requi res l ess t i me to set up t han i nvasive art eri al cathet er pl acement
and avoi ds the ri sks associated wi th an i nvasi ve arteri al catheter. One study f ound
t hat the bl ood pressures agreed cl osel y wi th si mul t aneous pressures measured
i nvasivel y f rom a contral at eral radi al artery (101).
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P. 844


Questions
For the f ol lowing quest ions, answer
i f A, B, and C are correct
i f A and C are correct
i f B and D are correct
i s D i s correct
i f A, B, C, and D are correct .
1. Duri ng the measurement cycle to determine the bl ood pressure,
A. The poi nt of maxi mum ampl i tude is consi dered the systol i c pressure
B. Syst ol i c and diastol i c pressures may be esti mated by i dent i f yi ng t he region
where ampl i tudes of osci l l at ions increase and decrease rapi dl y
C. The diastol i c pressure i s the point where osci l lati ons cease
D. Mean pressure is determi ned and t he systol i c and di astol i c pressures are
calculated
Vi ew Answer2. Which statements regardi ng accuracy of noninvasive
bl ood pressure monitors are correct?
A. Si nce most use osci l lometric t echnol ogy, there i s close agreement bet ween
di ff erent i nstruments
B. Pl acement of the cuf f over the artery i s import ant
C. Pati ent movement causes a great deal of art i f act to an osci ll omet ri c technique
D. The posi ti on of the cuff i n relati on to t he heart i s import ant
Vi ew Answer3. Accuracy of the automati c bl ood pressure monitor may be
affected by
A. El ectrosurgi cal i nterference
B. Venous engorgement
C. Peri pheral vasoconstricti on
D. Cuff si ze
Vi ew Answer4. Which factors characterize the relati onshi p between the
size of the cuff and the size of the arm?
A. Undersi zed cuf f s give f al sel y l ow readi ngs
B. The cuf f wi dth shoul d be 125% to 150% of the di ameter of the l i mb on whi ch i t i s
used
C. Oversi zed cuf fs give f al sel y hi gh readi ngs
D. The cuf f l engt h has li t tl e ef f ect on accuracy
Vi ew Answer5. Factors that can affect the determi nation of blood
pressure by the auscul tatory method i nclude
A. Rate of cuf f def lati on
B. Rate of cuf f i nf l ati on
C. Heari ng acui t y
D. Standardized concept of systol i c and di astol i c end poi nts
Vi ew Answer6. Which techni ques constitute proper cuff placement?
A. The cuf f should be placed ti ghtl y on the l i mb
B. A l oosely appl ied cuff wi l l usual ly cause f al sel y el evated readi ngs
C. The cuf f should be kept on t he same arm even duri ng long procedures
D. The l i mb shoul d be wrapped wi t h paddi ng where t he cuf f i s t o be pl aced
Vi ew Answer7. Pati ents at ri sk for developing petechiae i ncl ude
A. Those on anti coagul ants
B. Those taki ng st eroids
C. Those t aki ng nonsteroi dal ant i -i nfl ammatory drugs
D. Those wi th redundant ski n
Vi ew Answer8. Contributi ng causes of a compartment syndrome i ncl ude
A. Prol onged use
B. Hyperact ive pati ent
C. Low pl acement of the cuf f
D. Stabl e bl ood pressures
Vi ew Answer