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Measuring blood pressure using a manual sphygmomanometer: a literature review of blood pressure measurement techniques

Author(s): Tracey Valler-Jones, Kirsty Wedgbury

Automated blood pressure devices have been embraced by clinicians for their convenience and ease of use. Along with the pressure to remove mercury containing medical devices this is leading to the demise of the mercury sphygmomanometer and the loss of this essential skill. This paper argues that there is still a place for manual sphygmomanometry particularly when a clinical decision is based on accurate blood pressure readings. It is a recommendation of the Independent Advisory Group on Blood Pressure Monitoring in Clinical Practice [1] that auscultation as a method of determining blood pressure should continue to be taught to health care workers as appropriate.

This is a review of the available literature to explain the rationale for the use of manual sphygmomanometry and gives a step-by-step guide to the procedure with current supporting evidence. There is a brief discussion of special considerations when dealing with certain client groups. Normal blood pressures ranges for adult and children have been included along with a definition of hypertension in both.

Key points: (1) There is pressure to remove mercury containing medical devices from the clinical area. However, they are currently exempt from legislation governing the use of mercury. (2) The manual auscultatory method is still perceived as the ‘gold standard’. (3) It is important that clinical staff are trained to undertake a blood pressure correctly and understand the rationale for each step of the procedure. (4) Manufacturers are still not required to meet set standards or benchmarks against which electronic devices are measured. (5) All blood pressure monitors for use within the clinical area must be CE marked; however, there are no recognised standards of accuracy that must be obtained to achieve a CE mark. (6) It is essential that all staff using electronic devices understand the device limitations and are aware of sources of error. (7) Where treatment protocols are based on accurate blood pressure readings, the clinician must ensure that the equipment is appropriate for that application.


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