Flipped Classroom - Blood Pressure monitoring Flashcards
How is blood pressure estimated using palpation?
By occluding an artery with a sphygmomanometer cuff and palpating for the return of pulsations with the progressive release of pressure (2-3 mmHg per heartbeat).
What blood pressure value can be obtained using palpation?
Estimation of systolic blood pressure (SBP).
How is a Doppler probe used in blood pressure measurement?
Same procedure as palpation but with the use of a Doppler probe.
What blood pressure value can be obtained using a Doppler probe?
Estimation of SBP.
What is auscultation in blood pressure measurement?
Listening for Korotkoff sounds, broken into five phases
* Phase 1: indicates estiated SBP
* Phase 5: Indicates the estimated diastolic blood pressure (DBP).
What factors can cause inaccurate diastolic pressure estimations with auscultation?
Loss of Korotkoff sounds due to hypertension.
What conditions decrease the ability to auscultate Korotkoff sounds?
Increased peripheral vasoconstriction, hypotension, and noisy environments.
How is Mean Arterial Pressure (MAP) calculated?
MAP = DP + (SP - DP)/3
or
MAP = [(DP x 2) + SP]/3
Alternatively, MAP = [(DP × 2) + SP] / 3
What is the preferred method of non-invasive blood pressure monitoring in the US and worldwide?
Oscillometry
what causes the oscillations
Arterial pulsations within the BP cuff.
How are oscillations analyzed?
analyzed by an electronic microprocessor via an algorithm to estimate SBP, DBP, and MAP.
* SBP is estimated at the highest-pressure oscillations
occur
* DBP is estimated at the lowest-pressure oscillations
occur
* MAP is estimated at highest amplitude of oscillations
What is a consideration when using oscillometry for blood pressure measurement?
Algorithmic data collection varies among manufacturers, so measurement results may differ
How does arterial tonometry measure arterial blood pressure?
By sensing the pressure required to partially occlude a superficial artery supported by a bony structure
What are the benefits of arterial tonometry?
Offers continuous non-invasive blood pressure (NIV) monitoring and provides waveform tracing.
What are the limitations of arterial tonometry?
Requires frequent calibration and is highly sensitive to patient movement.
How does the finger cuff method facilitate blood pressure monitoring?
Uses a small-volume cuff with an infrared light detector
What does the finger cuff method generate?
An arterial pressure waveform and uses algorithmic interpretation with specific patient characteristics to interpret BP readings
What is the ClearSight System, and how does it aid anesthesia providers?
A finger cuff system by Edwards Lifesciences that helps guide fluid management via NIV methods
What parameters can be monitored continuously using the finger cuff method?
Stroke Volume (SV), Stroke Volume Variation (SVV), Systemic Vascular Resistance (SVR), Mean Arterial Pressure (MAP), and Cardiac Output (CO)
Why is obtaining the correct cuff size and position important in blood pressure measurement?
Ensures accurate measurements.
What are acceptable alternative sites for blood pressure cuff placement if the upper arm is inaccessible?
Forearm, wrist, and ankle.
How much of the extremity should the cuff’s bladder encircle?
At least 50% of the extremity.
How should the cuff width compare to the extremity’s diameter?
It should be approximately 40% greater than the extremity’s diameter.
A more distally positioned cuff will ____ SBP and ____ DBP.
A more distally positioned cuff will elevate SBP and decrease DBP.
What is the preferred blood pressure site in pediatric patients, and why?
The upper extremity due to its closer correlation to cerebral perfusion
Above the heart: Falsely ____ results. Below the heart: Falsely ______ results.
Above the heart: Falsely low results. Below the heart: Falsely high results.
How much does blood pressure change per 10 cm of height difference from the heart?
7.4 mmHg change in BP.
How much does blood pressure change per 1 inch of height difference from the heart?
2 mmHg change in BP.
If a blood pressure cuff is 12 inches below heart level and the monitor reads 124 mmHg, what is the correct systolic pressure?
12 inches × 2 mmHg per inch = 24 mmHg increase
124 mmHg - 24 mmHg = 100 mmHg.
What are the complications associated with repeated blood pressure cuff use?
Patient discomfort, increased tendency for measurement errors, limb ischemia, neuropathies (Radial, Ulnar, & Median Nerves), compartment syndrome, bruising, and petechiae.
What is recommended in prolonged surgical cases to prevent neuropathy complications?
Relocate the blood pressure measurement site if allowable
What are the contraindications for blood pressure cuff placement?
Bone fractures, open injuries (burns), arteriovenous fistulas, peripherally inserted central catheters (PICC lines), and sites of previous lymph node dissection.
What are considerations for advancing to invasive monitoring in anesthesia?
- Abrupt and extreme changes in blood pressure,
- present or anticipated inability to compensate for hemodynamic changes,
- surgical procedures that expose the patient to large intra/extracellular volume shifts
- patients with compromised respiratory function, oxygenation, or ventilation
Why is blood pressure monitoring crucial in anesthesia administration?
The administration of anesthetics requires precise and routine blood pressure monitoring.
What are the most frequent methods of non-invasive blood pressure monitoring in anesthesia care?
Oscillometry, Tonometry, & Finger Cuff Methods.
Why is recognition of positioning and sizing important in blood pressure monitoring?
It helps anesthesia providers achieve accurate non-invasive blood pressure results.
Why should anesthesia providers be aware of complications and contraindications of non-invasive blood pressure monitoring?
To ensure safe and effective patient management.
How should the decision between non-invasive vs. invasive blood pressure monitoring be made?
Based on the patient’s condition and the surgical procedure
