Abstract
An understanding of the principles of blood pressure measurement with automated oscillometric devices (e.g., Dinamap) allows a user to realize the purpose and level of accuracy for which the equipment is designed. Good technique calls for various actions: (1) using a cuff of proper size (too large a cuff will generally work acceptably, but too small a cuff will yield erroneously high readings); (2) squeezing all of the residual air out of the cuff before applying it to the arm or leg; (3) wrapping the cuff snugly around the arm or leg; (4) instructing the patient to refrain from talking or moving and letting nothing press against the cuff during measurement; (5) keeping the cuff and heart at the same horizontal level. (6) When instrument malfunction is suspected, first checking the status of the patient (not the status of the instrument) to be sure that a clinical emergency is not causing the suspected “malfunction”; (7) repeating a reading several times when it is suspicious and, if necessary, modifying the measurement conditions by using, for example, different limbs or different cuffs until the question is resolved; and (8) remembering that a leak in the cuff, hoses, or connection can cause an unexpected malfunction.
Similar content being viewed by others
References
Cushing H. On routine determinations of arterial tension in operating room and clinic. N Engl J Med 1903;148:250–256
Prys-Roberts C. Arterial manometry under pressure? Anesthesiology 1974;40:1–3
Ramsey M. Non-invasive automatic determination of mean arterial pressure. Med Biol Eng Comput 1979;17:11–18
Erlanger J. Studies in blood pressure estimations by indirect methods. Am J Physiol 1916;39:401–446
Geddes LA. Direct and indirect measurement of blood pressure. New York: Yearbook Medical Publishers, 1970
Posey JA, Geddes LA, Williams H, Moore AG. The meaning of the point of maximum oscillations in cuff pressure in the indirect measurement of blood pressure. Cardiovasc Res Cent Bull 1969;8:15–25
Geddes LA, Moore AG, Garner H, et al. The indirect measurement of mean blood pressure in the horse. Southwest Veterinarian 1970;23:289–294
Cullen DJ. Interpretation of blood pressure measurements in anesthesia. Anesthesiology 1974;40:6–12
Benson H, Herd JA. Oscillometric measurement of arterial blood pressure. Circulation 1969;[Suppl 3]:39–40
Ream AK. Systolic, diastolic, mean or pulse: Which is the best measurement of arterial pressure? In: Gravenstein JS, Ream AK, Smith T, eds. Essential noninvasive monitoring in anesthesia. New York: Grune & Stratton, 1980:53–74
Yelderman M, Ream AK. Indirect measurement of mean blood pressure in the anesthetized patient. Anesthesiology 1979;50:253–256
Von Recklinghausen H. Neue Wege der Blutdrugmessung. Berlin: Springer-Verlag, 1931
Fabré PH. Determination de la pression arterielle maxima par la methode oscillometrique. C R Soc Biol (Paris) 1922:951–952
Ramsey M. Automatic mean blood pressure reading device. U.S. Patent 4,360,029. Washington, DC: U.S. Patent Office, 1982
Ramsey M. Automatic mean blood pressure reading device. U.S. Patent 4,349,034. Washington, DC: U.S. Patent Office, 1982
Medero R, Hood RW, Apple HP, Ramsey M. Method of automated blood pressure detection. U.S. Patent 4,543,962. Washington, DC: U.S. Patent Office, 1985
Ramsey M, Muskatello JM, Hood RW, et al. Sphygmonanometric cuff pressurizing system. U.S. Patent 4,627,440. Washington, DC: U.S. Patent Office, 1986
Ramsey M, Medero R, Hood RW. Automated diastolic blood pressure monitor with data enhancement. U.S. Patent 4,638,810. Washington, DC: U.S. Patent Office, 1987
Ramsey M, Medero R, Hood RW. Automated mean arterial blood pressure monitor with data enhancement. U.S. Patent 4,754,761. Washington, DC: U.S. Patent Office, 1988
Link WT. Apparatus and process for producing sphygmometric information. U.S. Patent 3,903,872. Washington, DC: U.S. Patent Office, 1975
Nunn DE, Beveridge RW. Apparatus and method for measuring blood pressure. U.S. Patent 4,427,013. Washington, DC: U.S. Patent Office, 1984
Flynn GJ. Method and apparatus for diastolic pressure measurement. U.S. Patent 4,271,843. Washington, DC: U.S. Patent Office, 1981
Williams WJ. Method and apparatus for blood pressure measurements. U.S. Patent 4,117,835. Washington, DC: U.S. Patent Office, 1978
Swearingen, JD, Watson RC. Methods of and apparatus for the measurement of blood pressure. U.S. Patent 4,263,918. Washington, DC: U.S. Patent Office, 1981
Adiseshiah M, Cross FW, Belsham PA. Ankel blood pressure measured by automatic oscillotonometry: a comparison with Doppler pressure measurements. Annals of the Royal College of Surgeons of England (1987) vol. 69:271–273
Montfrans GA, Van Der Hoeven GMA, Karemaker JM, Wieling W. Accuracy of auscultatory blood pressure measurement with a long cuff. Br Med J 1987;295:354–355
Linfors EW, Feussner JR, Blessing CL, et al. Spurious hypertension in the obese patient. Effect of sphygmomanometer cuff size on prevalence of hypertension. Arch Intern Med 1984;144:1482–1485
Manning DM, Kuchirka C, Kaminski J. Miscuffing: inappropriate blood pressure cuff application. Circulation 1983;68(4):764–766
Anderson T, Stokholm KH, Nielson PE. Blood pressure and arm circumference during large weight reduction in normotensive and borderline hypertensive obese patients. J Clin Hypertens 1987;3:547–553
Mariotti G, Alli C, Avanzini F, et al. Arm position as a source of error in blood pressure measurement. Clin Cardiol 1987;10:591–593
Waal-Manning HJ, Paulin JM. Effects of arm position and support on blood-pressure readings. J Clin Hypertens 1987;3:624–630
Wadsworth TG, Williams JR. Cubital tunnel compression syndrome. Br Med J 1973;1:662–666
Park MK, Menard SM. Accuracy of blood pressure measurement of the Dinamap monitor in infants and children. Pediatrics 1987;79:907–914
Wareham JS, Haugh LD, Yeager SB, Horbar JD. Prediction of arterial blood pressure in the premature neonate using the oscillometric method. Am J Dis Child 1987;141:1108–1110
Debru JL, Doyon B, Morin B, et al. Mesure automatique de la pression arterielle par methode oscillometrique (Dynamap 845). Arch Mal Coeur 1981;74:125–129
Pessenhofer H. Single cuff comparison of two methods for indirect measurement of arterial blood pressure; standard auscultatory method versus automatic oscillometric method. Basic Res Cardiol 1986;81:101–109
Silas JH, Barker AT, Ramsay LE. Clinical evaluation of Dinamap 845 automated blood pressure recorder. Br Heart J 1980;43:202–205
Cullen PM, Dye J, Hughes DG. Clinical assessment of the neonatal Dinamap 847 during anesthesia in neonates and infants. J Clin Monit 1987;3:229–234
Hutton P, Dye J, Prys-Roberts C. An assessment of the Dinamap 845. Anesthesia 1984;39:261–267
Johnson CJH, Kerr JH. Automatic blood pressure monitors; a clinical evaluation of five models in adults. Anesthesia 1985;40:471–478
Van den Broeke JJ, Karliczek GF. Labor- Und Kontrollverfahren. DINAMAP—eine neue automatische Blutdruckmessung; Ergebnisse von Vergleichsmessungen. Anasth Intensivther Notfallmed 1979;14:533–536
Loubser PG. Comparison of intra-arterial and automated oscillometric blood pressure measurement methods in postoperative hypertensive patients. Med Instrumen 1986;20:255–259
Dellagrammaticas HD, Wilson AJ. Clinical evaluation of the Dinamap non-invasive blood pressure monitor in preterm neonates. Clin Phys Physiol Meas 1981;2:271–276
Milsom I, Svahn SO, Forssman L, Sivertson R. An evaluation of automated indirect blood pressure measurement during pregnancy. Acta Obstet Gynecol Scand 1986;65:721–725
Hutton P, Dye J, Prys-Roberts C. An assessment of the Dinamap 845. Anesthesia 1984;39:261–267
Kimble K, Darnall RA, Yelderman M, et al. An automated oscillometric technique for estimating mean arterial pressure in critically ill newborns. Anesthesiology 1981;54:423–425
Baker LK. DINAMAP monitor versus direct blood pressure measurements. Dimens Crit Care Nursing 1986;5:228–235
Borow KM, Newburger JW. Noninvasive estimation of central aortic pressure during the oscillometric method: a comparative study of brachial artery pressure with simultaneous central aortic pressure measurements. Am Heart J 1982;103:879–886
Nystrom E, Keid KH, Bennett R, et al. A comparison of two automated indirect arterial blood pressure meters: with recordings from a radial arterial catheter in anesthetized surgical patients. Anesthesiology 1985;62:526–530
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ramsey, M. Blood pressure monitoring: Automated oscillometric devices. J Clin Monitor Comput 7, 56–67 (1991). https://doi.org/10.1007/BF01617900
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01617900