Non Invasive Blood Pressure

Monitoring

Biomedical Instrumentation

By
Saravanan R
110122091
 Index Page

 Introduction
 Principles of NIBP
 Oscillometric Method
 Auscultatory Method
 Advantages & Limitations
 Clinical Applications
 Conclusion
Non Invasive Blood Pressure (NIBP) Monitoring :

• NIBP monitoring refers to techniques used to measure blood

pressure without puncturing the skin or entering the body.

• It relies on indirect methods to estimate arterial pressure, making it a safe

and convenient option for routine monitoring.

• Common NIBP methods include

oscillometry and auscultation, which
use a cuff to measure pressure
changes or listen for arterial sounds.
Principle of NIBP :

 NIBP methods indirectly estimate arterial blood pressure by applying external

pressure to an artery.
 These methods avoid direct arterial puncture, reducing the risk of complications.
 The key is to accurately correlate external measurements with internal arterial
pressure.

Two primary methods :

 Detects oscillations in cuff pressure to estimate systolic, diastolic, and mean

arterial pressure.
 Listens for Korotkoff sounds as the cuff deflates to determine
systolic and diastolic pressures.
Oscillometric method :

 The oscillometric method detects arterial blood pressure by sensing

Oscillations in the cuff pressure.
 The device inflates the cuff to a pressure above the expected systolic
Pressure, occluding the artery.
 As the cuff deflates, it measures small pressure oscillations caused by
Arterial pulsations.

Components :

 Cuff: An inflatable bladder wrapped around the upper arm.

 Pump: An electrically powered pump to inflate and deflate the cuff.
 Pressure Sensor: Measures the cuff pressure and oscillations.
 Microprocessor: Analyzes the oscillometric waveform and
Calculates systolic, diastolic, and mean arterial pressure (MAP).
How it works..

 The cuff is inflated to a pressure

above systolic blood pressure,
occluding the artery.
 The cuff pressure is gradually
reduced.
 The device detects and measures
pressure oscillations as blood flow
returns.
 The microprocessor uses algorithms
to determine MAP, systolic, and
diastolic pressures based on the
amplitude and timing of these
oscillations.
Advantages :

Ease of Use :
 Automated devices simplify blood pressure measurement, reducing
the need for extensive training.
 Measurements are quick, typically taking less than a minute.

•Reduced Over Bias :

 Automated readings minimise subjective interpretation, improving consistency.
 Less susceptible to human error compared to manual auscultation.

Wide applicability :
 Suitable for various clinical settings, including hospitals, clinics, and home use.
 Can be used on a broad range of patients, including children and the
elderly (with appropriate cuff sizes).
 :
Auscultatory Method :
 The auscultatory method determines blood pressure by listening for
Korotkoff sounds as the cuff deflates.
 These sounds are produced by the pulsatile flow of blood through the
compressed artery.

Components :
 Cuff: Inflatable bladder wrapped around the upper arm.
 Sphygmomanometer: A device to inflate the cuff and measure the pressure
 Stethoscope: Used to listen for Korotkoff sounds over the brachial artery.

w it works..
 The cuff is inflated to a pressure above the expected systolic pressure,
occluding the brachial artery.
 The stethoscope is placed over the brachial artery, just below the cuff.
 The cuff pressure is gradually reduced while listening for Korotkoff sounds.
 The systolic pressure is recorded when the first clear tapping sound is heard
 The diastolic pressure is recorded when the sounds disappear
General Advantages of NIBP :

•Convenience: Easy to use and can be performed quickly in various settings.

•Comfort: Non-invasive, reducing discomfort for the patient compared to invasive
methods.
•Cost-effective: Generally less expensive than invasive blood pressure monitoring.
•Repeatability: Allows for frequent and repeated measurements.

General Limitations of NIBP :

•Accuracy: Can be less accurate than invasive methods, particularly in patients with
arrhythmias or low blood pressure.
•Cuff Size Dependance: Accurate readings depend on proper cuff size selection.
•Motion Artifact: Patient movement can interfere with measurements.
•Not suitable for All patients: May not be reliable in critically ill patients or those
with certain medical conditions.
Sources of Error in NIBP Measurements :

Patient-Related Factors:

Motion: Movement during measurement can cause inaccurate readings.

Arrhythmias: Irregular heartbeats can lead to errors in pressure detection.
Obesity: Excess tissue can affect cuff pressure transmission and accuracy.
Anxiety/Stress: Elevated stress levels can temporarily raise blood pressure.

Equipment-Related Factors:

Incorrect Cuff Size: Using a cuff that is too small or too large can significantly affect accuracy.
Cuff Placement: Improper placement on the arm can lead to incorrect readings.
Calibration Errors: Inaccurate calibration of the device can result in systematic errors.
Equipment Malfunction: Faulty equipment can produce erroneous results.

Environmental Factors:

Noise: External noise can interfere with auscultatory measurements.

Temperature: Extreme temperatures can affect the performance of some devices.
Techniques for Minimizing Errors in NIBP Measurements :

 Proper Cuff Selection :

 Ensure the cuff is the correct size for the patient's arm.

 Patient Positioning :

 Maintain the arm at heart level during measurement.

 Regular Calibration:

 Check equipment accuracy regularly to prevent systematic errors.

 Minimize Motion:

 Ensure the patient remains still during the measurement process.

Continuous NIBP Monitoring :

What is Continuous NIBP?

Instead of taking blood pressure readings only at specific times, continuous NIBP monitors blood pressure all the time,
providing a constant stream of data.This is especially useful in critical care settings or when monitoring patients with
unstable blood pressure.

Volume Clamp Method :

In Simple Terms: Imagine a tiny cuff on your finger that's always adjusting its pressure to keep the artery at a constant
size.
How it Works: The device shines a light through your finger to measure the artery size. If the artery gets bigger, the cuff
squeezes a little more; if it gets smaller, the cuff loosens. The pressure of the cuff is then used to estimate your blood
pressure.

Arterial Applanation Tonometry :

In Simple Terms: This method gently flattens an artery near the surface of your skin and measures the force needed to do
so.
How it Works: A sensor presses lightly on an artery (usually in your wrist). The amount of force needed to slightly flatten
the artery is related to the blood pressure inside it.
Clinical Applications of NIBP :
Monitoring Hypertension Management:
 NIBP is crucial for diagnosing and managing hypertension, allowing for regular monitoring of blood pressure trends.
 Home NIBP devices enable patients to track their blood pressure and treatment effectiveness.

Critical Care Settings:

 Continuous NIBP monitoring is essential in intensive care units (ICUs) for patients with unstable hemodynamics.
 Provides real-time data to guide interventions and assess treatment responses.

Anesthesia and Surgery:

 NIBP monitoring is standard during anaesthesia and surgery to ensure hemodynamic stability.
 Helps detect and manage hypotension or hypertension during procedures.

Diagnosis:

 Identify high blood pressure and cardiovascular risk

Future Trends in NIBP Monitoring :

Wearable Sensors:

 Development of comfortable, cuffless wearable sensors for continuous, real-time monitoring.

 Integration with smartphones and telehealth platforms for remote patient management.

Improved Accuracy:

 Advancements in sensor technology and algorithms to enhance the accuracy of NIBP measurements,
especially in challenging patient populations.

Integration with AI:

 Use of artificial intelligence and machine learning to predict blood pressure changes and provide
personalized insights.
Conclusion :

Recap of Key Points:

 Non-invasive blood pressure monitoring is a fundamental technique in healthcare.
 Oscillometry and auscultation are the primary methods, each with its advantages and limitations.
 Continuous NIBP methods offer real-time monitoring for critical care.
 Future trends focus on wearable sensors, improved accuracy, and AI integration.

Importance of Accurate NIBP Measurements:

 Accurate NIBP measurements are essential for effective diagnosis, treatment, and management of
hypertension and other cardiovascular conditions.
 Proper technique, cuff selection, and regular calibration are crucial for minimizing errors.

Final Thoughts:
 NIBP monitoring will continue to evolve, driven by technological advancements and the need for more
convenient and reliable solutions.
Inferences :

 Principles of Biomedical Instrumentation by R.S. Khandpur

 Medical Instrumentation: Application and Design by John G. Webster

 American Heart Association: heart.org

 National Institutes of Health (NIH): nih.gov