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Outline Thesis

WILL UPDATE THIS PART ABIT LATER

Theoretical part

Anatomy of blood pressure

Definition of blood pressure?

The heart is responsible for supplying the tissues and body organs with blood. Whenever it beats, it transfuses blood into the vast vessels of the circulatory system. As the blood is transported around the body vessels, it puts pressure on them. As a result, Blood pressure is a concept used to explain the strength with which an individual’s blood exerts force on the arteries as it is pumped and circulated around the body. Blood-pressure readings are determined in two values. First, Diastolic blood pressure that is felt on the walls of the blood vessels whenever the muscles relaxes. In other words, relative to systolic pressure, the diastolic pressure is lower. Second, systolic blood pressure that is experienced whenever the heart muscles contracts causing a heart beat and pumps blood rich in oxygen throughout the blood. Blood pressure is determined in millimetres of mercury units and the measurements are always issued in pairs. The first value is the systolic or upper value and the second value is the diastolic or the lower value.

How it is measured

It is imperative to determine and measure blood pressure on more than one occasion since it tends to incur changes in the course of the day. It can also incur fluctuations because of issues such as pain, stress, exertion or temperature changes. For this reason, if an individual’s blood pressure is established to be high, that does not necessarily imply that it is always extreme. A blood pressure reading that is obtained at the office of the doctor can sometimes be misleading. Visiting a doctor makes some individuals nervous and anxious and this may cause their blood pressure to increase.

To get readings that are reliable and credible, blood pressure is determined on varying days while a person is resting. In other words, this implies relaxing, sitting down, and waiting for close to three minutes before taking the readings so that the circulatory system is in a relaxation state. The upper arm which is the commonly used body organ in determining blood pressure is placed in a resting position on a table at almost the similar height as the heart while measurements are being taken. In some occasions, it is possible for an individuals to measure there blood pressure on their own with the help of a tool known as Sphygmomanometer for manual readings or a digital blood pressure monitor for taking automated measurements.

There are other places on the body that can be instrumental in determining blood pressure. Fingers and wrists can be used in monitoring blood pressure. Yet, tests and research have established that wrists or finger blood pressure devices can sometimes be inaccurate relative to other forms of monitoring blood pressure. For instance, Casigila et al., 20116 have conducted a research on the reliability of wrist blood pressure self-measuring at home. In the research, the authors aim at establishing the reliability of blood pressure determination with wrist monitoring devices and this research had not been previously done under real life situations. However, the findings of the research revealed that the accuracy of wrist blood pressure measuring devices relies heavily on the positioning of the heart. Based on 721 selected subjects, the population based research identified several discrepancies between home-based measurements and the office measurements, As such, the employment of wrist devices for measuring blood pressure at home results into falsely elevated measurements of blood pressure. ……………………………………………………… In fact, devices that are used in measuring blood pressure on wrists or fingers are highly sensitive to the position of the body. For instance, to achieve near accurate readings, it is recommended that the wrist and the arm should be at a similar level with the heart. Even then, it is imperative to note that the blood pressure measurements determined from the wrist are less accurate and usually higher relative to those taken at the upper arm. One reason behind this is that the wrist arteries are less deep and narrower relative to those in the upper arm. Some individuals experience difficulties measuring their blood pressure at the upper arm because of the pain or the extensiveness of their arm. In such instances, determining blood pressure at the wrist is an acceptable option for them. However, the costs involved in getting monitoring devices for performing this function successfully is high compared to other related forms of monitoring. For instance, based on Amazon prices, an approved medical wrist Digital Blood pressure Monitor costs around U.S $9.063 to 11.78 per piece whereas Full automatic blood pressure monitor costs less than $ 9. Furthermore, an arm type blood pressure from Amazon retailers costs less than $ 8.5 .It is not possible to get a device for monitoring wrist or finger blood pressure going for less than U.S. $ 9.

How to measure blood pressure using automatic monitors

It is common for individuals to measure their blood pressure. Some of them may require performing this activity so as to treat or manage a certain condition. If you happen to engage in such activities, it is important to keep a log or a record the measurements especially if the readings are taken at home. The records will be instrumental in helping the actors notice any changes in an individuals blood pressure throughput the day. To measure blood pressure at home, an automatic monitor will be useful. It is important to select the type of automatic monitor that best meets your demands. When selecting an automatic monitor, there are certain features that need to be taken into account. First, the size of the Cuff since it depends on the length and the extensiveness of the arm. There have been rowing suggestions for anyone who wants to use an automatic monitor to ask the orpharmacist, nurse or doctor to assist them in choosing the required size. The readings can be inaccurate if cuff size is wrong. Second, the price since cost may be a primary factor when choosing an automatic monitor. Home blood pressure units possess varying units. It is important to carry out appropriate research before settling. Display and Sound are also crucial when selecting an automatic monitor. Research and tests have indicated that wrist and finger monitoring devices tends to provide inaccurate measurements because of they are highly sensitive to body temperature and placement

Automatic monitors are one of the most prominent instruments for determining blood pressure. They are simpler and easier to employ relative to aneroid units. Furthermore, it also possesses an error indicator. The earings or measurements are easily shown on a screen that makes them simpler to use as opposed to a dial. Some of its units possess a paper printout that offers individuals a log of the measurements. Furthermore, the cuff inflation is either manual or automatic based on the model of the Automatic monitor. The deflation activity is automatic. Furthermore, one of the advantages associated with automatic monitors is that they are useful when dealing with hearing-impaired patients. It makes it possible for individuals to get their readings without necessarily listening to their heartbeat.

There are some limitations associated with taking blood pressure measurements using an automatic monitor. … An irregular heartbeat or the movements of the body can impact its accuracy levels. An irregular heartbeat makes it challenging for blood to flow and can put extended pressure on the normal functioning of the heart. In the process, it makes the heart weak which makes it challenging for the Monitors to detect accurate levels of blood pressure. Dangerous arhthimias of the heart such as atrial fabrication can occur which makes it more difficult to take blood pressure readings using automatic Monitors. It is a requirement that when taking blood pressure using an automatic monitor, the Arm should be positioned at the same height as the arm . AS such, in case of any movement, there is a high chance that the accuracy levels of the readings will be affected. Some automatic monitors only work perfectly when they are embedded on the left arm. As a result, this can make them difficult for some patients to find them useful. Besides, they are more expensive and need batteries to function.

To take blood pressure readings with the help of an automatic blood pressure monitor, it is imperative to find a comfortable place .it should have a good back support at a desk or a table. Before commencing taking the readings, it is important to sit quietly for about five minutes before starting. Ensure that the arm is placed in a relaxation state on a table top at the same height as the hart with feets flat on the floor. Then a patient is required to stretch their arm out and palm upward. The cuff is placed on the bare upper arm just above the elbow bend. Furthermore, it is important to ensure that the tubing are at the arm centre to see to it that the sensors is at the right position. Ensure that the cuff is evenly tight to ensure that a person can only slip about two fingertips at the edge of the cuff. Finally, ensure that your skin does no feel much pain whenever the cuff is inflating.

There are certain steps that are followed when using an automatic Monitor. First, the patient is requiring pressing the power button top switch on the monitor. On the automatic monitors, the inflation of the cuff will be automatic as soon as the button is pressed. After the inflation is complete, the monitoring device will exhale the air out slowly. It is at this point that the readings of the blood pressure are displayed on the screen. The rhythmic relaxation and contraction of the heart causes a change in the blood pressure along the blood vessels walls. In the process, the blood vessels start pulsating to the rhythm that is similar to the hear beat. The pulsation is detected with peizo sensors or pressure sensors placed at a relevant part of the human body such as the upper arm. The pulses that are detected by the automatic monitors are known as oscillometric. The pressure signal emerges from the vessels of the blood is detected using the pressure sensors in the monitors. The signal is later filtered and amplified to ensure that the heart signals are separated from the rest of the other body signals. The monitor uses a timer as a reference for computing the rate at which the hear is beating. It will indicate both readings for diastolic and systolic pressures. After recording the readings starting with the systolic pressure measurements in front of the diastolic, press the exhaust button to ensure that all the air in the cuff has been let out. In case of any repeat, it is highly recommended to wait for approximately 2 to 3 minutes before going through the process again.

Measurements during inflation

During inflation, the automatic blood pressure monitors determines the oscillations of blood when the heart is experiencing an inflation phase. For automatic monitors such as OMRON-MIT, Systolic blood pressure is taken without necessarily over-inflating the cuff higher relative to the true stylostic pressure. After taking the reading without over-inflating the cuff, it is immediately deflated rapidly. In other words, a sudden increment in the oscillations implies that the blood vessels are experiencing systolic pressure. Moreover, the point of maximum oscillation amplitude showcases the mean arterial pressure. For this reason, the total time taken for an automatic BP monitor for deflation and inflation is shorter compared to the one taken by conventional deflation devices. During inflation, the automatic monitor tends to detect blood pressure measurements at a quick rate compared to the deflation technique without necessarily compromising reading’s reliability. In this case, it leads to early treatment of illness and complications caused by high or low blood pressure. Moreover, detecting blood pressure during the inflation phase helps an automatic monitor preclude errors and inaccuracies associated with other oscillatory monitors since it helps to precisely measure blood pressure when the arterial vessels are being pressed. Furthermore, immediate determination of blood pressure during the inflation process does not cause or allow any delay in pressure transmission something that is common during the deflation phase.

Measurements during deflation

Automatic non-invasive blood pressure devices are also signed in such away tat they are able to detect blood oscillations when the heart is deflating. Therefore, during the deflation process, the cuff pressure is elevated higher than the systolic pressure. However, to some individuals, this additional cuff pressure may result into adverse im0plications such as pain, enoustasis and compartment syndrome. During this process the slowness in detecting the oscillations may result in inaccuracies. As a result, compared to the inflation method, the chances of inaccuracies are high .The inflation method

Technique or calculation on how it is measured. How does the monitor measure the heartbeat?

Difference between measuring with the deflation method (measuring during deflation) and inflation method ( measuring during inflation)

Are automatic blood pressure monitors more accurate relative to manual?

Reliability and accuracy of blood pressure measurement Monitors in different health settings is an increasing concern despite the ever improving promotion of measurement techniques. Manual BP measurements in some instances can produce accurate results when using a mercury manometer that is closely related to Mean Awake Ambulatory blood pressure. A number of research works such as SOURCE have shown that an accurate and reliable Blood pressure readings needs around 14 minutes which encompasses a conversation between the patient and a physician and a period of rest to ensue that there is lower or reduced levels of white coat anxiety. Because of the increasing concerns associated with manual BP measures and overestimation, new suggestions and recommendations have been suggested. As a result, greater reliance on automated monitoring machines helps in eliminating the cases of white coat anxiety. Furthermore, it also help in improving reliability since it reduces and eliminates many elements that are influencing impreciseness in taking measurements.

The manual BP measurements especially those that depend on sphygmomanometer have now existed for over a century. Based on the developments in BP recording techniques, mercury techniques are now disappearing from clinics. Nonetheless, Mercury Sphygmomanometer is still the commonly used reference point until an alternative monitoring device is in place. Research studies tat are peeping the automated Monitors against the manual BP monitors have indicated that manual technique possess some extra levels. Yet, this variation can be cut if some guidelines used in automated monitoring techniques are closely and strictly adhered to. For instance, if the patients relax in a conducive room then the results can be more reliable. Is there a study about this? If so please attach . On the other hand, if multiple instruments are used in making a decision on the patient’s BP condition, the chances of white coat hypertension are high. Apparently, there could remarkable reduction in anxiety if the patient is left alone in the room and this is where automated BP monitors becomes more reliable.

Based on research undertaken by SOURCE, automated blood pressure monitors tends to produce readings that are more reliable and accurate relative to the manual systems. Experts suggest that individuals wit high blood pressure monitor their situation at some on a regular basis. In doing so, it offers individuals an idea of how they are performing between office visits and can act as a motivation to take good care of their health. It is also instrumental in making doctors make quick adjustments on a patient’s medication to ensure that the blood pressure is maintained in the healthy zone. However, some of the home blood pressures are not as accurate and reliable as expected. For instance, SOURCE indicates that manual blood pressure monitors may experience inaccuracy levels in around 5% to 15% of patients based on the accuracy threshold. Since a number of doctors depend highly on Home based measurements as a guideline of making treatments, such inaccuracies and unreliability could make individuals to either take less or much blood pressure medication.

Automatic BP managers are clinically proven and validated to have an accuracy levels of blood r accuracy of +-3mgHg or 0.02 of reading SOURCE.

Automated BP monitors are reliable because manual devices rely heavily on the environmental conditions. There is a high chance that the patients BP can be higher when physicians as opposed to nurses administer them. They could also be affected if they are taken in non-office settings compared to office settings. Furthermore, if recorded in routine clinics, manual BP devices could be 15-18mmHq more relative to automated BP device measurements. Findings from SOURCE tends to offer support o the fact that manual BP monitoring device could be sue as a reference point relative to automated devices. The research shows that manual BP on a frequent basis tends to show higher readings. As such, it is imperative to note that, the level of reliability between the automated BP monitoring devices and manual BP devices depends on the setting, environment and the time required to get the readings.

Blood pressure readings

In Blood pressure readings, there are two numbers. The upper measurements are the systolic and the lower ones are the Diastolic. Systolic is the higher one on the reading calibre and the diastolic is the lower number of the calibrator. It is imperative for individuals to keep this numbers within the required range to ensure that they move away from the angers of hypotension or hypertension. Based on American Heart Association, an individual is well within the healthy range when its systolic readings are less than 120 whereas its diastolic readings are below 80. Apparently, if an individuals systolic reading is less than 90 and their diastolic readings are below 60, then there is a high chance that they have low blood pressure. Hypotension is a common illness in young people or athletes.

An individual having an elevated blood pressure cannot be classified as hypertensive. In the process, they can engage in some activities that can help tem not to advance to the hypertension level. Some of the issues that can help them under this stage is reducing their salt intake, losing weight and exercising more frequently.

There are three known stages of high blood pressure or hypertension. They include; stage 1, stage 2, and the final stage is the Crisis phase. During the first hypertension stage, Stylostic readings will range between 130 and 139 and for the diastolic phase, they will range between 80 and 89. During the second stage of hypertension, it is possible for Stylostic reasons to extrapolate higher than 140 and diastolic readings to be 90 or higher. Finally, if an individuals is experiencing hypertension crisis, the readings will range between 180 or higher for stystolic level and lie between 120 and higher when it comes to diastolic level. It is imperative to note that the measurements mentioned are for adults. Any caregiver or parent should talk to their child’s doctor regarding healthy ranges for children. The numbers can change based on weight, age, and sex.

PRACTICAL PART

Practical part

The Mindray VS 900

The device operates using mmHg/kPa as its measurement units. It deals with different types of measurements such as diastolic, systolic, pulse rate and mean. It boasts of a maximum mean error of +-5 mmHg and its maximum standard deviation is 8 mmHg. It has a NIBP measuring range such that for children, it ranges from 10-200mmHg, for adults it ranges from 10-270mmHg and finally for the new borns, it ranges as from 10 to 135mmhg. The device also has double protection b software and hardware in case of overpressure. The monitor also has a pulse range of 40 and 240 bpm. With 1 mmHg, It is one of the devices that have an exemplary resolution. It has an accuracy level of +-0.03 or +-3bpm

Welch Allyn

Welch Allyn is one of the Blood pressure devices that is made for the home but trusted in the doctors office, It is instrumental in monitoring and combining t he accuracy and clinical quality. It is easy to operate since it is made of a simple one-button operation. It is highly comfortable and fast since it makes it possible for a patient to take blood pressure measurements at the comfort of their home.

Welch Allyn has exemplary features that make it an interesting BP monitoring device. It is able to capture the readings of blood pressure on inflation for comfortable and quick readings. Besides, it can also indicate the levels and rate of irregular heartbeats and any form of motion. Through its free app, it ensures that patients remain engaged in their advancement towards their blood pressure objectives. In fact, it sends the progress reports automatically to the patients physicians for assessment. It is also embedded with a free clinical portal that permits and gives the physicians a chance to securely review the progress and compliance of patients.

The Welch Allyn Home BP monitor an its related devices use the SureBp algorithm. SureBp algorithm is acknowledge as a higher level blood pressure Measurement technology that is capable of taking readings during inflation cycle but not when the Cuff is deflating. The results are faster for the clinician and comfort for the patient how does this work, what does it do, more info about this please. The devices are accurate in BP estimation. The device has an accuracy level of +-3 mmHg. How accurate? and ensuring during both involuntary and voluntary patient motion. Additionally, the framework and protocol for devices that are highly associated with Transport Artificat Tolerance are believed to be the future of these devices. The device estimates Blood pressure measures faster and people using it experience less discomfort relative to deflation-based oscillometric devices. For this reason, most of the clinicians have improved confidence in home based measurements since the Welch Ally device uses the same SureBp algorithm that is employed in most professional grade category of automated devices.

The most important attribute of this device is tat it makes estimations of Blood Pressure during inflation as opposed to deflation hence reducing the level of discomfort for patients. The inflation level requires exceeding SBP by around 10-15 mmHg just before it further goes through rapid deflation. As such, the routine-deflation algorithm that this device employs starts by first inflation in adults to around 160mmHg to reach the SBP in several patients. Apparently, the deflation/inflation cycle is experienced almost twice for deflation-based monitoring devices as opposed to those devices that uses the inflation-based algorithms. Considering tat this device is less expensive compared to other professional automated devices, most physicians will likely recommend it for home-based use. In fact, because of its capacity to use the SureBp algorithm as other professional grade monitor, Wich algoritm is this? it makes it possible to clearly make a comparison and make quick recommendations hence fastening the patient medication process. In additionally, the device is designed with an OMRON woe-range D-ring cuff which is useful in optimising the experience eof its customers. The cuff is soft in nature and is created t enable comfortableness when taking measurements. For this reason, whether an individual has a large-sized or standard arm, the cuff is able to fit up to 17 inches for adults. Another important feature is that the unit cannot operate without the 4 AA batteries.

Omron Device

The device is easy to use and is a product of the OMRON Advanced technology. The device is able to determine the Blood pressure measurement points five times for precise readings and consistency. In Omron devices, the stylostic pressure is measured without having to over-inflate the cuff. Immediately all the measurements have been recorded, the cuff is deflated rapidly. In the en, the total time taken when the blood pressure is determined during the inflation [phase is reduced. Please give more info on how they do that . It also assists in curbing the effect that the movement and breathing of individuals has on their BP reading measurements. In the process, it assists in preventing and minimising measurement errors and inconsistencies. It is embed with a convenient on-touch design that makes it possible to record the BP readings, body movement or any irregular heartbeat when taking BP measurements. Through the employment of the SureBp algorithm, the rate at which this device perfumes activities is quicker and reliable. How is this possible, special algorithm, .. ? Furthermore, it also stores around 14 readings for the patient’s review later on. In doing so, the device makes it easy for the patient to share important information wit their caregivers, family, and clinical professionals.

The capacity and ability to monitor the patients blood pressure wherever the are an easily is important to not only their peace of mind but to their health as well. Whenever this is made possible, it is crucial to have complete assurance that the measurements taken are reliable and accurate. For this reason, the OMRON device offers convenience, portability and complete blood pressure accuracy. It ensures this is possible by making sure that patients go about their activities with the confidence they require. Furthermore, the device has gone through several research and testing to prove its accuracy of both the wrist models and the upper arm. The accuracy has been validated and proven by the primary international organisations that are prominent in development of testing protocols. Omron devices have been clinically validated to have an accuracy range of approximately 0.02 or +-3 mmHg.

Please also give this validation as picture or attachment.

Part b

If possible I would need more scientifically proven things like how they calculate it or which algorithm do they use.

What certainly needs to be included in the thesis:

More info on the inflation and deflation method of measuring the BP. If possible with the different algorithms and/or calculations.

Comparison between the inflation and deflation method of measuring the BP. What are the advantages and disadvantages.

I’m guessing you didn’t start on part b yet but just to be sure, this also should be included;

Measurement Setup

How does a simulation of this kind works? How is the prosim 4 simulator simulating the pressure?

What are the constraints of this setup? What can influence the measurements?