Repair of Blood Pressure by Frank Weithöner

Measurement Devices
Blood pressure measurement is a routine examination that determines the
pressure in the arteries. The measurement provides information about the
pumping capacity of the heart and the condition of the blood vessel walls.
Blood pressure measurement is a harmless and easy-to-perform diagnostic
measure.

The most common blood pressure

measurement is the non-invasive measurement. For this purpose, a
mechanical sphygmomanometer or an electronic blood pressure
monitor is used. A non-invasive blood pressure monitor is also called
a NIBP (Non-Invasive Blood Pressure) monitor.
In both cases, an inflatable cuff is needed, which is placed around the
patient's upper arm. By inflating the cuff, pressure is applied to the artery
(brachial artery) and the blood flow is stopped. The pressure is then slowly
released in a controlled manner. The pressures at which the blood starts to
flow again and when it starts to flow freely are measured.
Manual sphygmomanometers are always used together with a stethoscope,
electronic blood pressure monitors work automatically without any additional
equipment.
This non-invasive method of measurement does not require an instrument
to be inserted into the body. However, blood pressure can also be
measured invasively by inserting a catheter directly into an artery. This
method is sometimes used during operations, for example, because it allows
continuous measurement.

Blood pressure
Blood pressure (BP) is the pressure of the circulating blood in the large
arteries and is therefore the result of the pumping action of the heart. Blood
pressure is one of the vital signs that indicate the status of the body's life-
sustaining functions.
Two values are used to express arterial blood pressure: systolic pressure,
the maximum pressure during one heartbeat, and diastolic pressure, the
minimum pressure between two heartbeats. During each heartbeat, the
blood pressure varies between the systolic and diastolic pressures. The
pressure is measured in millimetres of mercury (mmHg).
In addition to systolic and diastolic pressure, mean arterial pressure
(MAP) is sometimes used. This is the average arterial pressure during a
cardiac cycle.
Blood pressure is not static, but varies throughout the day. Normal resting
blood pressure for an adult is about 120 mmHg systolic and 80 mmHg
diastolic. This result is expressed as '120 over 80' and written as BP 120/80.
A patient has hypotension, or low blood pressure, when the blood pressure
is lower than 90/60. High blood pressure is called hypertension and is
defined when the blood pressure is consistently higher than 140/90. Both
conditions are indicators of disease.

Principles of operation
There are two main methods of measuring blood pressure:
the auscultatory method and the oscillometric method.

Auscultatory method
Systolic and diastolic pressures are measured by listening to the flow of
blood in the brachial artery, the main blood vessel in the arm, with a
stethoscope. To do this, the cuff of a sphygmomanometer is wrapped around
the patient's upper arm and a stethoscope is placed over the brachial
artery. When the cuff is pumped up and the pressure becomes higher than
the patient's systolic blood pressure, the blood flow through the artery stops.
No sound can be heard at this point.
The pressure is then slowly released. When the pressure in the cuff is lower
than the pressure produced by the heart, blood begins to flow through the
artery and a flow noise can be heard. This noise, which is the result of
turbulence in the blood, is also called the Korotkoff sound. The pressure at
which this sound first appears is the systolic blood pressure. If the pressure
in the cuff drops but is still high enough to narrow the artery, the turbulence
can be heard. When the sound finally disappears, the pressure in the cuff has
reached the diastolic blood pressure.
Flow noises are nothing unusual. It can also be heard in everyday life when
water pipes are partially blocked or water valves are not fully opened.
The beginning of the flow sound marks the systolic pressure and the last
audible sound marks the diastolic pressure.

Oscillometric method
Automated blood pressure monitors work a little differently. Instead of
listening to the sound of the blood flowing, a sensor detects oscillations in
the blood flow. These oscillations can be detected by a pressure sensor as
small changes in pressure. This method also uses a cuff to control the flow of
blood through the artery. Again, the beginning of the oscillation marks the
systolic pressure and the last detectable oscillation marks the diastolic
pressure.

Types of blood pressure measuring devices

The traditional mercury sphygmomanometer measures the blood
pressure by means of a mercury level in a glass tube. The aneroid
sphygmomanometer uses a mechanical pressure gauge. Both systems
require a user to manually inflate and deflate the pressure in the cuff. At the
same time, the user has to listen with a stethoscope to the sounds of blood
flowing through the artery. Manual measurement with a sphygmomanometer
is a very accurate technique and is still a very good method of measuring
blood pressure. Sphygmomanometers are durable instruments that will last
many years if used carefully and checked from time to time.
An automatic blood pressure monitor automatically inflates and deflates
the cuff. The blood pressure monitor also measures the systolic and diastolic
blood pressure. Automated blood pressure monitors come in two different
types: The blood pressure monitor for use in hospitals, which often also
monitors other vital signs, and the small, inexpensive, portable device that is
made for use in the home care sector. Automated blood pressure monitors
for use in hospitals are essential for long-term measurements. Although
cheap home-care devices are not very durable and not suitable for long-term
use, they are often used in hospitals in developing countries.
The advantage of electronic blood pressure monitors is their easy operation
and the simple reading of the measurement result. But this does not mean
that they are more accurate or better. In fact, the accuracy of an electronic
device depends on several factors, such as the accuracy of the pressure
transducer, the software, the tolerance of the electronic components and the
quality of the calibration, whereas the reading of a mercury
sphygmomanometer is basically always correct.

Mercury sphygmomanometer
In a mercury sphygmomanometer, the weight of the mercury column in the
riser tube acts against the cuff pressure and thus against the blood pressure.
The height of the mercury column also acts as an indicator. This direct
measurement means that no other mechanics are required.
As the working principle is based on the specific weight of mercury, which
does not change, mercury sphygmomanometers do not require calibration.
They are considered the gold standard. Readings are always correct as long
as the riser is vertical and the mercury level is '0'.
Mercury sphygmomanometers are no longer used in Europe and the USA
because of the toxicity and environmental impact of mercury. They are being
replaced by aneroid instruments. However, mercury sphygmomanometers
are still common in developing countries.

Older mercury sphygmomanometer, as still found in developing countries

today. When not in use, the instrument can be closed.
Aneroid sphygmomanometer

The aneroid sphygmomanometer is a mechanical

instrument that displays blood pressure on a circular dial. This is why it is
called aneroid, which means 'without liquid'. All other components are the
same as for a mercury sphygmomanometer. The aneroid type also needs a
cuff and an inflating bulb with a pressure release valve. Aneroid
sphygmomanometers are also available as large wall mounted units for
stationary use.
The advantage of an aneroid sphygmomanometer is that it is smaller,
lighter, more portable and, of course, does not contain poisonous mercury.
Although the manometer contains some delicate mechanics, it is surprisingly
robust. Defective instruments can often be repaired and calibrated easily.
The aneroid sphygmomanometer is the most common type of blood pressure
device in developing countries.
Unlike a mercury sphygmomanometer, an aneroid needs to be calibrated
from time to time, but it is easy to do. By the way, calibration can be done
very well with a reference instrument: the mercury sphygmomanometer.

Cuff
Traditionally a cuff consists of two parts, an inner bladder made from rubber
and the outer envelop made from strong fabric, often nylon, with a Velcro
fastener. Attached to the bladder are one or two rubber hoses. Cuffs for
mercury and aneroid sphygmomanometers have two tubes, one for the
pumping bulb and one for the pressure gauge. Electronic home care devices
only have one tube.
Cheap cuffs as they are found today in the developing world consist of one
piece only. They are made of plastic and are not as strong as those with a
separate bladder and fabric. They do not last very long and are almost
impossible to repair.

With good cuffs, it is easy to remove the bladder. The fabric sleeve can then
be washed or the bladder repaired.

Cuffs are available in various sizes. The size is based on the circumference of
the upper arm. The cuff should cover two-thirds of the length of the upper
arm. If the cuff is too small, the blood pressure reading will be too high. If the
cuff is too large, the result will be too low. The range of arm circumferences
is printed on each cuff.
Typical upper arm cuff sizes are:

Infant Child Small adult Adult Large adult

7 9 10 11 12

The size is approximately the width of the cuff in cm. If in doubt, it is better
to take the next larger cuff than a cuff that is too small.

Stethoscope
The stethoscope is a simple acoustic examination instrument. It is used for
listening to the sounds of heart and lung and the blood flow during blood
pressure measurement.
 The stethoscope consists of a sound-detecting device,
the chest piece, and two earpieces connected by a Y-shaped flexible plastic
tube.
The principle is simple: sound is transmitted through air-filled hollow tubes to
the user's ears. The sound is picked up by a resonator called the chest piece.
The chest piece is a metal housing that usually has two sides, one with a
larger diameter and one with a smaller diameter. The larger side usually has
a diaphragm, which is a thin plastic disc. The other, smaller side is called the
bell and is shaped like a small cup with a small hole. The larger, flat side with
the diaphragm is used to hear higher frequencies and the smaller bell is used
to hear lower frequencies.
For examination, the user must cover the opposite side with a fingertip if
there is no mechanical closure. The chest piece is placed on the patient,
body sounds move the diaphragm and the vibrations cause small changes in
air pressure in the tubes that travel to the earpieces.

NIBP monitor
In addition to manual blood pressure monitors, there are also automated
blood pressure monitors. These electronic blood pressure monitors are used
in operating theatres, intensive care units and other areas where patients'
vital signs need to be monitored around the clock. For this purpose, the
devices take readings regularly and independently. This type of automated
blood pressure monitor is also known as an NIBP (Non-Invasive Blood
Pressure) monitor. NIBP monitors have programmable alarms and also
measure mean arterial pressure and pulse rate.
Typical patient monitor measuring blood pressure. Only the cuff is connected
and only the blood pressure is shown on the display.

Automated clinical blood pressure monitors are usually combined devices

that also measure other vital signs such as blood oxygen saturation, ECG or
body temperature. Such a multi-parameter device is also called a patient
monitor.
Another type of electronic blood pressure monitor is the small portable unit
for home use. These battery-powered devices are also automatic, but are not
designed for continuous use. They are designed to be easy to use so that
anyone can take a blood pressure reading. Portable home blood pressure
monitors are cheaply made, not very robust and therefore not designed for
daily use in a hospital for several years.

A typical automatic blood pressure monitor for home use.

Operation

As a biomedical technician, you should know

how to take blood pressure with a sphygmomanometer and a stethoscope. It
always makes a good impression if you can operate the equipment you are
repairing.
Before you start, make sure that the stethoscope is working and that you can
hear properly. Put the stethoscope in your ear and tap the chest piece head
with your finger.
Also check that the aneroid pressure gauge is zeroed, the pointer should be
within the rectangular box on the dial.
Also check the cuff size. Incorrect cuffs will give incorrect blood pressure
readings.

1. The tested person has to be relaxed, calm and should not speak during
the measurement.
The arm should be placed on a table with the palm facing upwards so
that the blood
pressure cuff is at the same height as the heart.
2. Fasten the cuff around the bare upper arm. The tube connectors should
point towards the
crook of the arm. There should be about 3 cm (1 in) of space between
the crook of the arm
and the cuff for the stethoscope.
3. Hold the inflating bulb with the pressure gauge with your right hand.
Close the release
valve on the bulb by turning the screw clockwise. Squeeze the bulb and
inflate the cuff.
 The pressure should be about 180 to 200 mmHg.
4. Place the stethoscope in your ears and the stethoscope head between
the crook of the arm
and the cuff where the artery is located.
5. Open the release valve slightly and slowly deflate the cuff. Listen
carefully to the sound of
the pulses and watch the gauge carefully.
6. The systolic blood pressure is shown on the dial gauge when you first
hear a rhythmic
thumping sound. In a healthy person, the reading is around 110 to 120.
Memorise this
number.
7. Continue to slowly release the pressure and continue to listen to the
sound. When you no
longer hear the knocking sound, the diastolic pressure has been
reached. This reading is
normally around 60 to 80 mmHg.
8. The blood pressure measurement is complete. Now deflate the cuff
completely.

Example: A reading of 120 systolic and 80 diastolic is expressed as '120

over 80' and written as BP 120/80.

If you have done something wrong, perhaps you released the pressure too
quickly, do not inflate the cuff again right away. Wait at least a minute
before repeating the measurement.
There is no single reference value for blood pressure. However, the following
blood pressure values can be considered normal for adults:

Age Systolic Diastolic

up to 20 years 118 75
20 to 30 years 122 79
30 to 40 years 125 85
40 to 50 years 130 87
50 to 60 years 140 90
over 60 years 150 100

Cleaning by the user

Cuff, tubes and bulb should be wiped regularly with a little soapy water.
Some manufacturers also recommend disinfection with 70 % isopropyl
alcohol or 0.5 % bleach/water solution. Sphygmomanometer are not
autoclavable.
It is not a bad idea to instruct the user on how to do this so that no water
gets into the system. After cleaning, components should be allowed to dry
before reuse.

Construction
Mercury and aneroid sphygmomanometers and digital blood pressure
monitors differ in the way they work and display blood pressure. The first two
are mechanical devices, whereas NIPB monitors are electronic devices where
not only is the display digital, but the measurement process is automatic.

Mercury sphygmomanometer

The image shows the components of a mercury

sphygmomanometer.
The user inflates the cuff using the rubber bulb. For this reason, the bulb has
an inlet valve at the end. When the bulb is squeezed, the air from the bulb
passes by the closed release valve and the flexible rubber tubing into the
cuff. There is also a second tube attached to the cuff which is connected to
the mercury reservoir and the riser tube. The higher the pressure, the more
mercury is pumped up the riser tube from the reservoir.
Once the cuff has been inflated to the desired pressure, it must be slowly
deflated. To do this, the user carefully opens the release valve screw. Air is
released from the system, the pressure decreases, the mercury level in the
riser tube drops and the mercury returns into the reservoir.
In order to allow the air above the mercury column to escape during
inflation, the end of the riser tube is closed with an air-permeable plug,
usually made of felt. Another similar plug is in the inlet of the mercury
reservoir to prevent mercury escaping into the cuff.
Aneroid sphygmomanometer
Aneroid sphygmomanometers are smaller, lighter, more portable and
therefore more convenient than mercury sphygmomanometers.
The hose connection at the bottom of the meter is connected to a closed
brass pressure can. This pressure can is made out of corrugated brass sheet
which expands when the pressure inside increases. The bellow is coupled to
a gear mechanism which converts the up and down movement of the bellow
into rotation of the pointer.

Parts of an aneroid sphygmomanometer. Despite its delicate mechanics, the

instrument is surprisingly robust.

NIBP monitor
While the sphygmomanometer blood pressure method is based on listening
to Korotkoff sounds, electronic blood pressure monitors work differently.
They use the oscillometric method.
A pressure transducer (pressure sensor) in the device detects small pressure
changes in the cuff pressure caused by oscillations in blood flow. A filter and
amplifier then separates the oscillation signal, an A/D (Analogue/Digital)
converter converts the signal into digital data, and a microprocessor
interprets the signals and displays the result.
Additionally the inflation and deflation of the cuff work automatically.
Hospital NIPB monitors are also be timer controlled so that a long term
monitoring can be carried out.
Home blood pressure monitor
The following is the construction of an automated blood pressure monitor for
home use. These devices are also called digital blood pressure devices.
The word digital refers only to the display, the blood pressure measurement
itself is analogue. As the accuracy of the device depends on the conversion
of the measurement signal from analogue to digital, or on its calibration,
these devices are not fundamentally more accurate than an aneroid
sphygmomanometer. They are just easier to use.
The air pump consists of a small DC motor with attached diaphragm pump.
The pump pumps air through the connector into the cuff. At this moment the
solenoid valve is closed. When the device releases the pressure from the
cuff, the pump stops and the solenoid valve opens.
Also connected to the tubing is the pressure sensor on the electronic board.
As the pressure in the system is everywhere the same, the sensor must not
be close to the cuff. That is why the sensor can be mounted directly on the
PCB. A microcontroller on the board analyses the pressure in the cuff as well
as the oscillations during blood flow through the artery, drives the display
and controls pump motor and solenoid valve.

The inside of a typical automated blood pressure monitor for home use.
In principle, more expensive clinical blood pressure monitors do not work
much differently. However, there are two things that are different, apart from
additional display options. For more accurate measurement, these devices
usually have a second tube. Inflating and deflating the cuff is separate from
measuring the pressure. The pressure sensor has its own tube. Also the
pump is bigger and more robust, because the clinical monitors need to be
able to take measurements regularly and automatically.

Clinical blood pressure monitor (NIBP monitor)

The working principle of an automated blood pressure monitor for hospital
use is similar to that of the small portable device for home use. The
components, however, are designed for continuous use and are therefore of
a higher quality and more robust. The following photo shows the inside of
such a monitor.

Let's take a look at the tubing. The pump is at the top right. A one-way valve
(red) is connected to it. A pressure sensor is connected to the first T-piece.
This is followed by another T-piece to which a solenoid valve (yellow) is
connected. This gradually releases the pressure during the measurement.
From there, a tube leads to another pressure sensor and to the patient
connector.

An open blood pressure monitor for clinical use.

The two sensors are used because blood pressure and control pressure are
measured separately. Some monitors even have two separate tubes leading
to the cuff. One sensor is closer to the patient connector. This is the sensor
that measures blood pressure. Both pressure sensors and their input
amplifiers are located under a metal shield to protect them from external
interference. The output from the first amplifier then goes to the
measurement electronics with the display. The other output goes to the
control electronics, which controls the pump and the solenoid valve.

Repair
Blood pressure monitors should always be delivered for repair with the cuff
and connecting tube, as this is often where the fault lies.

Before you start with the repair:

Note accessories such as cuff and power adapter on the job card to avoid
confusion later.
Put the cuff on yourself and carry out a test run in order to confirm the
fault. Make sure that
the problem is really a fault and not an operating error.
If you are not sure how to operate the unit yourself, consult the user
manual.

TIP! Flexible hoses made of rubber or silicone should not be pulled

from their connectors but pushed off, possibly using a screwdriver. Pulling
will make the flexible hose longer and the diameter smaller. The
connection becomes tighter and the tube or connector may tear off.

Special measuring and test devices

For calibration a reference pressure gauge is needed. The instrument is
connected with a Y-piece to the sphygmomanometer on test. For creating a
stable pressure in the cuff, the cuff should be wrapped around a solid object
with the approximate diameter of an upper arm. A glass bottle, for example
an infusion bottle, is perfect.

Tips & Tricks: Cheap workshop reference pressure gauge

A mercury sphygmomanometer is the perfect reference instrument for
doing calibrations and adjustments because it does not have to be
calibrated itself. Get an old one that is no longer in use and clean the
mercury if necessary. Just add a tube and a Y-piece and you are ready to
calibrate all types of sphygmomanometers.

Leakage test
Leaks in the pressure cuff or connecting tubing can be detected with a
simple test set-up. Wrap the cuff around a glass bottle approximately the
diameter of an arm. Apply pressure to the cuff with the rubber bulb until
200 mmHg is reached. The pressure should remain stable and should not fall
by more than 2 mmHg in 10 seconds.
If you are using an automatic blood pressure monitor, disconnect the
connecting tube and connect it to a rubber bulb and follow the same
procedure.

Performance test
Calibration is performed by comparing the device under test with a reference
instrument. This reference instrument, for example a mercury
sphygmomanometer, is attached to the device under test by a Y-piece. The
cuff is wrapped around a glass bottle, such as an infusion bottle, and
calibration can be performed.
However, before calibrating, perform a leakage test as described above.
Then calibrate and adjust the '0' position of the sphygmomanometer.
Aneroid sphygmomanometers are set to '0' as described above.
Aneroid sphygmomanometers can now be calibrated at different pressures.
Mercury sphygmomanometers do not require calibration as the specific
weight of mercury does not change. It is only necessary to ensure that the
level indicates "0" when no pressure is applied. Aneroid manometers are
different. The mechanics can wear out or get damaged over time. They need
a regular calibration.

Set-up for calibration of sphygmomanometers.

1. Inflate the cuff to 200 mmHg and compare the readings. The result
should not differ by
more than ± 3 mmHg.
2. Repeat the procedure at 150 mmHg, 100 mmHg and 50 mmHg.
3. Inflate the cuff again to 200 mmHg and check that the pressure remains
stable for
10 seconds. The system should not lose more than 2 mmHg during this
time.

Common problems
Apart from dropped aneroid sphygmomanometers that need to be
readjusted, most problems are related to leaks. Leaks can be caused by
holes in the bladder, worn tube connections, porous tubes and rubber bulbs,
dirty release valves or damaged pressure gauges.
Leaks in the bladder of the cuff can usually be repaired. This involves taking
the bladder out of the fabric. The fabric must be opened on one side and
sewn back together later. A rubber bladder can then be repaired in the same
way as a bicycle inner tube. The first step is to locate the leak. Inflate the
bladder and watch and listen for air escaping. Major leaks will be easy to
hear or see. A quicker way is to put the inflated bladder in a bucket of water.
The escaping air will create bubbles.
Cheap cuffs without inner bladders can often not be repaired because rubber
glue does not work on synthetic or plastic materials. Instead of using rubber
glue and bicycle repair patches, try gluing a piece of similar synthetic
material, for example from an old cuff, with elastic contact adhesive or
silicone.

Tips & Tricks: Using bicycle repair patches

Rubber bladders with holes can be repaired with

bicycle repair patches. Sets of patches and rubber cement for gluing the
patch can be found in supermarkets or bicycle or motorcycle shops.
Use sandpaper to roughen the surface around the hole. Apply the rubber
cement to the bladder and spread it out with your finger. Allow the glue to
dry for 10 minutes. When the glue is dried, press the patch firmly onto the
repair area. It is the pressure, not the time, that is important. The repaired
tube can be used immediately.
Blood pressure tubes are very flexible and are made of rubber or soft
plastic. They have an internal diameter of 4 mm. The connectors and
adapters have a larger diameter, usually 5 mm.
Deformed, cracked or lost stethoscope diaphragms are easy to replace.
The only problem is finding a suitable replacement. The diaphragm must be
thin but also stiff. Old X-ray images are perfect. The foil can easily be cut into
shape with scissors.
To remove the membrane, the chrome ring must be unscrewed. If the ring
cannot be turned, you are pressing too hard on the ring. The ring will
become deformed and will not come off. Loosen your grip and turn gently.
Mercury sphygmomanometers should no longer be used in hospitals for
environmental and health reasons. However, as they make a good reference
instrument, it is worth refurbishing an old one.
At the end of the riser pipe and at the inlet of the mercury reservoir there are
felt discs. Their task is to ventilate the system with air and keep the mercury
inside the sphygmomanometer. If dust and dirt accumulate on the felt, the
air cannot escape or enter and the mercury column moves slowly or not at
all. After cleaning the felt, the sphygmomanometer will respond quickly
again.
Clean mercury has a shiny silver appearance, but over time it can become
dirty. Either dirt from outside gets into the system or the mercury oxidises.
Mercury oxide is a black powder that floats on the surface of the mercury. A
small amount of mercury oxide is not a problem, but if there is too much, the
mercury will not flow. It can also block the filter at the end of the riser or at
the inlet to the mercury reservoir.
If this happens, the mercury must be cleaned. This means that all the
mercury must be removed from the sphygmomanometer and then filtered.
The procedure is not difficult, but it must be done very carefully.

Hint! There is no health concern from acute short-term exposure to

mercury under the conditions of a broken mercury-containing
thermometer or energy-saving lamp at home. (Wikipedia: Mercury
poisoning)

It is advisable to work over a plastic tray so that spilt mercury cannot

disappear. Get two syringes, one should be a larger one (35 or 50 ml), the
other can be smaller. Pull the plunger completely out of the large syringe
and place one or two layers of cotton gauze in the syringe. Put the plunger
back in and push it down so that the cotton is in front of the outlet of the
syringe. Now remove the plunger again.
Tilt the sphygmomanometer so that all the mercury flows into the reservoir.
Close the outlet if possible and open the reservoir. Now use the small syringe
and draw up all the dirty mercury into the syringe. Inject the mercury into
the prepared syringe. Replace the plunger and push the mercury through the
cotton gauze into the reservoir. The mercury oxide will remain in the gauze.
Before returning the cleaned mercury to the reservoir, clean the riser tube
and reservoir. The riser tube can be cleaned by pulling a small piece of
cotton gauze with a long wire through the tube.
When filling the reservoir, make sure that the mercury level is correct. The
level is correct when the mercury level shows '0'.

After the mercury is pressed through the gauze, the black oxide remains.

It often happens that the pressure gauge of

an aneroid sphygmomanometer does not show zero in a pressure-less
state. The pressure gauge must then be set to '0'. In fact, '0' is often not
marked on the scale, but you will find a rectangle instead. The pointer should
be inside this square.
Most aneroid sphygmomanometers can be adjusted by turning the tube
connector. To do this, the locknut must be loosened slightly. Usually this
locknut is a round type with two holes. Loosening should be done with circlip
pliers, but small long nose pliers will also work. Once the locknut has been
loosened, the tube connector can be turned. When this is done, the pointer
will also rotate as the tube connector and dial are mechanically connected.
When the pointer is in the rectangle, tighten the locknut.
In order to adjust the pointer, simply loosen the locknut, which is the flat
washer with the two holes, and turn the tube connector a little.

If you have a sphygmomanometer where the bulb and pressure gauge are
combined, this method will not work. In this case, the gauge housing must be
opened and the position of the pointer itself corrected. To do this, unscrew
the metal ring, remove the glass and carefully lift the pointer off the shaft.
Sometimes a tool such as a small, flat screwdriver is needed. Do not use
pliers or forceps to remove the pointer. It can be easily deformed. Once
removed, the pointer can be carefully placed back in the correct position.

TIP! Tool for loosing locknut and for lifting up pointer

To make a tool for loosening the locknut, simply take a bicycle spoke, cut
off the ends, file them flat and bend them as shown in the picture. The
wire ends will then fit perfectly into the nut holes.

To lift the pointer without damaging it, you can cut a strip of epoxy from
an old circuit board and drill and file a small slot.

Automated blood pressure device for home care use are usually cheaply
made and often hardly repairable. They are also not designed for later
calibration and adjustment. They are disposable products. Battery-powered
devices suffer from high battery consumption. This is normal because the
pump motor draws quite a lot of current. In developing countries, where
these devices are often used in hospitals, this is a problem, especially
because batteries are either of very poor quality or very expensive.
Replacing the batteries with rechargeable ones does not work either,
because the resulting operating voltage will be too low. Typically, these
devices run on 6 V, which is supplied by 6x 1.5 V AA batteries. But 6x 1.2 V
AA rechargeable batteries will only give you 4.8 V, which is often too low to
run the device, or not long enough.
The best solution is to use an external power supply. This should provide at
least 500 mA. Universal power supplies are available in any city. If your
blood pressure monitor works reliably on 5 V, you can also use a USB power
supply, which is cheaper and easier to get.
Clinical blood pressure monitors are robust devices that do not break
often. When a problem does occur, it is often related to the tubing. Leaks are
possible due to ageing of the tubes. It is also possible that dirt has got into
the system and is blocking a sensor or the solenoid valve. This should not
actually happen, as there should be a filter before the pump.

Situation in developing countries

As equipment in developing countries tends to be much older, there are also
problems with wear and tear. Blood pressure cuffs are often very old, which
means that the Velcro fasteners do not hold well any more. However, if the
bladder is removed, a tailor can easily sew on new ones.
Blood pressure cuffs can also be subject to operator error, for example when
the wrong cuff is used. This is because departments often only have one
blood pressure device. The cuff is then used for all patients, whether they
are children, adults or obese adults. But one size does not fit all. Not only will
the cuff not fit properly, but the measurement results will be incorrect.
There have been many cheap blood pressure monitors in hospitals for some
time - mostly as defective devices in the workshop. Once again, electronic
devices with digital displays are not necessarily better or more accurate than
mechanical devices! For routine measurements, aneroid
sphygmomanometers are simply unbeatable. They are accurate, not
expensive and, if handled with care, will last for many years. In addition,
there are no running costs in the form of batteries and the calibration
process is quick and easy.
A collection of broken blood pressure monitors in a hospital workshop in
Tanzania. Few of these cheap monitors worked for more than a year.

After the repair

After repairing the NIBP monitor, switch it on briefly before reassembly to
see that it works and that nothing else is faulty. If this is the case, remove
dust from the inside of the unit if necessary. Then screw the unit back
together.
When the NIBP monitor is reassembled, clean the outside of the unit with a
soap solution. Do not forget to clean the mains cable and the cuff as well.
After drying with a dry cloth, the unit can be disinfected with a spray
disinfectant.
Now a test run should be carried out. The test run should include a few blood
pressure measurements.
Finally, the electrical safety test should be carried out as explained in the
Maintenance chapter of the book, if it is a mains powered device. When the
test has been passed, you only need to fill out the job card and the NIBP
monitor can be returned to the ward.

Further literature
On Wikipedia you can find further articles about these topics:
Blood pressure
Blood pressure measurement
Diastole
Korotkoff sounds
Pressure measurement
Pressure sensor
Pulse
Sphygmomanometer
Stethoscope
Systole