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Advice from the BP Measurement Experts

Top 4 Reasons PLUS Cuffs are an Innovation to the Blood Pressure Industry

 

opd plus cuffs

With the launch of SunTech’s innovative PLUS Cuff sizes, here are some of the reasons you should consider changing your blood pressure cuffs. The PLUS Cuffs were designed to specifically target the need to fit a greater range of patients – including bariatric patients, improve measurement reliability, and cut hospital costs and inventory.

 

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Home Blood Pressure Devices Wrong 70% Of The Time

 

Man frustrated with home BP device

A recent study published in the American Journal of Hypertension shows the majority of blood pressure devices sold and used in people’s homes are potentially inaccurate as much as 70% of the time. Since lots of people measure their blood pressure at home to track their cardiovascular health, this study is understandably noteworthy. But what else can we learn from it?

 


 

You Get What You Pay For

First, let’s talk a little bit about oscillometry. Oscillometry is the general method that most automatic blood pressure devices use to measure blood pressure. This is true for devices in the home, in doctor’s offices, and even in hospitals. As the study pointed out, while the oscillometric method is commonplace, there are differences between devices from different manufacturers because of the mathematical formulas and algorithms used to calculate systolic and diastolic blood pressure values. The math is proprietary, and most private companies that have their own oscillometric technology—including SunTech—guard those calculations very closely.

Why? Well, the simple answer is that the math behind better-performing technologies is based on actual clinical research conducted over long periods of time—in SunTech’s case, decades. This research, and the analysis of the resulting data, is a significant and expensive undertaking that can provide an important commercial advantage when it comes to a device’s clinical accuracy. So if companies had to share their data with the rest of the world, what would be the incentive to conduct all of that research in the first place? So, proprietary data can result in devices with better clinical performance, which is better for physicians and patients. I say ‘can’ because it’s no guarantee, as this study clearly illustrates.

 

If the Cuff Fits...

One other fact about this study merits some additional digital copy. The authors discuss several potential reasons for the reported inaccuracy of almost 70% of the home blood pressure devices analyzed. But there is one that the authors mention briefly that could actually explain a lot. And that’s the blood pressure cuff itself. Now, it’s pretty common for folks to call the entire device—digital box, hose, and fabric that wraps around the arm and inflates--a ‘BP cuff’. But what I’m talking about is just the part that goes on the arm. That’s the actual blood pressure cuff.

Blood pressure cuff sizes are incredibly important for any oscillometric blood pressure device. The math behind these devices assumes that the correctly sized cuff will be used on the patient. See, because of the physics around how non-invasive blood pressure is measured, there’s no such thing as a ‘one size fits all’ blood pressure cuff. To be accurate, the cuff must be sized correctly according the circumference of the patient’s upper arm, for a variety of reasons. The researchers in this study reported that the mean arm circumference of study participants was a bit less than 33cm, and that increasing arm circumference was a statistically significant predictor of an inaccurate measurement.

Now, 33cm is on the high side for most standard, adult-sized blood pressure cuffs. Since home blood pressure devices typically include only a single cuff, manufacturers generally pick a very middle-of-the-road size for the cuff, hoping that it will cover the majority of arm sizes. But in the case of this study, the mean arm circumference is already pushing the upper limit of a middle-of-the-road adult cuff. So it should come as no surprise that as arm circumference increases, accuracy suffers. The researchers didn’t publish any data on the sizes of the BP cuffs that were used with the home BP devices, and I think that would have been helpful.

But the point here is that that size matters when it comes to BP cuffs and oscillometric devices. It matters a lot. It might even matter more than the math inside the device—although that matters too. So if you find yourself in need of a home blood pressure device, the first thing that you need to do is make sure that the cuff that comes with it is the right fit for your arm. Your doctor can help you figure this out if you bring it with you to the doctor’s office. If the cuff isn’t the right size, contact the manufacturer and see if they have a cuff that is.

In fact, even when you are having your blood pressure measured in a doctor’s office, it’s not a bad idea to ask the clinician taking your BP to double-check the sizing of the cuff to your arm, as other studies have shown that using the incorrectly sized cuff in clinical settings is commonplace as well.

 

Maybe We’re Barking Up The Wrong Tree?

While data that points to inaccuracies with home blood pressure devices is important, for professionals in the medical world, it’s not exactly news. And while asking how to make home BP devices better is fine, we should also be asking if there are more accurate alternatives to home BP. And the answer is yes. 24-hour Ambulatory Blood Pressure Monitoring (ABPM) is widely considered to be the gold standard for assessing a patient’s blood pressure.

Unfortunately, the reimbursement for ABPM in the United States is currently quite low, and only valid for diagnosing white coat hypertension. In other countries, like the U.K., ABPM is becoming recognized as an important tool for treating general hypertension, and is therefore being treated as such by government and private payers.

At SunTech, our goal is to continue to evolve our Oscar 2 ABPM devices to make them more patient friendly, and allow them to deliver more valuable clinical data, so that clinicians can make better diagnoses and treatments. It doesn’t happen overnight, but we’ll get there.

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Kiosk Users Get Advice from FDA on Accuracy of BP Measurement

Illustration of a Blood Pressure Monitoring Kiosk

Do you ever see a kiosk that measures blood pressure (BP) and take a seat to see how you fare? Well, make sure you are aware of the latest information regarding accuracy of kiosk BP measurements. On June 24, 2014, the US Food and Drug Administration (FDA) issued a consumer update for blood pressure monitoring kiosks. In this update, users are advised that blood pressure cuffs on public kiosks do not fit everyone and consequently, may not provide accurate BP readings for every user. Luke Herbertson PhD, Biomedical Engineer at the FDA stated, “[BP kiosks] are easily accessible and easy to use. But it’s misleading to think that the devices are appropriate for everybody. They are not one-size-fits-all.” Users with arm circumferences outside of the cuff range may receive inaccurate BP values.

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The Material World of BP Cuffs

The Material World of BP CuffsSo what’s in a fabric?  And why do manufacturers come up with so many choices?

Choosing the correct fabrics for medical products can be a bit more complicated than selecting the right material for a pair of jeans. Medical device manufacturers spend a lot of time considering things like where the product will be used, how often it will be used, what it will be cleaned with, who will be using it and how it interacts with human tissue.

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FDA Calls for Connector Standardization

Click to view the video on SunTech's Cuff Standardization ProgramTubing misconnections, wrong route errors, catheter misconnections or Luer misconnections: the FDA isn't picky about what you call them – they want them eliminated. Multiple and sometimes fatal connection errors between various medical devices, including blood pressure cuffs, have led to the need for standards designed to eliminate this potential. The intent is to achieve this by designating specific connectors for defined types of devices. Blood pressure cuffs are one of the device groups identified by the FDA for standardization1.

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What is a "Long" Blood Pressure Cuff?

Long size BP cuffAs a manufacturer of blood pressure (BP) cuffs, we are often asked: “What is the difference between an Adult BP cuff (or “standard” cuff) and an Adult Long BP cuff?”

Simply put, a “long” cuff has the same range indicators and bladder size as a “standard” cuff, but the actual length is longer than that of a “standard” cuff.  Therefore, a “long” cuff is able to fit on a larger patient population than a “standard”  cuff.

You are probably asking yourself, “If the range and the bladder size is the same on both a “standard cuff” and a “long cuff”, do they both give accurate readings?”


To answer this question, you need to understand the “80/40” rule.  The “80/40” rule states that in order to obtain an accurate blood pressure measurement, the cuff bladder length should be approximately 80% of the circumference of the upper arm and the cuff bladder width should be optimally 40% of the circumference of the upper arm.  The basic reasoning behind this rule is that the cuff bladder must be able to occlude the brachial artery (obstruct the flow of blood through the artery) when the bladder is inflated.  If the brachial artery is not completely occluded before you start to deflate the bladder, then you will hear the Korotkoff sounds earlier which will result in false high readings.  On the other hand, if the bladder size is too big for the arm, then it will take longer to hear the Korotkoff sounds which will result in false low readings.

So if a “long cuff’ is used on a patient with an arm circumference that fits in the intended range of the cuff, then an accurate blood pressure measurement can be expected.  However, if a “long cuff” is used on a patient with an arm circumference outside the intended range of the cuff, even if the cuff fits the arm of the patient, you risk obtaining inaccurate blood pressure measurements.

While we have kept customer demand in mind by making the long sized cuff available, we recommend always using best practices for obtaining an accurate blood pressure reading.  You can read “10 Steps to Accurate Manual BP Measurement” for a detailed guide for obtaining a high quality reading.  In addition, we highly recommend the following video tutorial for proper cuff sizing.

 

 

If you have experiences using "long" versions of blood pressure cuffs, we invite you to share your thoughts with us.

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10 Things to Look for When Purchasing Reusable Cuffs

Blood Pressure Cuff Check ListIn a recent blog post, we took a look at the various types of blood pressure cuffs available on the market. One of four main types of blood pressure cuffs is the reusable cuff. Given that there are many different manufacturers of reusable blood pressure cuffs with many different options, the selection process can be difficult.  So what do you look for when purchasing a reusable cuff?  Below, we have listed the top 10 features to look for when purchasing a reusable cuff:


  1. Durability: Reusable cuffs must be made with a durable material that will be able to withstand multiple inflations, multiples times per day, on multiple patients and used in a variety of applications (i.e. hemodialysis, EMS, primary care offices, hospitals, etc).
  2. Patient Comfort: Even though reusable cuffs need to be durable; they must also be comfortable to the patient.  If the cuff is uncomfortable, patients will probably let you know and resultant patient movement during a reading may lead to multiple re-inflates or error codes.
  3. Cleaning and Disinfecting: Since reusable cuffs are used on multiple patients, it is extremely important that these cuffs are washed on a regular basis (preferably after every patient).  This is especially true today since several studies have identified blood pressure cuffs as potential vehicles for transmission of nosocomial infections (i.e. MRSA, C-diff, etc).
  4. Range of Cuff Sizes: It is extremely important to make sure that a manufacturer makes a full range of cuff sizes.  There is a big difference in upper arm circumference between a child, a middle-aged man, and an elderly woman, so a medical facility should have the proper size cuffs to use on each patient.
  5. Color-Coding: Most cuff manufacturers color-code their cuffs to help medical professional quickly chose the right size cuff for a patient.  Most manufacturers follow the same color coding schemes for each size cuff, which is shown in the table below:
    Cuff Size Color
    Infant Orange
    Child/ Child Long Green
    Small Adult / Small Adult Long Light Blue
    Adult / Adult Long Navy Blue
    Large Adult / Large Adult Long Burgundy
    Thigh Brown
  6. Range Markings: A cuff must have range markers on the inside or outside, (or preferably both), of the cuff to indicate if the correct size is being used on a patient.  Using an incorrectly sized cuff often results in inaccurate blood pressure measurements.
  7. Latex Free & PVC Free: To minimize risk of adverse reactions to latex and to promote patient safety, reusable cuffs should be free of latex and PVC.
  8. Reliable Performance:  The last thing you want to happen when you purchase a blood pressure cuff is to have it leak.  Therefore, look for a cuff manufacturer that leak tests their cuffs on a regular basis.
  9. Regulatory Requirements: All blood pressure cuffs should be designed and validated to the AHA (American Heart Association) and the AAMI (Association for the Advancement of Medical Instrumentation) standards.  These standards provide recommendations for cuff sizing, life cycle of the cuff, maximum inflation, etc.
  10. Warranty:  Most cuff manufacturers have a 2 or 3 three year warranty on their reusable cuffs.  Of course, this doesn’t mean they will replace cuffs with normal wear and tear.  If the cuff leaks, rips, or tears, then you should be able to return the cuff under warranty with no hassle.

Whether you are a distributor, physician, nurse, or in materials management and responsible for purchasing blood pressure cuffs, it is good to know the features and benefits of reusable cuffs so you can make an informed decision on which brand of cuff you would like to purchase and use at your facility.  If you have any additional features you would like to add to the list, please leave us a comment below.

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The Different Types of Blood Pressure Cuffs on the Market

Specialty CuffMost people think of a blood pressure (BP) cuff as simply, “just a cuff.” However, there are actually a number of BP cuffs that have been developed to meet the varying needs of patients and medical facilities. In an effort to shed more light on the different cuffs available for use, here is some detailed information on each type, how they are used and the typical environment in which each are used.

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Blood Pressure Monitoring and Infection Control

Electron microscope imageInfection control has long been a hot topic for acute-care hospitals, and has been the focus of patient advocacy groups, the popular press, and legislators for some time. Old stories of sponges and instruments being left inside patients by harried doctors and nurses have been supplanted by nightmarish scenarios containing ominous-sounding names like Clostridium difficile and Methicillin-resistant Staphylococcus aureus. Unfortunately, for many patients in today's healthcare system, hypothetical scenarios and clinical studies have become a real matter of life and death. As a result, the spotlight is expanding to include other areas of the healthcare continuum-including long-term care facilities.

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Preeclampsia: Pregnancy and Hypertension

PreeclampsiaAn important health issue that expectant mothers may encounter during pregnancy is Preeclampsia, a condition in which the expectant mother is diagnosed with hypertension and has protein present in the urine.  Preeclampsia is the most common medical disorder of pregnancy and affects 10%-12% of all expectant mothers (Pickering et al, 2005).  Since blood pressure plays an important role in the health of mom and baby, accurate blood pressure measurement is extremely critical, because one would never want to be misdiagnosed with hypertension and be prescribed medications/medical interventions that could potentially injure both mom and baby.

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Wrist versus Upper Arm Blood Pressure Measurement

BP measurement device

Is wrist BP an acceptable way to guide treatment for obese patients?

For over 100 years, upper arm blood pressure (BP) measurement has been the gold standard method to guide treatment decisions. This is the recommended technique by both the American Heart Association (AHA) and the European Society of Hypertension (ESH).

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10 Factors That Can Affect Blood Pressure Readings

Proper blood pressure cuff sizingHave you ever visited the doctor's office and discovered your blood pressure was higher than you expected? Most people do not realize their blood pressure is constantly changing minute by minute in response to mood, activity, body position, etc. In fact, simple changes can cause blood pressure to fluctuate between 5 and 40 mmHg. Here is a list of 10 factors that can temporarily cause significant deviations in your blood pressure measurements.

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Larger Blood Pressure Cuffs, Please!

measurement tape imageIf you ask any nurse or doctor about blood pressure (BP) cuffs, one of the most common questions you will receive is "Why can't we get a larger cuff?" With the obesity epidemic increasing globally, the need for larger blood pressure cuffs is becoming more pronounced. The World Health Organization states that "currently more than 1 billion adults are overweight - and at least 300 million of them are clinically obese."1

So why can't BP cuff manufacturers just make larger size cuffs?

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