That’s the question I pondered while reading an article published earlier this year in the American Journal of Hypertension. In the article “Blood Pressure Measurement Method and Inter-Arm Difference: A Meta-Analysis,"* the authors reviewed studies where BP was measured in both the left and right arm of subjects. The results showed that on average, Systolic pressures differ by 5.4 mmHg between arms while Diastolic pressures showed an average inter-arm difference of 3.6 mmHg.
Here on the SunTech blog, we normally aim to provide valuable clinical information and helpful tips related to all things blood pressure. But allow me to wax philosophical for a moment, because…well, you’ll see why.
Right. So, for many of us who work in health-care or a health-care related field, there is significant meaning to be found in doing a job that can positively affect people’s well-being. It’s great to wake up every day knowing that you will indirectly or directly help to cure illnesses, heal wounds, save lives, and treat burns due to water skis on fire…wait, huh?
Hypertension is a prevalent condition globally and is quickly becoming a focus in the U.K., with particular emphasis on how to best diagnose the condition. In August, a study comparing blood pressure (BP) measurement methods, which was funded by the U.K.’s National Institute for Health and Clinical Excellence (NICE), was published on the same day that NICE announced the release of its new guidelines for hypertension management in adults.
In the study, Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: a modelling study, the research found that “ambulatory monitoring is cost effective compared with further monitoring in the clinic or home for confirming the diagnosis of hypertension” for all age and gender groups considered. Specifically, ABPM provided cost savings ranging from £56 in men aged 75 years to £323 in women aged 40 years (Equivalent to $89 and $511 respectively). Additionally, it was determined that ambulatory blood pressure monitoring (ABPM) “resulted in improved health outcomes for male and female age groups older than 50.”
Being a part of the healthcare industry, we know that reducing healthcare-associated infections (HAIs), such as MRSA (Methicillinresistant Staphylococcus aureus) and C.Diff (Clostridium Difficile), continues to be a top priority for hospitals everywhere. What is surprising though is that based on a survey conducted in July 2011, prospective patients are becoming increasingly aware of a hospital’s ability to protect their patients from HAIs and are using this information as a major factor in determining where they seek care.
It’s one of the occasional issues we hear about BP monitors and automated BP technology, ours included. And while it’s one of the reasons that we blog about the 10 Steps to Accurate Manual Blood Pressure Measurement and the 10 Factors That Can Affect Blood Pressure Readings, sometimes it takes more guidance to diagnose if a monitor is mis-reading. Comparing BP measurements manually taken by an observer to those from a monitor is a common way of examining the accuracy of a monitor. Clinical standards1 that determine a monitor's accuracy provide detailed methods for making these comparisons. Unfortunately, there are so many things done to control the environment and patient in these standards tests that it is not realistically possible to replicate in clinical practice. However, here are a few of the more important issues that Richard Prowse, our OEM sales manager for Europe, Middle East, and Africa, shares with his customers when they are investigating a monitor that might be reading high.
Dr. Henry Black, former President of the American Society of Hypertension, presents this very question in his recent video on Medscape News. While Medscape requires a free login account to view their content, we felt this report rather significant and worthy of sharing.
In the video article, Dr. Black points out that the practices of how we measure blood pressure are changing as technology advances and becomes more available. He also explains that while home monitoring is becoming more commonplace, studies of ambulatory blood pressure monitoring (ABPM) are telling us more about its unique prognostic benefits.
I don’t know about you, but I am bombarded daily with more information than I can possibly process or make use of. Yet each day dawns requiring that I sift through it all, applying only what is relevant or helpful to me and my family, and at times the whole process can be exhausting. The miracle of the information age is also its curse. ‘Connected’ devices are proliferating at an astonishing pace, inexorably finding their way into our living rooms, dens, kitchens, bedrooms, vehicles, and belt clips. Not that this is necessarily a bad thing, but how many Twitter messages can a sane person realistically absorb in a given day? And more importantly, which ones are really useful?
This same phenomenon is happening today in health care...
In our last OEM technology blog post, we discussed things to consider when deciding whether to work with an OEM clinical technology vendor. If thinking through these issues encourages you to investigate further, here are three key ingredients to identifying the right partner who will give you the best chance for your ideas and products to succeed in today’s dynamic healthcare marketplace. As you might expect from a partnership, the first two ingredients depend largely on the partners!
There have been decades of research on the transmission of Healthcare-Associated Infections (HAIs) throughout healthcare settings. Studies have shown patients can be exposed to HAIs from contaminated healthcare workers’ attire, environmental surfaces (cabinets, bedrails, countertops, etc.), and reusable medical equipment.7,8 Therefore, many healthcare facilities have implemented Infection Prevention and Control programs to help reduce the spread of HAIs. Some of the strategies employed to help control HAIs include hand washing and the use of disposable items, such as disposable blood pressure cuffs. With that in mind, the following is an abbreviated list of the “Top 7 Reasons to Use Disposable BP Cuffs to Reduce the Transmission of Healthcare-Associated Infections.” To download our free ebook version with more in-depth information, pleaseclick here
That’s just the question Dr. Mark C. van der Wel and colleagues sought the answer to in an article published in the Annals of Family Medicine. As we at SunTech have mentioned in previous posts, two of the most prevalent problems with traditional in-office blood pressure assessment is improper observer technique and the white-coat effect. As a way to overcome this, the authors developed a method of taking a series of in-office automated oscillometric blood pressure readings for 30 minutes by utilizing an ambulatory blood pressure monitor (ABPM) and compared those results with mean daytime ABPM results.
Quite a lot has been said in clinical circles about the best way to assess a person’s blood pressure. Manual? Oscillometric? During office visits? At home? Over 24-hours? Average? Trend? Peak? At times, the debate has gotten pretty hot. In a recent issue of the journal Hypertension, Drs. George Stergiou and Gianfranco Parati published an editorial that proposes a more practical approach.
As a manufacturer of disposable blood pressure cuffs, we are always interested in new information concerning infection control and potential ways to control antibiotic resistant bacteria (“superbugs”). Since superbugs are creating a serious and growing global threat to public health, the World Health Organization has made antibiotic resistance the central focus of this year’s World Health Day. Furthermore, the Infectious Disease Society of America (ISDA) warns that “unless sweeping actions are taken now, the future could resemble the days before these miracle drugs were developed. People will die of common infections and many medical interventions we take for granted – surgery, chemotherapy, organ transplantation, and premature infant care – will no longer be possible.”
The SunTech blog was established as a discussion place about blood pressure (BP) measurement because that's what we do. Naturally, we have tried to share our understanding of the clinical application experiences with using automated BP measurement in practicing medicine. However, we also partner with other manufacturers to integrate OEM NIBP technology in their medical devices. Some of these are patient monitors that you see in all parts of the hospital. But some of the more specialized devices are used to save lives in an ambulance or Lifeflight, on commercial airline flights, and even in the battlefield. Regardless of the application, these companies all considered whether they should buy, build, or partner in order to achieve their goals. Here are the top five factors companies should consider when deciding whether to use an OEM technology supplier:
One thing we like to do at the SunTech blog is share debates and comparisons of automated vs. manual auscultatory blood pressure measurements. The latest comes from an article published in the Journal of the American Society of Hypertension earlier this year. This evaluation compared one particular automated oscillometric device with the results from the auscultatory method of listening for Korotkoff sounds during cuff deflation. The authors’ aim was to help readers better understand the fundamental differences between these two methods and illustrate how that might assist clinicians in effectively controlling and managing hypertensive patients.
Understanding that there is a dramatic difference between these two methods is, in fact, an important consideration of which clinicians should be aware. The auscultatory method has been the standard method of determining BP for over 100 years and relies on the observer to detect the audible sounds (Korotkoff sounds) that occur during constricted blood flow. The oscillometric method, employed by most clinical-grade automated BP devices, analyzes pulse waves collected from the cuff during constricted blood flow. In this case, the cuff is the sensor. The auscultatory and oscillometric methods are two very different approaches to determining the same vital sign.
Each method also presents its own unique set of challenges. The manual auscultatory method is prone to poor technique, observer digit bias and poor hearing (often unbeknownst to the observer). The oscillometric method can be prone to errors when there is too much patient arm movement. In addition, each medical device manufacturer uses their own proprietary algorithm for acquiring blood pressure measurements so BP readings may vary significantly between devices which makes it important to shop around for a clinical grade device that is validated to industry standards such as the AAMI SP10 protocol.
Being aware of these differences and limitations can certainly be of help to clinicians when making hypertension treatment decisions. For further information on some of the challenges and best practices when taking an auscultatory blood pressure measurement, be sure to check out our e-book “10 Steps to Accurate Blood Pressure Measurement”. We also invite you to share your comments and experiences when comparing automated and manual BP measurements.
Most people have heard about the more popular “superbugs” (antibiotic resistance bacteria) such as MRSA (Methicillin Resistant Staphylococcus Aureus) and C.Diff (Clostridium Difficile). But now there is a “new” superbug starting to get alot of attention: NDM-1.
So what exactly is NDM-1 and how is it transmitted? How can disposable blood pressure cuffs play a role in combating this and other infections? These questions, and more, are answered below:
The regulatory world is changing. Countries are examining and changing the rules and regulations that govern the way businesses interact and make an impact. In the US, with his editorial article in the Wall Street Journal and his State of the Union Address, President Obama makes a clear message about government regulatory systems. He wants balance between commerce & safety, progress & common sense. Obama calls for regulations to be reviewed so that the US “(protects its) safety, health and environment while promoting economic growth.” While the call to update regulations is clear, the balance that is called for lies in a well-known, well-trodden, broad, gray area. It’s this same area that all countries are trying to define, regulate, and enforce for the good of their citizens.
The New Year is upon us and a lot of us have declared to get healthier in 2011. Whether you have started a new workout regimen or have changed your diet to consume more fruits and veggies, any change is good change, right? Growing up in North Carolina, where we fry everything from chicken to green beans, I was never fond of eating healthy so my mother always stressed the importance of “drinking your juice” instead of so many soft drinks. However, recent research may shed some light on the effects of juice consumption. Being that SunTech Medical is your one-stop shop for blood pressure (BP) measurement expertise, let’s explore the effects juice consumption has on BP!
Traditionally, we try not to engage in excessive self-promotion on the SunTech Blog. But last month marked the 24th anniversary of SunTech’s first journey into space, and we’d like to let our readers know about this important and interesting chapter in our history. In the pre-dawn darkness of January 12, 1986, the space shuttle Columbia blasted off from launch pad 39A at the Kennedy Space Center, carrying with it a special version of the SunTech Accutracker II ABPM device. When Columbia landed successfully at Edwards Air Force base after 98 orbits, it may have marked the end of mission STS-61C, but it was just the beginning of SunTech’s foray into space-based research.
As 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.