Robie-Ann Shippey 620040392
Nekiesha Thompson 620031859
Andrea Watson 620011659
Sade` Weir 620046946
Hadia Williams 620037376
PICO

Population- Adult hospitalized patients
with hypertension

Intervention- manual
sphygmomanometer

Comparison- automated device

Outcome- accuracy of reading.
PICO Question
In adult hospitalized patients with
hypertension, does the use of manual
sphygmomanometer compared to
automated blood pressure machines gives
a more accurate reading to evaluate the
patients’ condition?
Introduction
A wide variety of devices can be used to
measure blood pressure in the clinical
setting. These include automated blood
pressure devices and manual
sphygmomanometer but the question still
remains, which gives a more accurate
reading?
Procedure
Preparation:
 Obtain informed consent from patient
 Position machines on the appropriate
side of the beds
 Place patient in a supine position
with arms straight and legs
uncrossed
 Ensure cuff size is appropriate
Procedure cont’d
Fit cuff to patient’s arm
 Face dial away from the other nurse

Procedure cont’d
Standardized procedures used for each
device includes the following:
Mercury sphygmomanometer


Determine an estimate of the systolic pressure by
inflating the cuff until the radial pulse can no longer
be palpated. Inflate cuff to an additional 30mmHg
and release valve at 2mmHg per second until the
radial pulse reappears. This recording would be
the systolic blood pressure.
Wait 3 minutes to allow circulation to return
Procedure cont’d
Inflate the cuff 30mmHg higher than the
systolic estimate. Deflate cuff 2mmHg
per second. Using a stethoscope, record
results heard on the 1st and 5th Korotkoff
sounds (diastolic reading)
 Record both systolic and diastolic
readings

Procedure cont’d
Automated Blood Pressure Machine:




Plug machine into power socket
Turn on machine
Press start button to begin blood pressure
measurement
Record displayed readings for the diastolic and
systolic pressure
Summary of Evidence
According to Myers (2010), measurement
of a patients blood pressure using a
manual sphygmomanometer is affected by
several factors. These flaws could possibly
lead to misdiagnosis or even inappropriate
drug therapy.
Summary cont’d
In a survey carried out by Ostchega et al (2012), it
was observed that the systolic blood pressure
reading was higher using a manual
sphygmomanometer as opposed to using a
automated blood pressure machine. On the other
hand, the diastolic blood pressure reading was
higher using the automated blood pressure machine
as opposed to using the manual
sphygmomanometer.
Summary Cont’d
“Blood pressure measurement with the auscultatory
technique by a trained observer, using the mercury
sphygmomanometer remains the most accurate and
reliable form of indirect blood pressure measurement
and is currently regarded as the ‘gold standard’. All
alternative blood pressure measurement devices
need to be clinically validated in clinical protocols
against the current ‘gold standard’ of the mercury
sphygmomanometer”. (SCENIHR, 2009)
Summary Cont’d
According to Heinemann et al (2008) automated
machines are easier to use as it allows continuous or
intermittent blood pressure monitoring, provide
printouts of readings, allow pulse rate and oxygen
saturation levels to be taken concurrently. On the
other hand, automated machines are potential to
provide false readings especially on the first reading.
It is therefore important that nurses are aware that
automated blood pressure machines can provide less
reliable readings than those taken with a manual
sphygmomanometer.
Appraisal of Evidence
The articles that were used to complete
this research can be said to be of good
quality. This is so because:
 Contents of the articles are current and
valid
 Citations are accurately done
 The articles compose of all the elements
of a thorough research
Appraisal of Evidence

Actual studies were carried out to
support the evidence being presented
Limitations
Although the articles are said to be of
good quality, some flaws were still
noticed:
1.
2.
3.
One study was too generalized and so the
authors were not able to formulate a proper
conclusion.
One author failed to cite some of his references
accurately.
Another author presented biased literature.
Conclusion
After completing this PICO research, it can
be seen that more evidence supports the
traditional way of monitoring blood
pressure. Based on the four (4) articles
that were used, it is seen where three (3)
articles supported the manual
sphygmomanometer comparing to one (1)
which supports the automated blood
pressure machine.
Conclusion Cont’d
It can be concluded that the mercury
sphygmomanometer also referred to as
the goal standard remains the most
accurate and reliable form of blood
pressure measurement so as to better
evaluate and properly monitor the
condition of hypertensive patients.
References

Heinemann, M., Sellick, K., Rickard, C., Reynolds, P., &
Mcgrail, M. (2008). Automated versus manual blood
pressure measurement: A randomized crossover trial,
296-302. Retrieved from
http://web.ebscohost.com.rproxy.uwimona.edu.jm/ehost/
pdfviewer/pdfviewer?sid=6c3a98b8-56b5-418a-9e95cba8267af4f0%40sessionmgr12&vid=4&hid=1

Myers, M., (2010). Why automated office blood pressure
devices should replace the mercury sphygmomanometer:
The Journal of Clinical Hypertension, 12, 478-480. DOI:
10:1111/j.1751-7176.2010.00301.x Retrieved from
http://onlinelibrary.wiley.com/doi/10.1111/j.17517176.2010.00301.x/full
References Cont’d

Ostchega, Y., Zhang, G., Sorlie, P., Hughes, P.J., ReidGillette, S.D., Nwankwo, T., Yoon, S. (2012).
Blood pressure randomised methodology study
comparing automatic oscillometric and mercury
sphygmomanometer devices: National health and
nutrition examination survey, 2009-2010. National
health statistics reports. Retrieved from
http://www.cdc.gov/nchs/data/nhsr/nhsr059.pdf

Scientific Committee on Emerging and Newly Identified
Risks. (2009). Sphygmomanometers. Retrieved
from
http://ec.europa.eu/health/scientific_committees/opi
nions_layman/sphygmomanometers/en/l-3/5.htm#0