Physiological pressure and cardiovascular
Physiological pressure and cardiovascular
measurements and devices
The nominal values of haemodynamic pressure in the
basic circulatory system are as follows:
basic circulatory system are as follows:
Arterial system: 30 ‐‐ 300 mmHg
Venous system: 5 – 15 mmHg
Pulmonary system: 6 – 25 mmHg
Blood pressure measurements
Blood pressure measurements
• Ph
Physiological fluid pressures: cardiovascular system (Liquid),
i l i l fl id di l t (Li id)
pulmonary system (gas)
• Arterial blood pressure, central venous pressure (CVP),
p , p ( ),
Intracardiac blood pressures, spinal fluid pressures
• Stephen Hales (1773): Used an oen ended tube inserted
directly into an artery in the neck of an unanesthetized
directly into an artery in the neck of an unanesthetized
horse: direct measurement of blood pressure
• Indirect method of measurement: Sphygmomanometer
p yg
• Direct method of measurement: Pressure transducer that is
coupled to the patient’s artery or vein through a saline‐
filled catheter or needle or using Hale’ss method (to
filled catheter or needle, or using Hale method (to
measure spinal fluid pressure and CVP.
• Features:
• Accurate enough for ordinary clinical use
• Simple enough so that even nonprofessional
personnel can be rapidly trained
personnel can be rapidly trained
• Limitation on the ausculatory method include
the hearing acuity of the operator
f
• Several modern instruments are available for
Several modern instruments are available for
the indirect measurement of blood pressure in
by replacement of the stethoscope with an
by replacement of the stethoscope with an
electronic transducer
Pulpation method (indirect method)
• Uses the sense of touch to detect the patient’s
pulse in the radial artery (wrist)
pulse in the radial artery (wrist)
• The cuff is inflated until the radial pulse
disappears
• The operator then slowly releases the pressure in
th
the cuff until a pulse becomes palpable in the
ff til l b l bl i th
radial artery. The pressure at which this occurs is
th
the systolic blood pressure
t li bl d
• The method can detect only the systolic pressure
b
because no known palpable change occurs at the
k l bl h h
diastolic pressure.
Flush method (indirect method)
• Flush technique requires two cuffs and two
operators
• The cuffs are placed on the arm and are inflated.
• The blood in the section between the two cuffs is
h bl d h b h ff
massaged out, leaving the lower arm pale and
bl h d
blanched.
• The pressure in the upper cuff is then released
slowly.
• The pressure at which a sudden red flush is noted
in the blanched skin is recorded as the mean
arterial pressure (MAP)
Limitations of sphygmomanometer
b d
based ausculatory
l measurements
• Measurement is intermittent because it takes
time.
• The Korotkoff sounds are normally in the
range (less than 200 Hz) where human hearing
range (less than 200 Hz) where human hearing
is not very accurate.
A piezo‐resistive pressure
transducer is connected to the cuff.
Features
• Since sound is not used, environmental noise do
not hamper the measurement
h h
• As it does not require a microphone in the cuff,
placement of the cuff is not critical.
• Oscillometric technique is used extensively when
q y
monitoring is needed but it is not desirable when
direct pressure measurements are needed.
• Microprocessor‐controlled approach and design
with periodically inflate and slowly deflate the
p y y
cuff.
Ultrasonic pressure measurements
• A piezoelectric transmitting signal sends a sine‐
wave beam (ultrasound > 20 kHz) into the tissue
wave beam (ultrasound, > 20 kHz) into the tissue
• When it encounters a fluctuating vessel wall,
some of its energy is reflected back
some of its energy is reflected back
(backscattered) to the receive (sensing) crystal
• F
F F( h
F (where Fi h D
F is the Doppler shift) describes
l hif ) d ib
the frequency content of the backscattered wave
• The existence of the F component alers the
circuit in the turbulent flow that corresponds to
Korotkoff
k ff sounds, and it diminishes when near‐
d d i di i i h h
laminar flow resumes (P<Pdiastolic)
Ultrasonic Doppler shift method
If the artery wall is moving towards the transmitter, the apparent frequency f1 is
given by:
(C v)
f1 f
C
where f =transmitted frequency (carrier frequency in the medium)
C =velocity of sound in tissue
v =velocity of vibrating vessel wall
C
f2 f1
C v
The resultant Doppler shift
C (C v) C
f f f2 f f1 f f
C v C C v
2 fv
f
C
OR
2v
f
c
where c wavelength of the carrier frequency in the medium
Direct method: electronic manometry
• An electronic pressure transducer can be
connected to the patient through a thin piece
d h i h h hi i
of tubing called a catheter
• The catheter is introduced into the vessel
through a thin hollow tube called a cannula
through a thin, hollow tube called a cannula
• The transducer’s pressure diaphragm is
coupled to the patient’s bloodstream by a
column of saline solution that fills the catheter
How to measure blood pressure
p
• Transducer: a thin, flexible metal diaphragm is
stretched across an opening at one of the
transducer bodyy
• Strain gauges are connected to the diaphragm
• A clear plastic pressure dome fits over the
l l d f h
diaphragm to contain the fluid and provide
hydraulic connection to the catheter
Systolic, diastolic and mean detector circuit
• The pressure amplifier produces an analog
waveform with a peak amplitude representing
waveform with a peak amplitude representing
systolic pressure and a minimum or valley
that represents the diastolic pressure
that represents the diastolic pressure
• Additional circuitry is required that recognizes
these points and from them produces a
these points, and from them produces a
steady voltage or current that can be used to
drive a display meter
drive a display meter
• The MAP (mean arterial pressure) is found by
taking the time average i.e., integrating of the
pressure waveform
Practical problems in pressure monitoring
p p g
• Hydrostatic pressure: The liquid in the transducer plumbing
system has mass, so its weight can apply a force to the
transducer diaphragm that is also interpreted as a pressure
• Positive hydrostatic pressure head caused by the weight of
the fluid in the tubing brought to the transducer from
the fluid in the tubing brought to the transducer from
above
• Negative hydrostatic pressure is obtained when the tubing
i
is predominantly below the level of the transducer
d i tl b l th l l f th t d
diaphragm
• Balancing method the tubing should have approximately
Balancing method the tubing should have approximately
equal lengths above and below the level of the diaphragm
• The diaphragm should be level and at a height equal to the
height from the floor to the catheter tip (not the point
height from the floor to the catheter tip (not the point
where the catheter is inserted