EBME Forums Forums Management Medical Equipment Management BP Monitors...

Has anyone done any research into the best available BP monitors, cost, user friendly, breakdowns and maintenance etc? In my own experience I know a lot of problems arise because monitors are not plugged in or plugged in but not switched-on!
If your place of work is anything like here, then you’ll have about 6-7 different types of monitors, which in it’s self creates even more problems. Look forward to your comments?

R………

There's a Working Party been set up for almost a year now looking at the available equipment. The Chief Medical Officer set it up and it's referred to on the DoH web site - but there's no indication of when it's going to report !

There's some pretty awful rubbish out there - but if it's acredited by the British Hypertension Society then it's OK - according to one of our senior cardiac consultants.

We have a number units/models by a single manufacturer that has been validated by the BHS. But we find when we test on our simulator that they consistently read low on the systolic. The queston that comes to mind is the unit faulty or is it a design issue or is it my test gear which gets calibrated, wrong?

I would join Roy in his sentiments about rubbish - regardless of the claims by the suppliers.

Indeed some suppliers are very happy to sell products designated by the manufacturer as "Home Use" to GPs when the same manufacturer has developed a separate range for "Professional Use".

I also belive that some people glibly use the phrase "acredited by the British Hypertension Society" when in fact the BHS does not accredit any BP monitors as is spelt out in their disclaimer.

http://www.hyp.ac.uk/bhs/bp_monitors/disclaimer.htm

I think the working party are supposed to be reporting soon - minutes of previous meeting can be found somewhere on MHRA website.

And as I am sure you will agee a good monitor will never compensate for bad technique. There are some very good monitors out there giving very bad readings!!!!!!

Brian

Agreed, a healthy patient helps as well!

The way in which both BP monitors and Simulators work, means that you will not normally get an exact result. Most manufacturers of BP simulators make it clear in their documentation that they should not be used as a gold standard.

What you should see is consistency between monitors used on one simulator and the same monitor over an extended period of time.

If you are looking for true clinical performance, then you should ask the manufacturer of the BP Machine for the results from the clinical trials, these are part of the CE marking requirements, so should be available.

There are a number of organisations that lay down standards for clinical trials and the results, the two main ones being AAMI and BHS. The main difference between the two is the AAMI give a Pass/Fail whereas, BHS give a grade. If you can get a copy of the results from the manufacturer it is possible to assimilate this to a BHS grade.

Be careful with manufacturers claiming BHS validation, this in itself does not make the product any more accurate, it just make it more marketable in the UK.

Chilly

As I understand the situation there is no defined method of determining the point at which B.P. readings are recorded. Each manufacturer uses their own algorithm (obviously designed to give a similar result to a manual method). This means that different manufacturers instruments may give different results when measuring the same dynamic situation, e.g. B.P. simulator (which also has its own assumed calibration). Automatic machines should give good repeatable results from a source and show trends very accurateley (which is what they were initially developed to do) Also of course the static pressure readings during calibration should be accurate within a few mmHG.
What I think is most alarming is the way that "observations" are carried out by automatic machines operated by people who often do not have the qualifications/experience to observe a patients condition.
There is a useful trend at the moment to do initial/clinical evaluations using the old manometer/stethoscope method to assess the patient before resorting to the automatic machine to show the patients progress/response to treatment, over time.

Very interesting reading thanks for the replys!
Am I right in saying as a general rule, all monitors are approximately 5% out, up or down, therefore, to get a more accurate reading, it should be done twice, maybe standing and sitting or switch arms? I was told this by an F grade once, so it probably isn't true!

Ro………

You shouldn't take blood pressure measurements on someone who's standing up - definitely not.

The rumour here is that you should do the measurement 3 times, discard any reading which is widely different and then take an average. What you do if you get 3 widely different readings isn't specified - probably apply for re-training

I was taught at college that you take four readings, you then disregard the first and average the next three and that was accepted as normal practice when I first started as a biomed.
I have yet to get a definitive answer to this question from several companies. I attended a service course at Datex where we were given a presentation on vital signs monitoring I asked the question and was told if you take more than one reading you will get arterial compression which will affect the reading and was told if you use the correct technique you only need to take one reading.
This makes sense to me and as this is the only answer I have recieved I use this when asked.
The problem I and I am sure lots of people involved in training users of medical devices come across is that there is an asumption that all the user needs to do is to put the machine on the patient press the appropriate button and await the results.
As for taking consecutive readings on different arms, this should not be done, this is because mucsles in the patients dominant arm will be more developed and in effect there will be greater resistance in the brachial artery in that arm.
Which arm has been used should be written on the patients notes for this reason.
I would be very interested in other peoples views, knowledge and comments on this subject as there is a lack of information and guidance available.

Steve