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Contents
Non-Invasive
Blood Pressure
Blood Flow Ultrasound Doppler Laser Doppler Flowmetry Strain Gage Plethysmography Electric-Impedance Plethysmogr. Photoelectric Plethysmography Thermal Convection Probes
Palpatory Method
(Riva-Rocci Method)
Invasive
Observation of blood pressure allows dynamic tracking of pathology and physiology affecting to the cardiovascular system, which has profound effects to all other organs of the body Originates from the heart Commonly refers to arterial blood pressure Value depends on 3 factors: cardiac output diameter of arteries the quantity of blood peripheral resistance
General Facts
Indirect measurement = non-invasive measurement Brachial artery is the most common measurement site Close to heart Convenient measurement Other sites are e.g.: forearm / radial artery wrist (tends to give much higher SP) The most common indirect methods are auscultation and oscillometry
Palpatory Method
Method)
When the cuff is deflated, there is a palpable pulse in the wrist. Pcuff = BP Several measurements should be done as the respiration and vasomotor waves modulate the blood pressure levels ADVANTAGES
(Riva-Rocci
+) The blood pressure can be measured in noisy environment too +) Technique does not require much equipment DISADVANTAGES -) Only the systolic pressure can be measured (not DP) -) The technique does not give accurate results for infants and hypotensive patients
Auscultatory Method
Pulse waves that propagate through the brachial artery, generate Korotkoff sounds. There are 5 distinct phases in the Korotkoff sounds, which define SP and DP The Korotkoff sounds are ausculted with a stethoscope or microphone (automatic measurement) The frequency range is 20-300 Hz and the accuracy is +/- 2mmHg (SP) and +/- 4mmHg (DP)
-) The observations do not always correspond with intra-arterial pressure -) The technique does not give accurate results for infants and hypotensive patients
Ultrasonic Method
A transcutaneous (through the skin) Doppler sensor is applied here. The motion of blood-vessel walls in various states of occlusion is measured. The vessel opens and closes with each heartbeat when DP < Pcuff < SP The frequency difference between transmitted (8 MHz) and received signal is 40-500 Hz and it is proportional to velocities of the wall motion and the blood.
Oscillometric Method
The intra-arterial pulsation is transmitted via cuff to transducer (e.g. piezo-electric) The cuff pressure is deflated either linearly or stepwise The arterial pressure oscillations
(which can be detected throughout the measurement i.e. when P > SP and cuff Pcuff< DP) are superimposed on the
cuff pressure
http://colin-europe.com/docpdfdemos/oscillo0104.wmv
SP and DP are estimated from the amplitudes of the oscillation by using a (proprietary) empirical algorithm.
Tonometry
Linear array of pressure sensors is pressed against a superficial artery, which is supported from below by a bone (radial artery). A sensor array is used here, because at least one of the pressure sensors must lay directly above the artery When the blood vessel is partly collapsed, the surrounding pressure equals the artery pressure. The pressure is increased continuously and the measurements are made when the artery is half collapsed The hold-down pressure varies between individuals and therefore a calibration must be done
Tonometry (cont.)
ADVANTAGES +) Can be used for non-invasive, non-painful, continuous measurement DISADVANTAGES -) Relatively high cost -) The wrist movement and tendons result in measurement inaccuracies
General Facts
Direct measurement = Invasive measurement A vessel is punctured and a catheter (a flexible tube) is guided in The most common sites are brachial and radial arteries but also other sites can be used e.g. femoral artery A division is made into extravascular and intravascular sensor systems This method is precise but it is also a complex procedure involving many risks.
Used only when essential to determine the blood pressure continuously and accurately in dynamic circumstances
Extravascular Sensor
The normal measuring system The sensor is located behind the catheter and the vascular pressure is transmitted via this liquid-filled catheter. The actual pressure sensor can be e.g. strain gage variable inductance variable capacitance optoelectronic piezoelectric, etc
too narrow catheter too long tubing various narrow connections air bubbles in the catheter
Cs
The catheter-sensor system must be flushed with saline-heparine solution every few minutes in order to prevent blood from clotting at the tip.
Normally the interesting frequency range is 0 100 Hz. If only MP is measured the bandwidth is 20 Hz (harmonics > 10 are ignored)
Intravascular Sensor
The sensor is located in the tip of the catheter. This way the hydraulic connection is replaced with an electrical or optical connection The dispacement of the diaphragm is measured +) The frequency response is not limited by the hydraulic properties of the system. No time delay. +) Electrical safety and isolation when using fiber optics -) Breaks easily -) More expensive
Disposable Sensors
Disposable sensors decrease the risk of patient cross-contamination and reduce the amount of handling by hospital personnel Cheaper and more reliable than reusable pressure sensors
Blood Flow
O2 and other nutrition concentration in the cells are one of the primary measurements. Blood flow helps to understand basic physiological processes and e.g. the dissolution of a medicine into the body. It also helps to understand many pathological conditions, since many diseases alter the blood flow. Also the blood clots in the arterial system can be detected. Usually the blood flow measurements are more invasive than blood pressure measurements / ECG
Normal blood flow velocity 0,5 m/s 1 m/s (Systolic, large vessel)
In the recent years ultrasound contrast agents have been used in order to increase the echoes.
v fd = 2 fc c
f c = 2 10 MHz c = 1500 - 1600 m/s (1540 m/s)
The ultrasound beam is focused by a suitable transducer geometry and a lens f d = 1,3 13 kHz
In order to know where along the beam the blood flow data is colledted, a pulsed Doppler must be used
The flow velocity is obtained from the spectral estimation of the received Doppler signal
CW DOPPLER
No minimum range
PULSED DOPPLER
Accuracy No minimum flow
Minimum range
the resolution and SNR are related to the pulse duration. Improving either one of the parameters always affects inversely to the other
F=
[ C ( t ) ] dt
t1 0
1% peak C
F=
b cb Tb ( t ) dt
t1 1
An artery puncture is not needed in this technique Several measurements can be done in relatively short time A standard technique for measuring cardiac output in critically ill patients
If only a segment of limb is measured, there is a need for arterial occlusion cuff also.
Chamber plethysmograph is the only accurate non-invasive way to measure changes in the blood volume
L2 Vol = 2 Z Z0
The accuracy is often poor or unknown
The blood flow modulates the attenuated / reflected light which is recorded. The light that is transmitted / reflected is collected with a photodetector
Radioisotopes
A rapidly diffusing, inert radioisotope of lipid-soluble gas (133 Xe or 85 Kr) is injected into the tissue or passively diffused
The elimination of the radioisotope from microcirculatory bed is related to the blood flow:
C (t ) = C 0 exp( kt )
k = ln 2 / t1 / 2
This is one of the earliest techniques for blood flow measurements The rate of heat removal from the tissue under probe is measured
The method is not very common due extreme nonlinear properties and difficulties in practical use (e.g. variable thermal characteristics of skin)
Summary (1)
BLOOD PRESSURE
Describes the physiology and pathology of cardiocvascular system Normal values are 120 / 80 mmHg High values may lead to heart attack and strokes Low values may lead to low oxygen perfusion Almost all indirect methods rely on an occlusive cuff which is placed on the bracial artery. The actual measurement is done when the cuff is deflated All direct methods require skin punctuation and a use of catheter. Methods are used only when continuous and accurate measurements are needed.
Summary (2)
BLOOD FLOW
Usually more invasive methods are used than with blood pressure measurements Used for understanding physiological processes (e.g. medicine dissolution). Also used for locating clots in arteries Normal velocity is 0,5 - 1 m/s Indirect measurements are done by using ultrasound or plethysmographic method Direct measurements are done by dilution methods (dye / thermal)