Oximeter, Blood Flow and Pressure

Measurement Instrument

1
2
 Physiology of respiration
Oxygen/Carbon dioxide interaction: Metabolism

Oxygen -> lungs -> alveoli -> blood Oxygen

breath
CO2 produced by cellular metabolism diffuses across the
CO2 cell membrane into the circulating blood. muscles + organs
lungs
5-10% carried in solution Oxygen
CO2 20-30% bound to haemoglobin
60-70% carried as bicarbonate in the red blood cell
cells
blood energy
Oxygen
+
Glucose
CO2
3
4
Respiratory Monitoring
• Rapid progress with greater safety in Anesthesia field and better ICU outcome.

Main Anesthesia Enemies

5
Blood ➔ RBC ➔ Hemoglobin

6
 Inadequate Oxygen Transport

• Anemia
• Reduces red blood cells reduce oxygen carrying capacity
• Inadequate hemoglobin (Hemoglobin is the protein inside red blood cells. It
carries oxygen. Red blood cells also remove carbon dioxide from your body,
bringing it to the lungs) results in the loss of oxygen saturation
• Poisoning
• Carbon monoxide on-loads on the hemoglobin more readily preventing
oxygen saturation and oxygen carrying capacity
• Shock
• Low blood pressures result in inadequate oxygen carrying capacity

7
Pathophysiology
• Oxygen is exchanged by diffusion from higher concentrations to lower
concentrations
• Most of the oxygen in the arterial blood is carried bound to hemoglobin
• 97% of total oxygen is normally bound to hemoglobin
• 3% of total oxygen is dissolved in the plasma

8
Terminology
• SaO2 : Arterial (invasive)Oxygen Saturation (oxygen bound to the hemoglobin
molecules)
• SpO2 indicates the oxygen bound to hemoglobin
• Non invasive oxygen saturation. SpO2 indicates the saturation was obtained with non-
invasive oximetry
• Closely corresponds to SaO2 measured in laboratory tests
• The key difference between SAO2 and SPO2 is in the type of measurement of O2
levels in the blood. SAO2 or Saturation of Oxygen is the direct measurement of O2
bound to heme protein of hemoglobin in the blood. SPO2 measurement or
oximetric measurement of O2 bound to hemoglobin is an indirect measurement
of saturation of haemoglobin with O2.
• SAO2 and SPO2 are measured during different disease conditions to monitor the
level of available O2 in hemoglobin. The saturation levels of O2 bound to
hemoglobin will provide details regarding the efficiency of the alveolar lung
system.

• PaO2 : Arterial Partial Pressure, oxygen dissolved in the plasma (only about 3% of
total content) or PO2
• CaO2: Total amount of oxygen in the blood or the (SaO2 + PaO2).
9
 Oxygen Saturation
• Percentage of hemoglobin saturated with oxygen
• Normal SpO2 is 95-98%
• 97-100% sat :Good gas exchange .
• 90-95% sat: Mild hypoxia
• <90% sat : Severe hypoxia

• Suspect cellular perfusion compromise if less than 92% SpO2

• Insure adequate airway
• Provide supplemental oxygen
• Monitor carefully for further changes and intervene appropriately

10
Saturation O2

Biomedical Instrumentation Technology and Applications

R. S. Khandpur
2nd Edition
Chapter 10: Oximeters: Page 312

11
 PULSE OXIMETRY: WHAT DOES IT DO?

• MEASURES/DISPLAYS
• O2 SAT OF HbG
• PULSE RATE
• INDICATES PERFUSION
• PULSATE FLOW

12
Various forms of pulse ox’s

13
Pros of Pulse Oximeters
PROS
• Non-invasive
• Allows continuous measurement in real time
• Easy to use

14
Cons of Pulse Oximetry

CONS
• Measures Hb saturation rather than the actual level of Hb. Only
measures oxygenation status.
• Does not detect carbon dioxide levels in the blood. CO2 determines
the ventilation status.
• Measurements are not always accurate. Inaccuracy may occur due
to nail polish, light interference, poor peripheral perfusion,
intravenous dyes, the presence of carboxyhemoglobin and
hemoglobinopathies.

15
Pros/Cons of an arterial blood gas

PROS CONS
• Accurate • Invasive
• The gold standard for • Not easy to perform on a
measuring respiratory status patient
• Does not reflect measurements
in real time status

16
 Photospectrometry

Photospectrometry is a method of using light

emission or absorption to determine the
composition of substances. It generally involves the
use of light emitters and receptors coupled with
signal analyzers.

17
18
Pulse Oximetry
• The pulse oximeter has Light-emitting diodes (LEDs) that produce red and
infrared light
• LEDs and the detector are on opposite sides of the sensor
• Sensor must be place so light passes through a capillary bed
• Requires physiological pulsatile waves to measure saturation
• Requires a pulse or a pulse wave (Adequate CPR)

❑Optical plethysmography: detects pulsatile changes in blood volume

❑Spectrophotometry: measures pulsatile hemoglobin saturation
❑Assumptions
all pulsation is arterial
light passes through pulsatile beds
19
Pulse Oximetry Physics (Beer-Lambert law)

Beer s law:
The concentration of a liquid is
exponentially related to the intensity of
light that will pass through it.
* Lambert s Low:
distance
The of light travelled through the
liquid is exponentially related to the
intensity of light that will pass through it.
Oxygenated hemoglobin absorbs a
different wavelength of light than
does deoxygenated blood

20
 Pulse Oximetry
Beer-Lambert Law
• The combination of both Beer’s Law and Lambert’s Law
• Beer’s Law – the absorption of light is proportional to the concentration
of a sample
• Lambert’s Law – absorption is proportional to the thickness of a sample

Extinction coefficient refers

to several different
measures of the absorption
of light in a medium:
Attenuation coefficient,
sometimes called
"extinction coefficient"

 Extinction Coefficient
21
Characteristics of Common Hb Species

Spectrophotometric
Name Symbol Normal (%) Peak (nM)
Oxy O2Hb 97 530
Reduced RHb <1 585.2
Adult HbA 97 530
Fetal HbF 85 NA
Carboxy COHb 2-5% 594.5
Sulf SulfHb <0.5 618
Meth Methb 1.5% 620

22
ABSORPTION SPECTRA

23
Pulse Oximetry
HEMOGLOBIN ABSORBS LIGHT.
- THE ABSORBED LIGHT VARIES WITH:
* OXYGEN SATURATION
* TYPE OF HEMOGLOBIN
* LENGTH OF THE OPTICAL PATH.
ABSORBENCE CAN BE CALCULATED
* EXTINCTION CO-EFFICIENTS
* OPTICAL DENSITY EQUATIONS
* BEERS-LAMBERT EQUATION

24
Pulse Oximetry
First Principle of operation – 1
Infrared absorption by oxygenated and de-oxygenated
haemoglobin at 2 different wavelengths

Second Principle of operation - 2

The success of pulse oximetry depends on its ability to measure
the saturation of the arterial blood by analysis of infrared
absorption of vascular bed throughout the whole pulsatile pulse
cycle.

Oxygenated blood and deoxygenated blood absorb different light

sources
Oxyhemoglobin absorbs more infrared light
Reduced hemoglobin absorbs more red light
Pulse oximetry reveals arterial saturation by measuring the
difference.

25
Pulse Oximetry

26
Second principle for pulse oximetry

• Light is absorbed by the tissues and

does not vary with the cardiac
cycle
• During the cardiac cycle there is a
small increase in arterial blood
• Light absorption is increased during
this phase.

27
Pulse Oximetry

• 2th -Principle of operation

The variable absorption due to pulse added volume of arterial blood is used to calculate the
saturation of arterial blood
28
 Second principle for Spo2

• What is the amount of light absorbed by

the “peak” of the cardiac cycle

This is the only area that changes with

Wave of blood associated with the pulse

This area remains constant

and therefore irrelevant

29
Pulse Oximetry

30
Pulse Oximetry

The red and infrared LEDs within the probe are driven in
different ways, depending on the manufacturer. Most probes
have a single photodetector (PIN-diode), so the light sources
are generally sequenced on and off. A typical pulsing scheme of
the LEDs is shown in Fig. 10.7. To compensate for ambient light
during the time when both LEDs are off, the light level is
measured and then subtracted from each light channel
between cycles. This minimizes the effects due to
ambient conditions which may vary during monitoring.
Depending on the make and model of pulse oximeters, the
drive currents of LEDs, pulse widths, off and on cycles between
pulses and cycle times can all vary (Ackerman and Weith,
1995).

31
Pulse Oximetry
• Main Limitations of SPo2 :
- Ambient light
- Patient movement or shivering.
- Hypothermia.
- Peripheral shut down.
- Hypovlemia and shock.
- Carbon monoxide poisoning(carboxy HB).
- Other dysfunctional Hemoglobins(met HB).
- Skin pigmentation.
- Dye injection(methylene blue). Elaborated in
subsequent slides…

32
Patient Environments
• Ambient Light
• Excessive Motion

33
Ambient Lighting
• Any external light exposure to capillary bed where sampling is occurring may
result in an erroneous reading
• Most sensors are designed to prevent light from passing through the shell
• Shielding the sensor by covering the extremity is acceptable

34
SOURCES OF ERROR

• Sensitive to motion
• Standard deviation is certified to 4% down to 70% saturation
• Sats below 85% increase the importance of error in the reading
• Calibration is performed by company on normal patients breathing
various gas mixtures, so calibration is certain only down to 80%

35
 Hypothermia

• Severe peripheral vasoconstriction may prevent oximetry detection

• Shivering may result in erroneous oximetry motion
• Pulse rate on oximeter must coincide with palpable pulse rate to be
considered accurate
• Treat the patient according to hypothermic guidelines
and administer oxygen accordingly!

36
 SOURCES OF ERROR

• Skin Pigmentation
• Darker color may make the reading more variable due to optical shunting.
• Dark nail polish has same effect: blue, black, and green polishes
underestimate saturations, while red and purple have no effect
• Hyperbilirubinemia has no effect
• Low perfusion state(hypotension-shock).
• Ambient Light
• Delay in reading of about 10 seconds

37
 SOURCES OF ERROR
• Methylene blue and indigo carmine underestimate the saturation
• Dysfunctional hemoglobin
• Carboxyhgb leads to overestimation of sats because it absorbs at 660nm with an
absorption coefficient nearly identical to oxyhgb
• Methgb can mask the true saturation by absorbing too much light at both 660nm
and 940nm. Saturations are overestimated, but drop no further than 85%, which
occurs when methgb reaches 35%.

38
• Suspect the presence of carboxyhemoglobin in patient with:
• - Smoke inhalation
• - Intentional and accidental CO poisoning
• - Heavy cigarette smoking
Treat carboxyhemoglobin with high flow oxygen irregardless of the
pulse oximetry reading!

39
 SOURCES OF ERROR
• Affect of anemia is debated
• Oxygen-Hemoglobin Dissociation Curve
• Shifts in the curve can affect the reading
• Oximetry reading could correspond to a PaO2 of 60mmHg (90% saturation) or 160mmHg
(99% saturation)

40
• Normal PaO2 is 80-100 mmHg
• Normally
• 80-100 mm Hg corresponds to 95-100% SpO2
• 60 mm Hg corresponds to 90% SpO2
• 40 mm Hg corresponds to 75% SpO2

41
Clarck Electrode

42
Blood Flow Meter
43
 Measurement of Blood Flow & Volume

• Measurement of importance from patient:

• first class of measurement: concentration of O2 and other nutrients in cells → Very difficult to
measure
• Second-class measurement: blood flow and changes in blood volume
→ correlate well with concentration
• Third-class measurement: blood pressure → correlates well with blood flow
• Fourth class measurement: ECG → correlates adequately with blood pressure
• How to make blood flow / volume measurements:
• Standard flow meters, such as turbine flow meters (orifice, venturi etc.), obviously cannot be used!
• Indicator-dilution method: cont./rapid injection, dye dilution, thermo-dilution
• Electromagnetic flowmeters
• Ultrasonic flowmeters / Doppler flowmeters
• Plethysmography: Chamber / electric impedance / photo-plethysmography

44
 Measuring Cardiac Output-Several Methods

• Fick method: the indicator is O2, consumption is measured by a spirometer. The arterial-venous
concentration difference is measure by drawing samples through catheters placed in an artery and in
the pulmonary artery.
• Dye-dilution method: dye is injected into the pulmonary artery and samples are taken from an artery.
• Thermo-dilution method: cold saline is injected into the right atrium and temperature is measured in
the pulmonary artery.
45
 Indicator Dilution
• Indicator Dilution that uses continuous infusion (Indicator – Oxygen)- samples from artery &
Pulmonary artery
• Indicator Dilution method that uses rapid injection
• Dye dilution –indocyanine green – cardio green- dye injected to pulmonary artery – samples from
artery
• Thermo Dilution – cold saline- injected to RA- temp measured in pulmonary artery

• An Indicator I is mixed with the blood with a known injection rate.

• The Concentration C of the indicator is measured after mixing.

• Then the flow,

46
 Indicator Dilution
• When a given quantity of m0 of an indicator is added to a volume V, the resulting concentration C of the
indicator is given by
• C = m0/V

• When an additional quantity m of indicator is then added, the incremental increase in concentration is
• ΔC = m/V

47
Indicator Dilution with Continuous Injection
• Measures flow / cardiac output averaged over several heart beats
Change in [ΔC] due to continuously added indicator m to volume V
dm dt dV dm dt
C = F = =
dV dt dt C
Clinician must add a fixed quantity of indicator in order to maintain a fixed change in concentration

• Fick’s technique: the amount of a substance (O2) taken up by an organ / whole body per unit time is
equal to the arterial level of O2 minus the venous level of O2 times the blood flow ➔
dV dm dt
Blood flow, liters/min F = =
dt C Consumption of O2 (mL/min)
(cardiac output)
dm dt Arterial and venous
=
Ca − Cv concentration of O2
(mL/L of blood) 48
 Indicator – Dilution Curve
• where t1 is the time at which all effects of the first pass
of the bolus have died out (point E).

• The integrated quantity (∫ C(t) dt) ) is equal to the

shaded area in Figure we can obtain it by counting
squares or using a planimeter.

• If the initial concentration of indicator is not zero—as

may be the case when there is residual indicator left
over from previous injections( C(t) - > ∆ C(t) )

49
 Indicator Dilution with Rapid Injection

• A known amount of a substance, such as a dye or radioactive isotope, is injected into the
venous blood and the arterial concentration of the indicator is measured through a series
of measurements until the indicator has completely passed through given volume.
• The cardiac output (blood flow) is amount of indicator injected, divided by average
concentration in arterial blood.

m
F = t
 C (t )dt
0

50
 Fick’s technique
O 2 consumption(mL/ min)
Cardiac Output =
[O 2 ]a − [O 2 ]v
250 mL/ min
• How is dm/dt (O2 consumption) measured?
= = 5 L/ min
190mL / L − 140mL/L
• Where and how would we measure Ca and Cv?
• The blood returning to the heart from the upper half of the body has a different concentration of
O2 from the blood returning from the lower half.
• after it has been mixed by the pumping action of the right ventricle.
• Cv can be measure it in the pulmonary artery

• Ca can be measured in measured in any artery.

• The O2 concentration measured by the Spiro-meter.
• The arterial-venous concentration difference can also be measured by drawing samples through
catheters placed in an artery and in the pulmonary artery.

51
Fick’s Technique to measure blood flow from the heart

Fick’s Technique - Advantage

• The Fick technique is nontoxic, because the indicator (O2) is a normal metabolite that is partially
removed as blood passes through the systemic capillaries.
• The cardiac output must be constant over several minutes so that the investigator can obtain the
slope of the curve for O2 consumption.
• The presence of the catheter causes a negligible change in cardiac output.
52
Indicator Dilution with Rapid Injection – Dilution Curve

After the bolus is injected at time A, there is a transportation delay before the concentration begins rising at time
B. After the peak is passed, the curve enters an exponential decay region between C and D, which would continue
decaying alone the dotted curve to t1 if there were no recirculation. However, recirculation causes a second peak
at E before the indicator becomes thoroughly mixed in the blood at F. The dashed curve indicates the rapid
recirculation that occurs when there is a hole between the left and right sides of the heart.
53
 Indicator – Dilution Curve
• Bolus is injected at time A
• There is a transportation delay before the concentration begins rising at time B.
• After the peak is passed, the curve enters an exponential decay region between C and D,
which would continue decaying along the dotted curve to t1 if there were no recirculation.
• Recirculation causes a second peak at E before the indicator becomes thoroughly mixed in
the blood at F.
• The dashed curve indicates the rapid recirculation that occurs when there is a hole
between the left and right sides of the heart.
• An increment of blood of volume dV passes the sampling site in time dt.
• quantity of indicator dm contained in dV is the concentration C(t) times incremental
volume.
• Hence dm =C(t) dV . Dividing by dt, we obtain (dm/dt)= C(t) (dV/dt)
• dm= Fi C(t) dt
54
An Example

55
Dye Dilution
• A common method of clinically measuring cardiac output is to use a
• colored dye, indocyanine green (cardiogreen).
• It meets the necessary requirements for an indicator
• The dye is available as a liquid that is diluted in isotonic saline and injected directly through a
catheter, usually into the pulmonary artery.
• About 50% of the dye is excreted by the kidneys in the first 10 min, so repeat determinations are
possible.

• The plot of the curve for concentration versus time is obtained from a constant-flow pump, which
draws blood from a catheter placed in the femoral or brachial artery.

• Blood is drawn through a colorimeter cuvette which continuously measures the concentration of
dye, using the principle of absorption photometry.

56
 Thermo-dilution
• The indicator is cold – saline, injected into the right atrium using a catheter
• Temperature change in the blood is measured in the pulmonary artery using a thermistor
• The temperature change is inversely proportional to the amount of blood flowing through the
pulmonary artery

57
 Electromagnetic Flowmeters

• Based on Faraday’s law of induction that a conductor that moves through a uniform magnetic field,
or a stationary conductor placed in a varying magnetic field generates emf on the conductor:

When blood flows in the vessel with velocity u and passes

through the magnetic field B, the induced emf e measured
at the electrodes is.

L
e=  u  B  dL
0

For uniform B and uniform velocity profile u, the

induced emf is e=BLu. Flow can be obtained by
multiplying the blood velocity u with the vessel cross
section A.
58
Electromagnetic Flow Meters

59
Principle of Electromagnetic Blood Flow Meters

• A permanent magnet or electromagnet

positioned around the blood vessel
generates a magnetic field perpendicular to
the direction of the flow of the blood.

• Voltage induced in the moving blood column

is measured with stationary electrodes
located on opposite sides of the blood vessel
and perpendicular to the direction of the
magnetic field.

• This method requires that the blood vessel

be exposed so that the flow head or the
measuring probe can be put across it.

60
Electromagnetic Flowmeter Probes

• Comes in 1 mm increments for 1 ~ 24 mm

diameter blood vessels
• Individual probes cost $500 each Made to fit
snuggly to the vessel during diastole
• Only used with arteries, not veins, as
collapsed veins during diastole lose contact with
the electrodes
• Needless to say, this is an INVASIVE
measurement!!!
• A major advantage is that it can measure
instantaneous blood flow, not just average flow

61
Electromagnetic Flow Meters

62
Electro-magnetic Flowmeter: Issues

63
Types of Electromagnetic Blood Flow Meters
• DC Flow meters
• Use DC Magnetic field.
• Cause electrode polarization and amplifier drift.
• o/p same as ECG
• Poor SNR
• AC Flow meters
• Electromagnets are driven by alternating currents.
• The transducer acts like a Transformer and induces error voltages that often exceed the signal
levels by several orders of magnitude.

64
 Electromagnetic AC flow meters

• Error recovery is achieved by using several different waveforms for magnet current

• Sine, Square, Trapezoidal.

• Suitable balancing circuits are used to balance out the error voltage.

65
Thermal Convection

66
Thermal Convection

67
Thermal Convection

68
 Ultrasonic Flowmeters
• Based on the principle of measuring the time it takes for an acoustic wave launched from a
transducer to bounce off red blood cells and reflect back to the receiver.

• All UT transducers, whether used for flowmeter or other applications, invariably consists of
a piezoelectric material, which generates an acoustic (mechanical) wave when excited by an
electrical force (the converse is also true)

• UT transducers are typically used with a gel that fills the air gaps between the transducer
and the object examined

69
Ultrasonic Flowmeters

70
Ultrasonic Flowmeters

71
Ultrasonic Flowmeters

72
 Near / Far Fields
• Due to finite diameters, UT transducers produce diffraction patterns, just like an aperture does in optics.
• This creates near and far fields of the UT transducer, in which the acoustic wave exhibit different
properties
• The near field extends about dnf=D2/4λ, where D is the transducer diameter and λ is the wavelength.
During this region, the beam is mostly cylindrical (with little spreading), however with non-uniform
intensity.
• In the far field, the beam diverges with an angle sinθ=1.2 λ/D, but the intensity uniformly
attenuates proportional to the square of the distance from the transducer

Higher frequencies and larger

transducers should be used for near
field operation. Typical operating
frequency is 2 ~ 10 MHz.

73
UT Flowmeters

Zero-crossing
detector / LPF

Determine
direction

High acoustic
impedance material

74
Transit time flowmeters
Effective velocity of sound in blood: velocity of sound (c) + velocity of flow of blood averaged along the
path of the ultrasound (û)

û=1.33ū for laminar flow, û=1.07ū for turbulent flow ū: velocity of blood averaged over the cross
sectional area, this is different than û because the UT path is along a single line not over an averaged of
cross sectional area

Transit time in up/down stream direction:

distance D
t= =
conduction velocity c  uˆ cos

Difference between upstream and downstream directions

2 Duˆ cos 2 Duˆ cos

t = 
(c − uˆ cos  )
2 2 2
c2
75
Transit Time Flowmeters

The quantity ∆T is typically very small and very difficult to

measure, particularly in the presence of noise. Therefore
phase detection techniques are usually employed rather then
measuring actual timing.

76
 Doppler Flowmeters

• The Doppler effect describes the change in the frequency of a received signal , with respect
to that of the transmitted signal, when it is bounced off of a moving object.
• Doppler frequency shift

Source signal Speed of blood flow

frequency (~150 cm/s)
Angle between UT beam
2 f o u cos and flow of blood
fd =
c

Speed of sound in blood

(~1500 m/s)
77
Doppler Flowmeters

u
F =  f s (cos + cos  )
c
78
Doppler Flowmeters

79
Problems Associated with Doppler Flowmeters

• There are two major issues with Doppler flowmeters

• Unlike what the equations may suggest, obtaining direction information is not easy due to very
small changes in frequency shift that when not in baseband, removing the carrier signal without
affecting the shift frequency becomes very difficult

• Also unlike what the equation may suggest, the Doppler shift is not a single frequency, but
rather a band of frequencies because
• Not all cells are moving at the same velocity (velocity profile is not uniform)
• A cell remains within the UT beam for a very short period of time; the obtained signal needs
to be gated, creating side lobes in the frequency shift
• Acoustic energy traveling within the beam, but at an angle from the bam axis create an
effective ∆θ, causing variations in Doppler shift
• Tumbling and collision of cells cause various Doppler shifts

80
Directional Doppler
• Directional Doppler borrows the quadrature phase detector technique from radar in determining
the speed and direction of an aircraft.

• Two carrier signals at 90º phase shift are used instead of a single carrier. The +/- phase difference
between these carriers after the signal is bounced off of the blood cells indicate the direction,
whereas the change in frequency indicate the flowrate

81
Blood Pressure and Heart Sound Measurement
Instrument

82
• What is blood pressure and how is it measured?
• The heart supplies the organs and tissues of the body with blood. With every beat, it pumps blood into the
large blood vessels of the circulatory system. As the blood moves around the body, it puts pressure on the
walls of the vessels. Blood pressure readings are made up of two values:
• Systolic blood pressure is the pressure when the heart beats – while the heart muscle is contracting
(squeezing) and pumping oxygen-rich blood into the blood vessels.
• Diastolic blood pressure is the pressure on the blood vessels when the heart muscle relaxes. The diastolic
pressure is always lower than the systolic pressure.
• Blood pressure is measured in units of millimeters of mercury (mmHg). The readings are always given in pairs,
with the upper (systolic) value first, followed by the lower (diastolic) value.
• So someone who has a reading of 132/88 mmHg (often spoken “132 over 88”) has a
• systolic blood pressure of 132 mmHg, and a
• diastolic blood pressure of 88 mmHg.

83
• High blood pressure itself usually goes unnoticed. Only if it is extremely high
can it sometimes result in symptoms like dizziness or trouble seeing. Over the
long term, high blood pressure increases your risk of cardiovascular problems
like heart attacks, strokes, and heart and kidney failure. So if you or your
doctor think you have high blood pressure, it's important to have your blood
pressure checked regularly. If the readings are repeatedly too high, there are
several different ways of lowering your blood pressure and decreasing the risk
of long-term health consequences.

84
• Blood circulation: to transport oxygen
and other nutrients to the tissues and
carry metabolic waste products away
from cells
• Blood pressure measurement: to
determine the functional integrity of
the cardiovascular system
• Sound: fluctuations in pressure
recorded over audio frequency,
vibration due to acceleration and
deceleration of blood

85
Pressure at different regions around heart

86
 Measurement of blood pressure
• Invasive
• Pressure catheter and transducer
• Non invasive
• Sphygmomanometry
• Auscultation (by ear or automatically by microphone)
• Oscillometry
• Volume clamp: Continuous non-invasive BP monitoring. at the finger with an inflatable cuff combined
with a photodiode. The diameter of the artery in the finger is measured by the photodiode; the pressure
in the cuff is adjusted to keep the diameter of the artery constant. From the pressure changes in the cuff,
a BP curve can be calculated and transferred to correspond to brachial artery BP
• Tonometry (arterial applanation tonometry) : Continuous non-invasive BP monitoring. A transducer
strapped to an artery with a bone underneath, can obtain the arterial pulse wave. The technique has
been refined and now is able to assess mean arterial pressure in the radial artery and allows the
calculation of diastolic and systolic arterial pressure

87
 Measurement of blood pressure
Advantages/ drawbacks

• Invasive
• Accurate reproduction of central pressure waveforms
• Risk of thrombosis and arrhythmias

• Non-invasive
• Quick, cheap, widely used
• Lack of central pressure measurement
• Requires skilled and experienced operators

88
BP measurement
• According to the location of the sensor element there are two general
categories:
• Extravascular sensor:
• The most common clinical method for directly measuring pressure is to couple the
vascular pressure to an external sensor element via a liquid filled catheter.
• Intravascular sensor:
• In the second category the liquid coupling is eliminated by incorporating the sensor into
the tip of a catheter that is placed in the vascular system.

89
Different sensors for BP measurement
• Strain gauge
• Linear variable differential transformer
• Variable inductance
• Variable capacitance
• Optoelectronic
• Piezoelectric
• Semiconductor devices

90
 Measurement of blood pressure: Direct Method

• Extravascular Sensors: Vascular pressure is connected to the sensor via a liquid filled
catheter.

Blood pressure transmitted through

the catheter liquid to the sensor

• Diaphragm type pressure sensor

• Deflection gives the indication
• Strain gauge may be used
91
 Intravascular sensors
• Intravascular sensors: Sensor is mounted on the tip of the catheter and placed inside the vascular system.
• Sensor Elements: Strain gauge, LVDT, Capacitive, piezoelectric, fibre-optic etc.
• Bandwidth requirement for Blood pressure measurement: 20Hz… up to 10th harmonic if heart rate is 2 Hz …120 bpm

92
Extravascular sensors
• Catheter-sensor system:
liquid-filled catheter (saline-
heparin), three-way
stopcock, pressure sensor
(usually Si diaphragm with
piezoresistive sensor), flush
solution

93
Extravascular sensors
• The physician inserts the
catheter either by means of a
surgical cut down which
exposes the artery or vein or
by means of percutaneous
insertion which involves the
use of a special needle or
guide wire techniques.
• Blood pressure is transmitted
via the catheter liquid column
to the sensor and finally to
the diaphragm which is
deflected.
94
Extravascular sensors
• Limitation of Catheter-sensor system :
• The frequency response of the catheter sensor system is limited by the hydraulic
property of the system.
• Catheter insertion: surgical cut-down or percutaneous insertion

• Catheter tip sensors

• Catheter tip sensors have the advantage that the hydraulic connection via the catheter
between the source of pressure and the sensor element is eliminated.
• Detection of pressure at the tip of the catheter without the use of a liquid coupling
system can does enable the physician to obtain a high frequency response and
eliminate the time delay encountered when the pressure pulse is transmitted in a
catheter sensor system.

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Intravascular sensors
• Catheter tip sensors
• Sensors used at the Catheter tip:
• Strain-gage systems bonded onto a flexible diaphragm at the catheter tip.
• Catheter-tip micropressure sensor (micro silicone pressure sensor chips): Si
diaphragm and piezoelectric strain gage

• Disadvantages:
• More expensive than other
• may break after only a few uses, further increase its cost

• Fiber-optic intravascular pressure sensor: optical measurement of

diaphragm deflection, electrical safe, and usually cheaper
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Intravascular sensors
Fiber-optic intravascular pressure sensor
• Pressure sensor tip consists of a thin metal membrane mounted at the common end of the
mixed fiber bundle.
• External pressure -> membrane deflection -> Varying the coupling between the LED source
and the photo-detector

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Auscultatory method
• What is the Auscultatory method of measuring blood pressure?
• When measuring blood pressure using the auscultation method, turbulent
blood flow will occur when the cuff pressure is greater than the diastolic
pressure and less than the systolic pressure. The "tapping" sounds associated
with the turbulent flow are known as Korotkoff sounds.

• Auscultatory method: Keep the bell of stethoscope over the brachial artery
and inflate blood pressure cuff to a level higher than the systolic pressure
determined by the palpatory method. Steadily deflate. Record systolic and
diastolic pressures based on the Korotkoff sounds.

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 Auscultatory method
• Select an appropriate size cuff. The bladder in the cuff should encircle at least half of the arm. You have to use a
larger cuff in obese patients. Identify systolic blood pressure by palpatory method.
• Palpatory method:
• Empty air from the cuff and apply the cuff firmly around the patient's arm.
• Feel the radial pulse.
• Inflate the cuff until the radial pulse disappears.
• Inflate 30-40 mm over and release slowly until the pulse returns. That denotes systolic pressure.
• Diastolic blood pressure cannot be obtained by this method.
• Identification of systolic blood pressure by palpatory method helps one to avoid a lower systolic reading by
auscultatory method if there is an auscultatory gap.
• It also minimizes the discomfort of over inflating the bladder of the cuff.
• Auscultatory method:
• Keep the bell of stethoscope over the brachial artery and inflate blood pressure cuff to a level higher than
the systolic pressure determined by the palpatory method. Steadily deflate.
• Record systolic and diastolic pressures based on the Korotkoff sounds.

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 Sphygmomanometer Manometer
(mercury or capsule type)

A sphygmomanometer is used for auscultation.

d
Pulse detector
d + 20% (stethoscope or microphone)

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 Sphygmomanometer
• Occlusive cuff is inflated above the systolic pressure, then slowly bleed off.
• If cuff pressure is higher, no blood flow, no sound.
• When cuff pressure is slightly lower, blood spurts under the cuff.
• A palpable pulse in the wrist, a stethoscope is placed over brachial artery.
• Audible sound (Korotkoff sound) in stethoscope due to blood flow and vibrations.
• First detection pressure is systolic pressure.
• As the pressure of cuff continues to drop, at a certain pressure below which Korotkoff sounds
disappear….this is diastolic pressure.

• Automated Sphygmomanometer
– Microphone replaces stethoscope
– Korotkoff sound is detected by microphone
– Cycle start with rapid inflation of the cuff, 30mmHg higher than the expected systolic pressure.
– Systolic pressure noted when first Korotkoff sound heard, diastolic pressure noted when no sound.
– Automatically repeats the cycle.
– Block diagram available in Cromwell….(important)

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Oscillometric Method

Measures the amplitude of oscillation in the cuff pressure

created by expansion of the arterial wall each time blood is
forced to pass through the artery
• Measures the mean arterial pressure
when oscillation reaches max amplitude.
• Diastolic pressure can not be found as there
is no specific transition of oscillation

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Oscillometric Method

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Components of Oscillometric instrument

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• http://www.meddean.luc.edu/lumen/meded/medicine/pulmonar/pd/pstep6.
htm
• https://www.ncbi.nlm.nih.gov/books/NBK279251/
• VVIMP: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3639494/

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