STANDARD OPERATING PROCEDURE ARTSANA MERCURY SPHYGMOMANOMETER

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2 1. Scope This Standard Operating Procedure (SOP) applies to the staff and students using the Artsana Mercury Sphygmomanometer in the Pharmacy Practice Resource Unit (PPRU) at the Pharmacy Department, University of Malta. 2. Objective To describe the procedure for the operation and maintenance of the Artsana Mercury Sphygmomanometer. 3. Definitions 3.1. Blocking Lever: A safety valve that prevents the mercury from being released out of its storage reservoir during device transportation Diastolic Blood Pressure (DBP): Minimum pressure in the arteries when the heart is at rest Mercury Sphygmomanometer: A device used to measure BP. It consists of an inflatable cuff, a hand bulb with a deflator valve and a mercury column to display the obtained BP readings Systolic Blood Pressure (SBP): Maximum pressure being exerted when the heart is contracting. 4. Responsibility 4.1. The members of the Department of Pharmacy (staff and students) are responsible for following this SOP The designated Laboratory Officer or Laboratory Assistant is responsible for ensuring that this SOP is followed. 5. Procedure 5.1. Operation Open the lid of the device and set it in the proper upright position Push the blocking lever to the On position and wait for the mercury level to settle at Place the inflatable cuff 1-2cm above the bend of the elbow on the bare left/right upper arm. Page 2 of 8

3 Close the cuff around the arm Check that two fingers can still be inserted between the arm and the cuff Position the cuff marking on the artery Instruct the patient to lay his or her arm on a table with palm turned upwards and to keep still during the measurement Place the stethoscope chest piece below the cuff so that the membrane of the chest piece is resting against the inside of the bicep, where the artery is located (refer to SOP/PD/203_02) Hold the bulb with its tubing facing upwards Check that the deflating valve on the bulb is tightly closed by rotating it clockwise Squeeze the hand bulb until the cuff pressure is mmhg higher than the maximum expected BP Slowly start opening the deflator valve by rotating it anti-clockwise to allow air to escape uniformly at a rate of approximately 2-3 mmhg per second Record the level of the mercury column when the first rhythmical thumping sound is heard. This corresponds to the SBP Record the level of the mercury column when the thumping sound stops. This corresponds to the DBP Open the deflating valve completely to deflate the cuff Tilt the device about 45 o to the right to allow the mercury to flow back into its storage reservoir Push the blocking lever to the Off position Securely close the lid of the device Maintenance Clean the device with a clean soft cloth Contact an authorised supplier if the glass column blackens Contact an authorised supplier if the meniscus of the mercury lies either above or below the zero mark after allowing the device sufficient time to stabilise Service the device every 2 years by an authorised supplier. Page 3 of 8

4 5.3. Flow Charts Operation Start Open lid of device and set it in the proper upright position Push blocking lever to the On position and wait for mercury level to settle at 0 Place inflatable cuff 1-2cm above bend of elbow on bare left/right upper arm Close cuff around arm Check that two fingers can still be inserted between arm and cuff Position cuff marking on artery Instruct patient to lay his or her arm on a table with palm turned upwards and to keep still during measurement Place stethoscope chest piece below cuff so that membrane of chest piece is resting against inside of bicep, where artery is located (refer to SOP/PD/203_02) Hold bulb with tubing facing upwards Check that deflating valve on bulb is tightly closed by rotating it clockwise Squeeze hand bulb until cuff pressure is mmhg higher than the maximum expected BP 1 Page 4 of 8

5 1 Slowly start opening deflator valve by rotating anti-clockwise to allow air to escape uniformly at a rate of approx. 2-3 mmhg per second Record level of mercury column when first rhythmical thumping sound is heard. This corresponds to SBP. Record level of mercury column when thumping sound stops. This corresponds to DBP. Open deflating valve completely to deflate cuff Tilt device about 45 o to the right to allow mercury to flow back into its reservoir Push blocking lever to Off position Securely close lid of device End Page 5 of 8

6 Maintenance Start Clean device with a clean soft cloth Glass column blackened No Mercury meniscus lying above or below zero mark after allowing device sufficient time to stabilise No Yes Yes Contact an authorised supplier Service the device every 2 years by an authorised supplier End Page 6 of 8

7 6. Precautions 6.1. Medical Device Do not inflate the cuff by more than 300 mmhg since this can cause a mercury spillage When storing the device, always place the bulb with its metal deflator valve in the right case compartment to prevent accidental breakage of the glass column Avoid damaging the rubber tubings with sharp, cutting objects Do not expose the device to extremes of temperature Always store the device at a temperature range of 10 o C to 40 o C Do not use any chemical products to clean the device Do not scrub, machine wash, iron or dry clean the cuff In the case of a mercury spillage: Ventilate room to prevent inhalation of mercury vapours Wear appropriate latex gloves to handle the broken material Gather all the spilled mercury droplets, transfer them to a glass container, close tightly and dispose off as hazardous waste Accurate Measurement Ensure that the correct cuff size is being used to obtain precise BP readings Ensure that the patient is relaxed, still and is not speaking when measurement is being taken Wait for 5 minutes until the pulse rate returns to normal, if the patient had been active, before taking readings Ensure that the patient is sitting down and that the cuff is positioned at heart level when taking readings Ensure that the measurements are performed on a bare arm, as circulation could be restricted Ensure that the cuff is not too tight or too loose fitting as inaccurate readings may result Wait 3-4 minutes between successive readings Ensure that the membrane of the chest piece is placed on the artery. Page 7 of 8

8 7. Reference Artsana S.p.A. Artsana Mercury Sphygmomanometer. Grandate: Artsana. 8. Appendices N/A 9. Revision History Version Number Amendments/ Reasons for change 01 Initial Release 02 Inclusion of subheading titles of Procedure section in Table of Contents Page 8 of 8