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The mercury sphygmomanometer should be abandoned before it is proscribed
N D Markandu1, F Whitcher, A Arnold
1Blood Pressure Unit, Department of Medicine, St George's Hospital Medical School, London SW17 ORE, UK.
Insights
Mercury sphygmomanometers used for blood pressure measurement are often inaccurate due to poor maintenance and lack of staff expertise. Replacing these devices with validated automatic ones is crucial for accurate readings and patient safety.
Area of Science:
- Cardiovascular Medicine
- Medical Devices
- Environmental Health
Background:
- Blood pressure measurement is vital for predicting life expectancy and managing cardiovascular health.
- Accurate blood pressure monitoring is essential for effective treatment of hypertension, reducing risks of stroke, heart attack, and heart failure.
- Mercury sphygmomanometers remain widely used in clinical practice and research despite concerns.
Purpose of the Study:
- To assess the accuracy and maintenance of mercury sphygmomanometers in a large teaching hospital.
- To evaluate the technical proficiency of healthcare professionals in using the auscultatory method for blood pressure measurement.
- To advocate for the replacement of mercury sphygmomanometers with validated automatic devices.
Main Methods:
- Examination of nearly 500 mercury sphygmomanometers and associated cuffs for accuracy.
- Assessment of medical and nursing staff's knowledge of the auscultatory blood pressure measurement technique.
- Review of environmental concerns related to mercury as a pollutant.
Main Results:
- Over 50% of examined mercury sphygmomanometers exhibited significant inaccuracies.
- A considerable lack of technical knowledge regarding blood pressure measurement was observed among healthcare staff.
- Mercury sphygmomanometers are prone to measurement and observer errors, compounded by inadequate maintenance and expertise.
Conclusions:
- Inaccurate blood pressure measurements due to faulty mercury sphygmomanometers and insufficient staff training pose serious health risks.
- The environmental hazard of mercury further supports the discontinuation of its use in blood pressure devices.
- Validated automatic blood pressure devices should be adopted, alongside comprehensive training for healthcare professionals on accurate measurement techniques.
Abstract:
Both in clinical practice and medical research, blood pressure is still largely measured by auscultation using a mercury sphygmomanometer. Blood pressure is the most important predictor of life expectancy. Treatment of high blood pressure reduces strokes, heart attack and heart failure. Accurate measurement is therefore essential. At a large London teaching hospital, just under 500 mercury sphygmomanometers and their associated cuffs were examined. More than half had serious problems that would have rendered them inaccurate in measuring blood pressure. At the same time, assessment of the technical knowledge needed to measure blood pressure by the ausculatory technique was also carried out amongst medical and nursing staff. This showed a considerable level of ignorance. These results inevitably lead to inaccurate measurement of blood pressure with serious consequences. In addition mercury is a non-degradable pollutant, eventually accumulating on the sea bed. The use of mercury in sphygmomanometers is already in the process of being eliminated in Scandinavia and Holland and other countries are likely to follow. Our results suggest that mercury sphygmomanometers are not adequately maintained and require expertise that is not available for accurate measurement of blood pressure. Their use should be dispensed with on these grounds before a ban for other and, perhaps less justifiable reasons. Validated automatic devices, which are less liable to measurement and observer error should be used instead. At the same time a concerted effort is needed to instruct health care professionals on the importance of more accurate measurement of blood pressure. Journal of Human Hypertension (2000) 14, 31-36.