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Noninvasive blood-pressure measurement device and pulse oximeter are important for patient monitoring. When these are placed on the same side, cuff inflation sometimes causes measurement failure by pulse oximeter.The present study aimed to compare the pulse oximeter alarm frequency and pulse-wave disappearance duration between noninvasive blood-pressure measurement using the deflation method and that using the linear inflation method.The study included 10 healthy subjects. The cuff for automatic sphygmomanometer was wrapped on one side of the upper arm and for pulse oximeter was attached to the thumb of the same side of upper limbs.The alarm frequency was 0 and 26% using the linear inflation and the deflation methods, respectively. Additionally, the pulse-wave disappearance duration was significantly longer using the deflation method than that using the linear inflation method (10.0 ± 1.5 vs 1.7 ± 0.8 s). With the linear inflation method, this duration was or less 3 s. In the deflation method, an excess pressure of 40 mmHg was used, which caused the alarm to turn on. Additionally, the heart rate was found to influence the alarm occurrence during measurement using the deflation method.Heart rate may influence alarm occurrence during blood-pressure measurement using the step deflation method. Using the linear inflation method, the risks of alarm occurrence and measurement failure are low, even when the pulse oximeter and blood-pressure measurement cuffs are installed on the same side, suggesting that this method is suitable for clinical use.

Background Total hemoglobin (tHb) measurement is indispensable for determining the patient’s condition (hemorrhagic vs. ischemic) and need for blood transfusion. Conductivity- and absorbance-based measurement methods are used for blood gas analysis of tHb. For conductivity-based measurement, tHb is calculated after converting blood conductivity into a hematocrit value, whereas absorbance measurement is based on light absorbance after red blood cell hemolysis. Due to changes in plasma electrolytes and hemolysis, there is a possibility that conductivity- and absorbance-based measurement methods may cause a difference in tHb. Methods In this study, test samples with controlled electrolyte changes and hemolysis were created by adding sodium chloride, distilled water or hemolytic blood to blood samples collected from healthy volunteers, and tHb values were compared between both methods. Results Conductivity-based measurement revealed reduced tHb value (from 15.49 to 13.05 g/dl) following the addition of 10% sodium chloride, which was also reduced by the addition of hemolysate. Conversely, the addition of distilled water significantly increased tHb value than the expected value. In the absorbance method, there was no significant change in tHb value due to electrolyte change or hemolysis. Conclusions We have to recognize unexpected conductivity changes occur at all times when tHb is measured via conductivity- and absorbance-based measurement methods. The absorbance method should be used when measuring tHb in patients with expected blood conductivity changes. However, when using this method, the added contribution of hemoglobin from hemolytic erythrocytes lacking oxygen carrying capacity must be considered. We recognize that discrepancy can occur between conductivity- and absorbance-based measurement methods when tHb is measured.

Introduction: There are many reports that show remote monitoring system is useful. We succeeded in early discovery of shock lead dislocation of implantable cardioverter defibrillators (ICDs) by remote monitoring system. Case Report: 58 years old male presented with heart failure, non-sustained ventricular tachycardia (nsVT) and paroxysmal atrial fibrillation. Ejection Fraction was 25% by echocardiography, and Electrocardiograph shows nsVT repeatedly. There was an indication of ICDs implantation. A single lead VVI-ICD (Lumax540VR-T Biotronik, Germany) was implanted using a pentapolarand screw-in fixation lead (Linox Smart SD 65/18, Biotronik). Intraoperative pacing threshold was 0.4 V at 0.5 ms, pacing lead impedance 664 Ω, R wave potential 12 mV and slew rate 4 V/s. Predischarge ICD interrogation revealed regular values for pacing threshold (0.6 V at 0.4 ms), electrode impedance (556 Ω), and R wave amplitude (>12 mV). After discharge, we started remote monitoring, and followed up every four months in outpatient clinic, and every two months and with IEGM of remote monitoring system. An alerts was sent showing the R-wave potential was 2.0 mV 45 days after discharge. We contacted the patient and the chest X-ray showed dislocation of the ICDs lead. We re-admitted the patient and performed ICD lead fixation again. Conclusion: Remote monitoring allowed the early and reliable detection of ICD lead failure without requiring patient intervention.