CVS Health. Cuff Size: Pediatric . I need to select my product from a list. Copyright 2023 American Academy of Family Physicians. Recognizing ongoing evidence gaps and the need for an updated, thorough review of the relevant literature, the American Academy of Pediatrics and its Council on Quality Improvement and Patient Safety developed this practice guideline to provide an update on topics relevant to the diagnosis, evaluation, and management of pediatric HTN. The first and last audible sounds should be recorded as systolic and diastolic pressure, respectively. Blood pressure medication: Still necessary if I lose weight? Privacy Policy. Cutting the amount of salt (sodium) in your child's diet will help lower his or her blood pressure. What is hypertension? Before you purchase a home blood pressure monitor, its important to determine the best cuff size for you. Nominations are open Jan. 30 through March 6, 2023. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. If you're concerned about the size of your cuff or your blood pressure readings, talk to your doctor. In older patients, blood pressure should be measured routinely in the standing and seated positions to screen for postural hypotension. Set the pacer 10-20 beats per min above the patients intrinsic heart rate or 60 beats per min if there is no intrinsic heart rate. With your arm hanging at the side of your body, measure the circumference of your upper arm at the midpoint between the shoulder and elbow. Site Search. Compensated shock can be detected by evaluating the patients heart rate, presence of peripheral pulses, intravascular volume status, and end-organ perfusion. Second, is there possible injury or trauma that would change the providers method of treating an obstructed airway or inefficient breathing. However, body temperature may fluctuate depending upon the time of day, and a normal temperature may range between 97.0 F and 100.3 F . I purchased this cuff for . Most (83%) of the practitioners would . Here's how to line up a blood pressure cuff: Make sure the arm is bare, uncovered by a shirt sleeve or clothing - you won't get an accurate reading if the cuff is placed over clothing. The prevalence of hypertension and obesity in children age 8 to 17 has increased in all racial and ethnic groups since 2002. How to interpret BP chart in pediatric age group? 1. Key points when measuring blood pressure Ensure the correct cuff size is selected for each patient, favouring a . The minimum cuff length that can be used for this person is 32 cm, which is a large adult cuff. There is a high risk for patient becoming unstable. Mayo Clinic, Rochester, Minn. June 28, 2019. Graphic 73414 Version 4.0. The pressure within our arteries changes with every heartbeat, says Ian Del Conde Pozzi, M.D., a cardiologist and vascular medicine specialist at the Miami Cardiac & Vascular Institute. An undersized cuff increases errors in measurement. The lower number, or diastolic pressure, refers to the lowest pressure inside the artery. 14th ed. The medical facts are updated as per the date of posting, so the readers are expected to update themselves if referring to a very old post. Small (Pack of 1) 4.3 4.3 out of 5 stars (330) $12.95 $ 12. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); This site uses Akismet to reduce spam. If the patient is attempting spontaneous breaths without success, there may be noticeable effort of intercostal muscles, diaphram, or other accessory muscles without significant chest rise/expansion. Both work well, but if youre measuring your blood pressure on your own regularly, a digital one will likely be easiest to use correctly. Copyright 2005 by the American Academy of Family Physicians. I know the name of my product. Diastolic pressure is higher in the seated position, whereas systolic pressure is higher in the supine position. Children should have their feet on the floor rather than dangling above it. Based on classification criteria in the Fourth Report, 103 participants were hypertensive and 143 prehypertensive. Cuff bladder should encircle 80 percent or more of the patients arm circumference. The length of the bladder of the cuff should encircle 80 to 100% of the circumference of the upper arm at the same position. The first reading in a series is usually the highest. include protected health information. Dr. Singer has disclosed no financial relationship relevant to this commentary. A large adult cuff should be used if the measurement is 13 to 17 inches. Synopsis:Our Blood pressure chart shows if adults and children have high, low, or normal blood pressure according to their age. University of Iowa Stead Family Childrens Hospital is part of University of Iowa Hospitals & Clinics. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients. Diabetes and fasting: Can I fast during Ramadan? Wrap a tape measure around the patient's bicep, at mid-arm to determine the arm circumference (typically measured in cm). 2017 AHA/ACC adult hypertension guidelines. "Prevention and early detection are key," said Joseph Flynn, MD, MS, FAAP, who co-chaired the subcommittee. Document the patient's position, the limb, and the cuff size with each . Administer hydrocortisone if possible adrenal insufficiency. In children, cuff bladder width should be at least 40 percent of the arm circumference halfway between the olecranon and acromion; the cuff should then cover 80 percent or more of the arm circumference. Used to treat unstable bradycardias not responding to drug therapy. 2 Fischbach M, Terzic J, Menouer S, Dheu C, Soskin S, Helmstetter A et al. Error is minimized when the cuff width is 46 percent of the arm circumference, although for large adult and thigh cuffs this is not practical. This recording represents how high the mercury column is raised by the pressure of the blood. In obese patients, longer, wider cuffs are needed to compress the brachial artery adequately. Obesity is considered the primary risk for high blood pressure in children. Part #: 520124. According to the tables, if your child has a blood pressure that is higher than 90 to 95 percent of other boys or girls his or her age and height, then he or she may have high blood pressure. This calculator can help to determine whether a child has a healthy blood pressure for his/her height, age and gender. Give Epinephrine in a 1:10,000 solution: 0.01 mg/kg by IV or IO every 3 to 5 minutes (or give Epinephrine in a1:1,000 solution: 0.1mg/kg by ETT every 3 to 5 minutes). A. da Silva, Z. Cai, S. Lin, J. H. Dubinion and J . One of the most common observer errors is terminal digit bias (e.g., excessive recording of zero as the last digit, or fitting the measurement to a specific recognized threshold). Skip to main content Extra 15% off $40+ vitamins Trimline Reusable Blood Pressure Cuffs. Medium Cuff: Fits upper arms 9 to 13 in circumference. For correct cuff placement, the midline of the cuff bladder should be positioned over the arterial pulsation in the patients upper arm following palpation of the brachial artery in the antecubital fossa. Omron Blood Pressure Monitor CS2 Grey Upper Arm Children/Adult/Kid Small Cuff 17-22cm. Using a one cuff size-fits-all approach when measuring blood pressure may lead to striking inaccuracies in blood pressure measurement and diagnosis, according to a new study. "Single blood pressure chart for children up to 13 years to improve the recognition of hypertension based on existing normative data." Arch Dis Child. End-tidal CO2 should be verified during exhalation using monitor or ETD. All new Microlife blood pressure monitors are equipped with a guide to check the arm circumference in order to select the correct cuff size. The contents posted are by experts or based on literature search. official version of the modified score here. The inflatable part of the cuff (bladder) should cover a minimum of 90% and preferably 100% of the circumference of the arm. Careful not to cause trauma to nasal mucosa (results in bleeding). Note that cutoffs reported in the calculator may vary slightly from the published tables, as the calculator accommodates for ages between whole numbers (e.g. It is primarily directed at clinicians caring for children and adolescents in the outpatient setting. Configurations. "High blood pressure levels tend to carry into adulthood . Why monitor blood pressure (BP)? in circumference. Retraining of all health care professionals is strongly recommended by the AHA. comparing readings based upon the child's height, using the normal growth charts to determine the child's percentile (See appendix 1). Model number. A reliable disposable cuff solution, FlexiPort Disposable BP Cuffs deliver value to hospitals with the benefits of FlexiPort technology. The matter posted is entirely for the purpose of Continuing the Medical Education and has no commercial or personal interests. http://hyper.ahajournals.org/cgi/content/full/45/1/142, www.abdn.ac.uk/medical/bhs/tutorial/tutorial.htm. PEDIATRIC SIZE CUFF - Our blood pressure cuff is made of durable nylon and comfortably fits arms 7.2" - 10.5" (18.4 - 26.7cm) in circumference. The nurse notices that a colleague is preparing to check the blood pressure of a patient who is obese by using a standard-sized blood pressure cuff. If the airway is partially obstructed snoring or stridor may be heard. Pediatric Practice Pearls for your Pediatric Office Practice, An academic venture by BLK Centre for Child Health, Previous Post: Techniques to measure a BP. Ever Dixie USA Dixie EMS Pediatric Size Blood Pressure Cuff. Patients interested in self-monitoring should be instructed to sit in a comfortable chair for three to five minutes with the upper arm at heart level before taking a measurement, and should be reminded not to exercise or eat directly before the reading. If the pressure is high during the pumping phase , then the first number recorded with a blood pressure reading will be high. AHA AMA Website Terms of Use|Site Map. Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP. If the initial blood pressure is elevated, providers should take two additional measurements at the same visit and use the average value. Sign In {0} items in cart. Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. Do infrared saunas have any health benefits? information submitted for this request. Check device specifications for the range of arm circumferences covered. Deflation rates greater than 2 mm per second can cause the systolic pressure to appear lower and the diastolic pressure to appear higher. . For an arm circumference of 22 to 26 cm, the cuff should be a "small adult" size or 12 x 22 cm. health information, we will treat all of that information as protected health Blood pressure: Does it have a daily pattern? NIBP cuff U1881S. When high blood pressure has no disease-related cause, its called primary hypertension. If the breathing pattern or inspiratory volumes are inadequate to sustain life, rescue breathing will be required, and an advanced airway should be placed. Non-Hispanic Black people have a significantly higher rate of hypertension compared to non-Hispanic white people, and Hispanics and non-Hispanic Asians have lower rates than the first two, he says. Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission. Large (Model UA-281) - Fits upper arm sizes 14.2" to 17.7". Three readings should be taken at intervals of one minute or longer, and the average of the three recorded. A single copy of these materials may be reprinted for noncommercial personal use only. There should be a 2 to 3cm space for the stethoscope between the lower end of the cuff and the antecubital fossa, unless this would require an undersized cuff. (Spout is excluded) Material: Nylon/Single-tube with bladder plan. Epinephrine in a 1:10,000 solution: 0.01 mg/kg by IV/IO every 3 to 5 minutes (or Epinephrine in a 1:1,000 solution: 0.1 mg/kg by ETT every 3 to 5 minutes). Additionally, of obese participants, one third required a large . 95. . In fact, your heart is expected to rise during a bout of activity and return to its resting rate afterward. Hypertension in children and adolescents is defined as systolic or diastolic pressure, or both, at or above the 95th percentile of distribution, using tables to determine normal and elevated levels. or with $35+ orders. Required fields are marked *. POTENTIAL CONFLICT OF INTEREST: The authors have indicated that they have no potential conflicts of interest to disclose. Cuff Size: Adult. An unsupported back may increase diastolic pressure; crossing the legs may increase systolic pressure. Other devices, such as aneroid and hybrid sphygmomanometers, may be used as a substitute or a supplement, but there is no widely accepted replacement. Positive pressure ventilation is generally kept under 20 CmH2O to prevent inflation of the stomach.The patient is still at high risk of aspiration, even with an appropriately placed LMA. So the graphs on this page show the upper half of the blood pressure range found in children. Automated oscillometric devices may be useful for an increased number of readings and to avoid expensive training. L-arginine: Does it lower blood pressure? 2017 vol 140 (3) Tweet. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press. . Increasing evidence also suggests better target organ damage prediction with home readings, and self-measurement in older patients may aid physicians in antihypertensive medication dosing decisions. A teenager may have an acceptable blood pressure of 110/70 mm Hg, but that value would be of concern in a toddler. . Upper arm cuffs can come with either a manual or digital monitor. So the graphs on this page show the upper half of the blood pressure range found in children. The ideal cuff bladder width is 40 percent of the patient's arm circumference. Tetanus shots: Is it risky to receive 'extra' boosters? Browse high-quality aneroid and digital blood pressure cuffs from Welch Allyn . Use in children aged 1-17 years. View current promotions and reviews of Shop Walgreens.com for Blood Pressure Cuffs and other Home Medical Products. Guide in the LMA cuff without folding back the tip, pressing it against the hard palate. United States. concentration, NICU Data from the device are downloaded into software and can be translated into a report. Blood Pressure Measurement (Pediatric) - CE ALERT. (0.050.1 mg/Kg) 1:10,000, ** Central line preferred Why Does My Blood Pressure Go Up At Night. When you measure your blood pressure at home, it's important to use the proper size cuff. Additionally, of obese participants, one third required a large adult BP cuff, Disproportionately short arm compared to the cuff required for a given arm circumference, Conically shaped arms resulting in an average difference of 8.7 cm between the proximal and distal upper arm circumference, Over time, the disproportionate increase in pro-inflammatory adipokines leads to a chronic inflammatory state, For example, Leptins activation of SNS is mediated via leptin receptors present on POMC neurons in the brain. If you have difficulty forming a seal with the face mask. FAQs. Recent data from the American Heart Association suggests the optimal normal reading for adults over 20 is lower than 120/80 mmHg [1]. Mayo Clinic does not endorse any of the third party products and services advertised. Artificial sweeteners: Any effect on blood sugar? *Many devices are sold with variable size cuffs that will fit a majority of arms from the small adult to large adult range. Dr. Desai notes blood pressure can vary depending on a person . Deflation rates greater than 2 mm Hg per second can cause the systolic pressure to appear lower and the diastolic pressure to appear higher. Inaccurate readings due to wrong cuff size were particularly evident in people with obesity, who require large or extra-large cuff sizes for accurate blood pressure readings. As a result, the new blood pressure values are lower than those used in prior guidelines and allow for a more precise classification of blood pressure according to body size. The ideal cuff bladder width is 40 percent of the patient's arm circumference. Age-based Pediatric Blood Pressure Reference Charts. GE is a trademark of General Electric Company. It occurs when the heart relaxes and fills with blood. Neonatal One Piece Disposable Blood Pressure Cuffs. Remove the airway device, ventilate the patient using the ambu bag for a short period of time, and then reattempt placement. The content is not valid for any medicolegal purposes. pH: 7.35-7.45PaO2: 80-100 mmHgPaCO2: 35-45 mmHgHCO3: 22-26 mEq/LO2 sat: 95-100% (on room air)BE +/- 1Lowest acceptable SBP for patients older than 1 yr = 70+ (2 x age in years). UA-279. If possible, the patient should be seated five minutes before the reading. The subcommittee intends to regularly update this guideline as new evidence becomes available. With the unfortunate rising rates of childhood obesity, obtaining an accurate measurement has proven to be challenging due to an abnormally large arm circumference: Arm circumference can be large enough which requires the use of adult size BP cuff, NHANES data from 2007-2010 showed that boys and girls as young as 9 years of age required a standard adult-sized cuff. You may need to have your blood pressure taken several times during your visit using the same, properly sized cuff in the same arm. Provided repeated IV bolus of crystalloids at 20 ml/kg. ETT: 0.1 mg/Kg 1:1,000 Not for use in patients with low blood pressure. The AHA scientific statement, written by Pickering and colleagues, was first published in the January 2005 issue of Hypertension and also appears in the February 8, 2005, issue ofCirculation. The normal blood pressure range, while steadily increasing with age, will shift based on the child's height. Intensified and daily hemodialysis . Requires proper lead/pad placement to monitor ECG. Position the infant supine on a hard flat surface in sniffing position. Our survey revealed that 57% of practitioners would consider using a neonatal cuff for patients up to 1 month of age, 65% would use an infant cuff for those 1 year of age, 49% would use a child/pediatric cuff for those 5 years of age, and 84% would use a small adult cuff for those 10 years of age and older. IV/IO: 0.10.3 ml/Kg The normal blood pressure range, while steadily increasing with age, will shift based on the childs height. For children 13 years of age, this calculator has been adjusted to meet definitions presented in the. CarePass price $55.99. Elmoselhi A, ed. Best for a wrist monitor: ReliOn BP300 Wrist Blood Pressure Monitor. Monitor Features: Irregular Heartbeat Detection, Pressure Rating Indicator. Calcs that help predict probability of a disease, Subcategory of 'Diagnosis' designed to be very sensitive, Disease is diagnosed: prognosticate to guide treatment. When you measure your blood pressure at home, it's important to use the proper size cuff. Recommended cuff size; Adults (by arm circumference) 22 to 26 cm: 12 22 . Your email address will not be published. Using a wrong-size blood pressure cuff can affect accuracy by up to 30 mmHg. NOTE: A healthcare provider recommends you get your blood pressure checked at least once a year. Service & Support. Delivery within first 5 mins of cardiac arrest has best results. Mercury column should be deflated at 2 to3 mm per second. Fuster V, et al., eds. Electronic home monitoring is easy to use, cost-effective, and may improve therapeutic compliance. Bradycardia is a common sign of advanced shock and is frequently associated with hypotension. 1. In children with known renal problems the blood pressure should be maintained around the 50th percentile. In general, you can expect to pay between $40 and $100. Diagnoses hypertension in pediatric patients; official guideline of the American Academy of Pediatrics. AHA scientific statement recommendations (Hypertension 2005; 45:142-161), are presented below, and a diagram of a typical blood pressure cuff is depicted to the right. A circumference of 7 to 9 inches requires a small adult sized cuff. And the more intense you work, the more you should expect your heart rate to rise during exercise. Systolic and diastolic blood pressures are preferred for use in hypertension classification, rather than arterial or pulse pressure. Child Cuff & 2 Tube Bladder Replacement. Used to treat Atrial Fibrillation, Atrial Flutter, Atrial Tach, and Symptomatic VT. Accessed 7/16/2021. The lowering of target blood pressure for patients with diabetes or renal disease has made detection of small differences more important. Hypertension is an important health issue in children, because of its association with obesity. The ideal cuff bladder length is 80 percent of the patient's arm circumference. Tycos Large Adult Size Tr-1 Blood Pressure Monitor 5098-28 CB. The AHA recommends that the cuff be inflated to at least 30 mm Hg above the point at which the radial pulse disappears. Shop our complete line of blood pressure products, Emergency Manual Blood Pressure BP Cuff Kit, All customers get FREE Shipping on orders over $25 shipped by Amazon. Allows for positive pressure ventilation. Omron blood pressure monitors vary in price based on type and other features. These vital signs remain relatively constant throughout adult life. Blood Pressure Cuff McKesson LUMEON Adult Arm Medium Cuff 23 - 40 cm Nylon Cuff. https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings/monitoring-your-blood-pressure-at-home. You May Like: How To Lower Red Blood Cell Count. Atropine: 0.02 mg/kg by IV or IO with a minimum single dose of 0.1mg and a maximum single dose of 0.5mg in a child (used for AV block and to increase vagal tone). The most common error in blood pressure measurement is use of inappropriate cuff size. Clinical excellence. Another use is the identification of nondipping blood pressure (i.e., less than 10 percent reduction from daytime to nighttime pressure), which is thought to increase a patients risk for complications. other information we have about you. Prehypertension has increasing health risks and can progress to hypertension. The Omron Blood Pressure Monitor Upper Arm Children/Adult Kid Small Cuff 17-22cm CS2 is a high-quality cuff designed to fit children and small adults. Because of the potential for incorrect reporting to the physician, the AHA recommends that devices with memory or printouts be used. OVERVIEW. Your doctor's office should have several sizes of cuffs to ensure an accurate blood pressure reading. Correct cuff size depends on arm size. Sale Price: $385.00 1 - 36 of 52 Results 1 2; Articles A blood pressure cuff - aka a sphygmomanometer - is essential for monitoring patient vital signs. AAP Grand Rounds November 2016 36 : 58. . Blood pressure should be measured on the right arm for consistency. Generally, blood pressure is low in infancy, and rises slowly as children age. How would this likely affect the blood pressure reading? When you are unable to open airway using head tilt-chin lift or jaw thrust maneuvers. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Upper Arm Blood Pressure Monitor. Add to List. Sale Price: $33.13 . Parts & Accessories. Blood pressure data on 1,254 healthy children between the ages of 10 and 19 years were analyzed. Welcome to the free PALS algorithm and guidelines offered by United Medical Education. Children with high BMI are more likely to develop hypertension later in life compared to children with lower BMI. View all posts by Dr Swati Bhardwaj, Pediatric Nephrologist, Bladder width at least 4050% of the arm circumference, Bladder length at least 80100% of the arm circumference, Cuff width 66-75% of the acromion-olecranon distance (UAL). This can be done by auscultation over the popliteal fossa, with use of a thigh cuff or oversized arm cuff. Palm Aneroid Sphygmomanometer and Stethoscope Kit, 5-in-1,for Child and Adult, Infant, Youth, Thigh Cuffs, Palm Manual Blood Pressure Cuff, Portable Carrying Case Included, Ever Ready First Aid Fully Automatic Upper Arm Blood Pressure Monitor 3 Mode 3 Cuffs Electronic Sphygmomanometer, Fully Automatic Upper Arm Blood Pressure Monitor 3 Mode 4 Cuffs Without Adapter Electronic Sphygmomanometer, Primacare DS-9191 Pediatric Size Aneroid Sphygmomanometer Manual Blood Pressure Monitor Kit, BP Cuff with Latex Free Inflation System, Waterproof and Portable Nylon Carry Case, YBHOC Small Replacement Blood Pressure Cuff, Applicable for 5.9-8.6"/15-22cm, Fits Small Adult and Teenager Arm Circumferences(Cuff Only, Not Included BP Machine), EMI Pediatric Aneroid Sphygmomanometer Manual Blood Pressure Monitor with Child Sized Cuff (Fits arms Size: 18.4 cm to 26.7 cm) and Carrying Case EBC-215, Omron CD-CS9 Small D-Ring Cuff for BP710N/BP742N/BP765, EMI #311 Pediatric Aneroid Sphygmomanometer Set Child and Infant Cuff Plus Basic Dual Head (Navy), A&D Medical Premium Blood Pressure Monitor UA-767PSAC with Small Blood Pressure Cuff (16 - 24 cm / 6.3 - 9.4" Range), One-Click Operation, Irregular Heartbeat Detection, LCD BP Machine, MDF Latex-Free Pediatric Replacement Blood Pressure Monitor Cuff - Single Tube - Black (MDF2030421-11), Ever Dixie USA Dixie EMS Pediatric Size Blood Pressure Cuff, Dixie EMS Deluxe Infant Aneroid Sphygmomanometer Blood Pressure Set W/Infant Cuff, Carrying Case and Calibration Tool Latex Free Navy. Blood Pressure Levels for Girls by Age and Height Percentile (Continued) Systolic BP (mmHg) Diastolic BP (mmHg) Percentile of Height Percentile of Height Age (Year) BP Percentile This series is coordinated by Michael J. Arnold, MD, contributing editor. It usually is used for diagnosis in patients with suspected white coat hypertensionwho are thought to be at lower risk of blood pressurerelated complications than those with sustained hypertensionand recently has been approved by the Centers for Medicare and Medicaid Services for this purpose. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Read the measurement on the tape measure in inches. Microlife cuffs are available both in soft and rigid models. Using a Wrist Cuff to Measure Blood Pressure. a. Customer reviews: 4.4 out of 5 stars. If a cuff is too small, the next largest cuff should be used, even if it appears large. Consider the child's height and weight in your . Labs: blood gas, lactate, glucose, CBC, ionized calcium, cultures. All Rights Reserved. New research from the united states has put figures to the facts using modern blood pressure machines, as opposed to the old mercury sphygmomanometers which this knowledge was derived from. Observers should be assessed for physical and cognitive competency to perform the procedure, including vision, hearing, and eye/hand/ear coordination. Replacement Blood Pressure Cuff; AC Power Adapter; A&D Medical Personal Blood Pressure Measurement Journal; Weight Scales. Blood pressure monitor cuff for children or small adult arms 7 to 9 inches (18 - 22.86 cm) in circumference; Replacement for omron bp cuff model H-003DS; 3. A Mayo Clinic expert explains. 9.8. Nondipping blood pressure that does not drop overnight Suspected autonomic neuropathy, Suspected overtreatment with resultant iatrogenic hypotension, Suspected white coat hypertension and discrepant readings between home and clinic.

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