The IVY method is the traditional format for this test. While both the IVY and the Duke method require the use of a sphygmomanometer, or blood pressure cuff, the IVY method is more invasive than the Duke method, utilizing an incision on the ventral side of the forearm, whereas the Duke method involves puncture with a lancet or special needle. In the IVY method, the blood pressure cuff is placed on the upper arm and inflated to 40 mmHg. A lancet or scalpel blade is used to make a shallow incision that is 1 millimeter deep on the underside of the forearm.