Chapter 9 Flashcards
what are the capabilities of digit plethysmography and pressures?
help detect presence of arterial disease
differentiate fixed arterial obstruction from vasospasms
assess effects of treatment
what are some limitations with digit plethysmography?
quality of tracings greatly affected by the vasoconstricted state of arteries before testing begins
bandages cannot be removed, ulcerations or gangrene may prevent placement of cuff or photocell
patient with extremity tremor
what is a limitation with volume plethysmography?
cuffs applied too tightly, can obliterate or diminish the pulse waveforms
what is a limitation with photo plethysmography?
improper contact with skin surface will cause poor results
what is patient positioning for digit plethysmography?
toe evaluation: supine with some elevation of head
finger evaluation. sitting with arms resting on pillow place on patients lap
what is the technique with toe pressures?
patient should be kept warm as possible
the study is done with combo with a complete LE arterial exam or a limited version such as an ABI
what size cuff is applied to the toe?
at least 1.2 times that of the toe (2.5-3cm) is applied to base of great toe
what can you do when your getting a waveform?
warm the toes
what is the method for PPG?
digit cuff placed at base of great toe
photocell securely attached to plantar side of toe using double-stick tape or velcro strap
-pulses recorded paper speed= 5mm/sec
while pulsations are recorded cuff is inflated to 20-30 mmHg above highest brachial P
no pulsations should be seen
cuff is slowly deflated, watching for return of first pulse to define the pressure level
can also be with volume plethys
the increase in toe volume what is it secondary too?
obstruction of venous outflow
what is the technique for finger without cold stress?
upper extremity arterial study is completed initially
evaluate doppler signals (Tri, Bi or mono phasic) and obtain pressures
doppler exam of the palmar arch, to verify patency
apply finger cuffs (2-2.5cm)
pressures and waveforms obtained
what is the technique for fingers with cold stress?
after resting study performed, hands are immersed in ice cold water for 3 min if possible
following cold stress waveforms and pressures are obtained. immediately after and fiver min after
why are cold stress tests performed with fingers?
performed in cases of symptoms occurirng due to cold sensitivity (toes can also be evaulated)
what should you document with cold stress test on fingers?
patient symptoms, skin color observations and other pertinent findings on the report form
what are normal waveform qualities?
sharp upstroke during peak systole
prolonged down stroke with notch (reflected wave) approx half way down
amplitude is usually greater than toe tracings
what is an abnormal obstructive waveform qualities?
occlusion located anywhere proximal to the tip of the finger causes the pulse to assume an obstructive form
slow upslope to rounded peak
downslope that bows away from baseline
what are abnormal peaked waveform qualities?
upslope is slower than normal
sharp, anacrotic notch is present
reflected wave located high on the downslope
has characteristics of both normal and obstructve waveforms
what is an organic flixed obstructive disease?
has abnormal doppler arterial signals, systolic pressures and PPG tracings
what is functional (intermittent) obstructive disease?
has normal doppler arterial signals , systolic pressures and or PPG but abnormal findings after cold stimulation
the peaked waveform is more commonly seen with what?
raynauds phenomena
with cold immersion, how do you know that there is an abnormal cold sensitivity?
if the amplitude fails to return to baseline levels within 5min
what are normal digit measurements for UE digits?
finger/brachial index 0.8-0.9
what are normal digit measurements for LE digits?
toe/brachial index (TBI)
normal toe Ps vary from 60-80% of brachial P
the presence of artifactually high ankle pressures from arterial calcinosis usually negates a toe/ankle P index
digital artery occlusion: severely reduced pressure
