Chapter 9 Digit Plethysmography and Pressures Flashcards
Affected by the vasoconstricted state of arteries before testing begins. (Has patient: come in from the cold weather)
Limitations
Cuffs applied too tightly
Limitations
Contact with skin surface
Limitations
Toe technique
The study is done in combination with a complete lower extremity arterial exam.
Limited version such as an ABI
Digit cuff placed at base of great toe
While pulsations are reordered, 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.
The toe method.
After resting study is performed, hands are immersed in ice cold water for 3 minutes if possible ( to induce spasm)
Following cold stress, waveforms and pressures are obtained: immediately after and five minutes after.
Fingers with cold stress
Sharp upstroke during systole
Reflected wave seen on downslope
Normal waveform qualities
Upslope is slowed.
Reflected wave located high on the downslope.
Has qualities of both normal and obstructive waveforms.
(plateau vasospastic process)
Abnormal peak waveform qualities
(fixed) obstructive disease has abnormal Doppler arterial signals, systolic pressures and PPG tracings
Organic
(intermittent) disease has normal Doppler signals and pressures, and / or PPG tracings; but abnormal after cold stress
Functional
Pulse is unique to the waveform contours of patients with Raynauds’s phenomena
Peaked
Following cold immersion, abnormal cold sensitivity is likely if the amplitude fails to return to baseline levels within
5 minutes
Finger/brachial indices 0.8-0.9
Upper extremity
Toe/brachial Index (TBI)
Lower extremity
Normal toe pressures vary from _______ of brachial pressures
60 - 80 %
