Chapter 9: Digits Plethysmography and pressures Flashcards
digit plethysmography and pressures helps to
detect presence of arterial disease
differentiate fixed arterial obstruction from vasoplasm
asses effects of treament
limitations of digit plethysmography and pressures
quality of tracings effects by vasoconstriction from temperature (pt coming in from cold weather, cold room)
bandages that can’t be removed
ulcers
patient with tremor
with volume plethymography cuffs applied too tightly can
obliterate or diminish pulse waveforms
with photo plethysmography improper skin contact will cause
poor results
patient positioning for digit plethysmography and pressures
toe evaluation: supine with some elevation of head
finger evaluation: sitting with arms resting on pillow placed on patients lap
technique for toe plethysmography
pt kept as warm as possible
study done in combination with a complete LE arterial exam or limited ABI
cuff atleast 1.2 times the size of toe (2.5-3cm) applied to base of big toe
usual method for obtaining great toe pressures is
PPG
PPG great toe pressures method
cuff placed at base of great toe
photocell attached to plantar side of toe using tape or velcro
pulses recorded
paper speed slowed to 5mm/sec
cuff inflated 20-30 mmHg above highest brachial
cuff deflated waiting for return of first pule to define pressure level
Fingers without cold stress technique
complete UE arterial study
eval doppler signals and obtain pressures
doppler palmar arch to verify patency
apply finger cuffs (2-2.5cm)
pressures and waveforms obtained similar to toes
fingers with cold stress are preformed
in cases of symptoms occurring due to cold sensitivity
fingers with cold stress technique
after resting hands are immersed in cold water for 3 minutes
waveforms and pressures obtained following cold stress immediately after and then 5 minutes after
what should you document in fingers with cold stress technique
skin color
interpretation of digital plethysmography normal waveforms:
sharp upstroke during peak systole
prolonged down-stroke with notch (reflected wave) approximately halfway down
interpretation of digital plethysmography abnormal obstructive waveforms:
slow upslope
rounded peak
downslope bows away from baseline
occlusion located anywhere proximal to the tip of finger causes
pulses to assume obstructive form