Doppler Segmental Pressures LE

Question 1

What are the capabilities Doppler seg. Pa tests

3

Answer 1

Assess presence & severity of arterial disease

find the local area of disease (level of disease)

combined w/ Doppler velocity or volume pulse recordings

Question 2

You cannot preform seg. pa part of Doppler test if the patient has the following conditions

6

Answer 2

DVT
dialysis access
lymphedema
stent
bypass graft 
mastectomy

Question 3

Limitations for Seg. Pa of Doppler test

6

Answer 3

cannot discriminate between stenosis and occlusion

calciied vessels

uncompensated CHF

artifactually elevated high thigh pa when narrow cuff is used on thigh

difficult to interpret multi level disease

conditions that prevent seg. pa portion of test

Question 4

calcified vessels are also called

Answer 4

medial calcinosis

Question 5

what does medial calcinosis do to results of seg. pa doppler test

Answer 5

falsely elevated doppler pressures

Question 6

what conditions cause medial calcinosis

Answer 6

diabetis

end stage renal disease

Question 7

what effect will uncompensated CHF have on results

Answer 7

decreased ABI

Question 8

what is the correct % of cuff bladder width to the diameter of the pt thigh

Answer 8

20

Question 9

artificially elevated high thigh pa result when the cuff is too wide or narrow

Answer 9

narrow

too narrow = high

Question 10

what happens when the BP cuff is too wide for pt thigh diameter

Answer 10

BP is falsely lowered

too wide = low

Question 11

what concept is important to remember when positioning the pt for seg pa

Answer 11

hydrostatic pressure / keep the pt supine

the LE should be the same level as the heart

Question 12

a patient should rest ___ min before exam especially when ___ ___ is present

Answer 12

20 minutes rest period

especially when vascular disease is present

Question 13

cuff bladder should be placed over what part of the leg

Answer 13

medial — so it covers artery

Question 14

what is the correct placement of cuffs in 4 cuff method

Answer 14

brachial 
high thigh 
above the knee (low thigh)
below the knee (calf)
ankle

Question 15

which cuff method give a more accurate thigh pressure reading

3 cuff or 4 cuff ?

Answer 15

3 cuff method

but it does not discriminate between illiac disease or femoral disease

Question 16

what are the measurements of cuff width for the 4 cuff method

Answer 16

10 x 40  brachial
12 x 40  high thigh 
10 x 40  low thigh 
10 x 40  calf 
10 x 40 ankle

Question 17

where are the cuffs placed in the 3 cuff method ?

what is the diff in the size cuff for the thigh cuff?

Answer 17

Brachial
one thigh cuff (19 x 40)
below knee (calf)
ankle

Question 18

what is the difference between the 3 cuff and 4 cuff method

3

Answer 18

2 thigh cuffs = prox and distal pressure measurements

artificially elevated BP’s read in the high thigh
= >30mmHg than highest brachial

3 cuff method uses one large cuff placed high on the thigh that provides a more accurate thigh reading

Question 19

what can you do to optimize the Doppler signal

4

Answer 19

use 8-10 MHz probe

40 - 60 degrees probe angled to skin

b/c vessel angulation probe at 90 degrees to skin behind the knee

angle probe so blood moves antegrade (toward probe)

Question 20

sphygmomanometer can be used to manually do what in seg pa part of doppler exam

Answer 20

inflate the cuff

although most parks or falcons have automatic cuff inflator

Question 21

ORDER of SEGMENTAL PRESSURES when preforming that part of exam

Answer 21

Brachial

Ankle    (DPA)
Ankle    (PTA)
Calf       (use DPA/PTA  whichever gives best signal)
low thigh
high thigh

Question 22

what is the correct order of obtaining segmental pressures and why is this utilized

Answer 22

from ankle and move proximally

eliminates the possible underestimation of the systolic pressure measurement

Question 23

Why is it important to start distally and move prox when taking seg pa ?

Answer 23

eliminate underestimation of systsolic pressure measurement

tits- avoid dilation of vascular beds

Question 24

w/ seg. pa : complete cessation of blood flow is required
cuffs should be inflated ___ to ___ mmHg beyond last audible Doppler signal or
inflate cuff __ to ___ higher than the highest ___ Pressure.

Answer 24

20-30 mmHg

brachial

Question 25

how long should the cuff be deflated before repeat pressure is obtained ?

Answer 25

one min