Doppler Segmental Pressures LE Flashcards
What are the capabilities Doppler seg. Pa tests
3
Assess presence & severity of arterial disease
find the local area of disease (level of disease)
combined w/ Doppler velocity or volume pulse recordings
You cannot preform seg. pa part of Doppler test if the patient has the following conditions
6
DVT dialysis access lymphedema stent bypass graft mastectomy
Limitations for Seg. Pa of Doppler test
6
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
calcified vessels are also called
medial calcinosis
what does medial calcinosis do to results of seg. pa doppler test
falsely elevated doppler pressures
what conditions cause medial calcinosis
diabetis
end stage renal disease
what effect will uncompensated CHF have on results
decreased ABI
what is the correct % of cuff bladder width to the diameter of the pt thigh
20
artificially elevated high thigh pa result when the cuff is too wide or narrow
narrow
too narrow = high
what happens when the BP cuff is too wide for pt thigh diameter
BP is falsely lowered
too wide = low
what concept is important to remember when positioning the pt for seg pa
hydrostatic pressure / keep the pt supine
the LE should be the same level as the heart
a patient should rest ___ min before exam especially when ___ ___ is present
20 minutes rest period
especially when vascular disease is present
cuff bladder should be placed over what part of the leg
medial — so it covers artery
what is the correct placement of cuffs in 4 cuff method
brachial high thigh above the knee (low thigh) below the knee (calf) ankle
which cuff method give a more accurate thigh pressure reading
3 cuff or 4 cuff ?
3 cuff method
but it does not discriminate between illiac disease or femoral disease
what are the measurements of cuff width for the 4 cuff method
10 x 40 brachial 12 x 40 high thigh 10 x 40 low thigh 10 x 40 calf 10 x 40 ankle
where are the cuffs placed in the 3 cuff method ?
what is the diff in the size cuff for the thigh cuff?
Brachial
one thigh cuff (19 x 40)
below knee (calf)
ankle
what is the difference between the 3 cuff and 4 cuff method
3
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
what can you do to optimize the Doppler signal
4
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)
sphygmomanometer can be used to manually do what in seg pa part of doppler exam
inflate the cuff
although most parks or falcons have automatic cuff inflator
ORDER of SEGMENTAL PRESSURES when preforming that part of exam
Brachial
Ankle (DPA) Ankle (PTA) Calf (use DPA/PTA whichever gives best signal) low thigh high thigh
what is the correct order of obtaining segmental pressures and why is this utilized
from ankle and move proximally
eliminates the possible underestimation of the systolic pressure measurement
Why is it important to start distally and move prox when taking seg pa ?
eliminate underestimation of systsolic pressure measurement
tits- avoid dilation of vascular beds
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.
20-30 mmHg
brachial
