Doppler Segmental Pressures (UE)

Question 1

How should the patient be positioned for an upper extremity ABI

Answer 1

Supine with arms relaxed at the patients side

Question 2

What size cuff is used for upper extremities

Answer 2

Brachial artery (upper arm) = 12 X 40 cm
Radial and ulnar artery (forearm) = 10 X 40 cm

Question 3

What is the name of the test used to evaluate patency of the PALMER ARCH

Answer 3

Allen test

Question 4

The Allen test evaluates patency of the Palmer arch to asses for adequate perfusion of the hand if ____ artery is harvested, or being used for ____ access

Answer 4

Radial artery

Dialysis access

Question 5

Technique for Allen test:
While technologist manually compresses radial artery, the patient clenches ______ _____ for <1 minute……
Then patient relaxes hand while radial artery still compressed

Answer 5

Patient clenches IPSILATERAL FIST, inducing pallor while at the same time INCREASES RESISTANCE

Question 6

With the Allen test, what is considered normal results and what is considered abnormal

Answer 6

Normal = reappearance of normal color (meaning ulnar artery is providing flow to Palmer arch

Abnormal = color does not reappear (meaning ulnar artery occlusion or Palmer arch obstruction)

Question 7

Alternative method for Allen test is done by placing PPG on index finger before and during Manuel compression of radial artery. What is considered normal/abnormal with this method

Answer 7

normal = PPG documents pulsation during compression
Abnormal = PPG documents loss of pulsation during compression

Question 8

Limitations to the Allen test:
Compression of radial and ulnar arteries from what action?
And
Fingers forcible extended (hand open) can cause skin over palm to stretch leading to?

Answer 8

Compression of radial and ulnar arteries from EXCESSIVE DORSIFLEXION OF WRIST
And
Fingers forcible extended (hand open) can cause skin over palm to stretch leading to PALLOR FROM COMPRESSION OF SMALL VESSELS

Question 9

Upper extremity ABI with a 15-20mmHg difference from one brachial pressure to another suggests a >50% stenosis of….

Answer 9

Subclavian artery (or the vessel under the cuff)

Question 10

A > 15-20 mmHg drop from the upper arm to forearm suggests these 3 possibilities

Answer 10

Brachial artery obstruction DISTAL to the upper cuff
Obstruction in a SINGLE forearm artery
obstruction in BOTH radial and ulnar arteries

Question 11

If there is a difference of > or = 20mmHg between the radial and ulnar artery, obstruction would be in the higher or lower pressure vessel

Answer 11

Obstruction in vessel with LOWER pressure