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vascular 2 > Powerpoint 1 Upper/Lower Extremity Indirect Arterial Eval > Flashcards

Powerpoint 1 Upper/Lower Extremity Indirect Arterial Eval Flashcards

1
Q

Doppler Waveform analysis capabilities: (4)

A
  1. helps confirm dz (arterial occlusive)
  2. helps show severity of occlusion pre to post exercise
  3. obstruction location
  4. f/u on dz progression/results
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2
Q

Doppler waveform analysis limitations

A
  1. casts/bandages NO
  2. ambient temp (room temp) can affect waveform
  3. uncompensated CHF can cause dampened waveforms post exercise
  4. can’t tell tight stenosis from occlusion
  5. can’t localize obstruction
  6. test tech dependent - correct doppler angle impt
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3
Q

LEA patient position?

A
  1. supine, decubitus, or prone
  2. extremities same level as heart
  3. hips rotated out
  4. knee slightly bent
  5. can use deuce if trying to get PopA
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4
Q

UEA patient position?

A

Arms at side and relaxed

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5
Q

Doppler Exam what kind of probe (frequency)

A

8-10 MHz

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6
Q

PO or CW Doppler utilized … what kind of angle to the skin … why does this angle work?

A

CW… 45 to 60 degrees… most peripheral arteries parallel to skin so it works

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7
Q

these two modes usually utilized for doppler exam

A

analog velocimetry or spectral analysis

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8
Q

with analog recording, what is used (2)

A

with analog recording, a zero-crossing frequency meter used and strip chart recorder

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9
Q

with analog recording, the machine estimates what and counts what

A

estimates the reflected signal frequency and counts how many times the signal crosses the zero baseline

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10
Q

with analog recording, the tracings record what over time

A

record the amplitude of Doppler frequencies

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11
Q

with analog recording, what are DISADVANTAGES (6)

A
  1. spectral analysis is more sensitive than analog
  2. noise
  3. less sensitivity
  4. underestimates high velocities
  5. overestimates low velocities
  6. most analog systems self calibrate
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12
Q

with spectral analysis, this method displays what

A

with spectral analysis, this method displays frequency over time and the amount of backscattered signals at a given frequency and time

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13
Q

with spectral analysis, it does not have these drawbacks

A

does not have analog drawbacks

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14
Q

with spectral analysis, amplitudes are shown at what frequencies

A

all frequencies

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15
Q

with spectral analysis, is it more or less sensitive displaying multiple frequencies

A

more sensitive

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16
Q

where should doppler velocity waveforms should be obtained at what levels for LEA (6)

A

common femoral artery (at groin)
femoral artery (mid thigh)
politeal artery
posterior tibial artery
dorsalis pedis artery (top of foot)
peroneal artery (if necessary) @ lateral malleolus

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17
Q

where should doppler velocity waveforms be obtained at levels for UEA (5)

A

subclavian artery (supraclavicular)
axillary artery (axilla)
brachial artery (@ elbow)
radial artery (@ wrist)
ulnar artery (@ wrist)

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18
Q

some improper sources of error when dopplering arterial

A

improper position of probe, moving probe on accident, wrong angle, not enough gel, too much pressure on probe tip, pt needs more rest before testing

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19
Q

qualitative interpretation (normal) waveform is: (what kind of waveform, what kind of peak, what kind of stroke, what kind of waveform below baseline, what kind of resistance)

A

triphasic or multiphase waveform, sharp peak, rapid downstroke, short peak below baseline, high resistance pattern

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20
Q

qualitative interpretation (abnormal) waveform is: (what kind of waveform)

A

monophonic, nonpulsatile, absent, a change from triphasic to biphasic or monophasic, no changes should be noted from one level to another

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21
Q

can you determine the DEGREE of obstruction on the basis of JUST WAVEFORM?

A

NO

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22
Q

Stenosis and occlusion with good collateralization will cause

A

similar waveforms distal to stenosis

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23
Q

waveform analysis: monophasic flow occurs

A

can occur proximal AND distal to stenosis

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24
Q

waveform analysis: if no other obstructions are present distally, a monophasic waveform may

A

NORMALIZE TO A CERTAIN EXTENT

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25
Q

waveform analysis: monophasic can be present anytime there is (2)

A

there is vasodilation and blood is going to a low resistance vascular bed

26
Q

effect of exercise, normal post exercise waveforms: (2)

A

postexercise waveforms normally maintain or augment pre exercise waveforms with all waveform components usu depicted above baseline

element of arterial vasodilation does occur even in normal post exercise state

27
Q

effect of exercise, abnormal post exercise waveforms:

A

slow upstroke w more rounded peak
slow downstroke
no reverse component

28
Q

absence of doppler signals suggests what

A

OCCLUSION… suggest a preocclusive vessel

29
Q

in the absence of doppler signals… CW Doppler cannot detect flow slower than? In a preclusive vessel this would be known as what

A

6 cm/sec… known as a string sign

***SOME systems can show these slower flows

30
Q

Upper extremity arterial flow: normal subclavian artery flow:

A

multiphasic, high resistance flow

31
Q

Upper extremity arterial flow: abnormal subclavian artery flow:

A

similar to lower extremities w proximal or distal obstructions

32
Q

what causes flow patterns in the hand to vary a lot?

A

arteriovenous shunts in the skin in the fingertips

33
Q

what kind of waveforms can be seen in relaxed and warm brachial, radial, and ulnar arteries? a cool hand will have what kind of flow

A

continuous low resistance waveforms
COOL hand will have higher resistance

34
Q

several quantitative methods for arterial flow signals (4)

A

pulsatility index
inverse damping factor
acceleration time
transit time

35
Q

Pulsatility Index or PI = what to what

A

Peak to Peak… (mean frequency)

36
Q

Pulsatility Index… from central to peripheral arteries, how does PI change?

A

it increases

37
Q

what does the increase in PI from central to peripheral arteries help identify

A

it helps differentiate inflow from outflow dz
Example:
CFA PI >5.5
Popliteal artery PI is approx 8.0
Values decrease w proximal occlusive dz

38
Q

this graph represents what quantitative method for arterial flow signals ?

A

pulsatility index (PI) = peak-to-peak

39
Q

Inverse Damping Factor define… Also, Damping factor indicates the degree to which…

A

ratio of distal PI to the proximal PI of an arterial segment

indicates the degree to which wave is dampened as it moves through an arterial segment

40
Q

Ex of damping factor - normal inverse femoral popliteal damping factor

A

should 0.9 - 1.1

41
Q

Acceleration time helps differentiate what…? It is based on what principle

A

It helps differentiate inflow from outflow dz… it is based on the principle that arterial obstruction proximal to site of the Doppler probe lengthens the time between onset of systolic flow to the point of max peak in waveforms at the probe site…. BASICALLY… IF PROLONGED THERE IS DZ DISTAL TO THE PROBE

42
Q

Acceleration time is used only with what kind of Doppler?

A

only spectral analysis

43
Q

Can you have false positives with acceleration time? If so how

A

Yes… if large angle or poor cardiac output

44
Q

In the CFA, an acceleration time of > or equal to _______ suggests the presence of significant iliac dz

A

133 msec in CFA

45
Q

Can you use acceleration time value alone to determine dz?

A

NO, use with waveform eval

46
Q

Transit time… what should happen bilaterally during systole?

A

systole should be evident simultaneously at the specific site bilaterally
ALWAYS COMPARE SIGNALS BILATERALLY @ SAME SITE

47
Q

With transit time, a delay on one side may indicate

A

may indicate a more proximal occlusive process… ALWAYS COMPARE SIGNALS BILATERALLY @ SAME SITE

48
Q

Segmental pressures capabilities: identifies what, provides what, evaluates what, results should be COMBINED?

A
  1. identifies if and how bad occlusive arterial dz is
  2. provides baseline to follow progression of dz process
  3. evaluates treatment plan
  4. results should be COMBINED w Doppler analysis or PVRs
49
Q

Segmental pressures limitations: (7) … can identify type of arterial dz? can it show false reading? post exercise could show what? narrow cuff is a problem? when would it be hard to interpret pressures?

A
  1. can’t tell diff between stenosis/occlusion
  2. General site only, not specific
    Ex. hard to differentiate between external iliac and common femoral dz
  3. patients with dz like DIABETES or END STAGE RENAL DZ… it may show falsely elevated Doppler pressures in those pts BC they have calcified vessels…..
  4. May show decreased ankle/brachial indices post exercise in pts with uncompensated CHF
  5. If cuff is too narrow, may show artifactual elevated high thigh pressures
  6. multilevel dz makes it hard to interpret info
50
Q

patient prep: whats most important aspect… just walking into office could do what??? also imps to have patients limbs what if its cold (if taking segmental pressures)

A

most important aspect is allowing patient to rest for a minimum of 20 mins prior to test … just the walk into office could cause decreased blood flow… imps to have patients limbs warm if its cold out

51
Q

Segmental pressures technique: one or both sides… where at? how large of bladders? what frequency Doppler?

A

bilateral BRACHIAL pressures
cuffs with 12 x 40 cm bladders
8-10 MHz Doppler used

52
Q

With segmental pressures… there are two methods used for cuff placement…

A

Four cuff and. three cuff

53
Q

Segmental pressures: The four cuff method uses how many thigh cuffs?

A

two thigh cuffs

54
Q

Segmental pressures: explain an advantage and list disadvantages of the four cuff method

A

advantage: provides proximal and distal thigh pressure measurements

disadvantage: artifactual elevated pressure obtained, high thigh usu 30mmHg HIGHER than brachial, large girth of thigh with TOO NARROW cuff could cause increase

55
Q

What size cuffs and where can you place for the FOUR CUFF METHOD

A

12 x 40 cm cuffs…
high thigh
above knee
below knee
at ankle
(cuff size may vary according to limb)

56
Q

Segmental pressures : Explain cuff placement…

A

straight on limb
snug
loose could mean false pressures
widths of cuffs should be 1.2 x greater than limb diameter

57
Q

Segmental pressures : Too narrow cuff size will result in

A

falsely elevated blood pressure, too wide pressure will be falsely low

58
Q

Segmental pressures : What is the three cuff method

A

one large thigh cuff placed as high as possible on thigh
size is 19 x 40, which satisfies width-girth relationship
more accurate this way
countoured cuff ideal bc similar shape to thigh

59
Q

Segmental pressures LEA obtained in this order : (4)

A

obtained bilaterally in this order:
ankle (PTA and DP)
below knee (PTA and DP)
above knee (PTA, DP, or pop there is difficulty)
high thigh (same as above knee)

60
Q
A

vascular 2 (1 decks)

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