Segmental Pressure Flashcards
What is the primary purpose of segmental pressures?
To determine location of an obstruction.
What is an obstruction?
Stenosis or occlusion.
What are the three locations where a segmental pressures can locate an obstruction?
- Aorto-illiac
- Femero-popliteal
- Infrapopliteal
How big should the cuff width be?
> 20% of limb diameter.
Where should you keep the bladder of the cuff?
Medial.
Where are the 5 cuff locations?
- Upper thigh
- Lower thigh
- Calf
- Ankle
- Brachial
Where should use the CW doppler?
Dorsalis pedis and posterial tibialis.
Once you inflate the cuff, and the pulse signal disappears, you should inflate the cuff how much more?
30 mmHg
When you deflate, how fast should you deflate?
2-4 mmHg and note when the first pulse is heard.
If the pedal artery isn’t audible, what should you do?
You should listen higher up to obtain the calf pressure or use the popliteal to obtain thigh pressure.
What are some ways to help aid the patient during segmental pressures?
- Have the patient relax muscles as much as possible to avoid pain.
- If patient experiences severe pain, stop and indicate patient intolerance of the pressure cuff.
What is the “normal” pressure gradient between levels?
<20 mmHG
What is the “borderline” pressure gradient between levels?
20-30mmHg
What is the “abnormal” pressure gradient between levels?
> 30 mmHg
Are calf pressures occasionally greater than thigh pressures?
Yes.
In OUR class, what is our pressure gradient going to be in order to indicate a “hemodynamically significant obstruction”
30 mmHG
Does ABI’s tell you the location of an obstruction?
No.
Should ankle pressure be higher than brachial?
yes.
Why does cuff pressure decrease from upper thigh to ankle?
It decreases due to cuff artifact at the upper thigh level.
What is the upper thigh/brachial ratio normally?
> 1.15
What is the lower thigh, calf, and ankle/brachial ratios normally?
> 1.5
How should the cuff width be in order to create an accurate pressure measurement?
> 120%
A proximal obstruction is indicated with what ratio?
<1.15
What is considered “proximal disease”?
It may be aorto-iliac, iliac, CFA, or proximal SFA.
If segmental pressure drops, what does this indicate?
It typically indicates the obstruction is either at the cuff or proximal to it.
What are the advantages of segmental pressures?
- Quantitative
- Segmental location of obstruction can be determined.
- Absolute pressure measurements are useful to determine level of amputation.
What are some of the limitations that segmental pressures has?
- Calcification
- Obesity
- Patient discomfort.
- Cannot discern stenosis from occlusion.
- Significant obstruction with good collaterals may result in a normal pressure.
What should you do if a cardiac arrhythmia are present?
Drop the pressure slowly to catch the first pulse.
