Practice development Ten top tips for Doppler ABPI


The blood pressure cuff should be inflated


until the signal disappears, then the cuff slowly released while the nurse listens carefully for the signal to emerge. This is recorded as the brachial systolic pressure. This is then repeated on the other arm. The highest systolic pressure is used to compare against the ankle pressures.


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Blood pressure: The patient’s ulcer is then exposed and covered in cling film [Fig 3]. The nurse should then locate the patient’s pedal (foot) pulse to assess the arteries [Fig 4].


Two of these four pedal pulses can be used: n Anterior tibial artery n Posterior tibial artery n Peroneal artery n Dorsalis pedis artery.


The two most common arteries used in


the procedure are the dorsalis pedis and posterior tibial arteries, mainly because they are accessible when the blood pressure cuff is applied to the leg. The blood pressure cuff is then applied just above the patient’s malleoli (ankle). While the registered nurse applies the


Doppler probe over the artery and listens for the signal, the other nurse slowly inflates the blood pressure cuff. The registered nurse listens for the


Doppler signal to disappear due to the artery’s occlusion by the blood pressure cuff.


The cuff is then slowly deflated and both


nurses observe the pressure at which the Doppler signal reappears — this pressure is recorded for that artery. The registered nurse finds another pedal artery and the process is repeated. If the artery cannot be compressed by the blood pressure cuff, this indicates severe disease.


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Blood pressure result: In theory, a patient’s brachial blood pressure should be the


same as the ankle.


Doppler ultrasound signals: In addition to recording the ABPI, the nurse should also


be listening to the signals of the Doppler probe as these can impart useful information and are equally as valuable as the ABPI measurement.


Triphasic signal This is represented by three sounds heard very quickly together (duh...duh...dum), as the blood runs through a healthy non-diseased artery.


Biphasic signal This can be recognised as two sounds heard together (duh, dum ... duh, dum), this may be because the Doppler probe is not at the optimum angle. Again, it indicates a healthy artery.


Monophasic signal A single, almost ‘banging’ sound (...dum! ...) indicates that the Doppler signal is unable to penetrate a diseased artery.


Expert Commentary Geoff Sussman, Associate Professor, Consultant Wound Clinic,


Austin Hospital, Heidelberg, Victoria, Australia Useful links


Doppler and ABPI or LOI in screening for arterial disease


As a senior consultant at a very busy tertiary referral wound clinic in a major Australian hospital, I believe accurate vascular assessment is essential. Our clinic has five rooms and a multidisciplinary staff including medics, nurses, podiatrists, pharmacists, a dermatologist, plastic surgeon, dietician and an on-call orthotist.


We often treat 35–40 patients each day when we are open.


We have recently introduced an automatic ankle brachial pressure index (ABPI) system and the major advantage of this is the reduction in the time needed to obtain an ABPI measurement on each new patient attending the clinic, or those needing to be retested.


Patients do not need to rest prior to the procedure and the actual test time takes only a few minutes.


The simplicity of applying the cuffs to the patient and the operation of the test allows the procedure to be performed by any member of staff, even unqualified staff (after training). The test provides bilateral results often not done if only one leg is implicated. The result provided includes bilateral ABPIs and a wave form.


This device will be of great value in a busy clinic where time is at a premium.


www.woundsinternational.com


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Practice development


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