Chapter 9: Digits Plethysmography and pressures Flashcards Preview

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Flashcards in Chapter 9: Digits Plethysmography and pressures Deck (23):
1

digit plethysmography and pressures helps to

detect presence of arterial disease
differentiate fixed arterial obstruction from vasoplasm
asses effects of treament

2

limitations of digit plethysmography and pressures

quality of tracings effects by vasoconstriction from temperature (pt coming in from cold weather, cold room)
bandages that can't be removed
ulcers
patient with tremor

3

with volume plethymography cuffs applied too tightly can

obliterate or diminish pulse waveforms

4

with photo plethysmography improper skin contact will cause

poor results

5

patient positioning for digit plethysmography and pressures

toe evaluation: supine with some elevation of head
finger evaluation: sitting with arms resting on pillow placed on patients lap

6

technique for toe plethysmography

pt kept as warm as possible
study done in combination with a complete LE arterial exam or limited ABI
cuff atleast 1.2 times the size of toe (2.5-3cm) applied to base of big toe

7

usual method for obtaining great toe pressures is

PPG

8

PPG great toe pressures method

cuff placed at base of great toe
photocell attached to plantar side of toe using tape or velcro
pulses recorded
paper speed slowed to 5mm/sec
cuff inflated 20-30 mmHg above highest brachial
cuff deflated waiting for return of first pule to define pressure level

9

Fingers without cold stress technique

complete UE arterial study
eval doppler signals and obtain pressures
doppler palmar arch to verify patency
apply finger cuffs (2-2.5cm)
pressures and waveforms obtained similar to toes

10

fingers with cold stress are preformed

in cases of symptoms occurring due to cold sensitivity

11

fingers with cold stress technique

after resting hands are immersed in cold water for 3 minutes
waveforms and pressures obtained following cold stress immediately after and then 5 minutes after

12

what should you document in fingers with cold stress technique

skin color

13

interpretation of digital plethysmography normal waveforms:

sharp upstroke during peak systole
prolonged down-stroke with notch (reflected wave) approximately halfway down

14

interpretation of digital plethysmography abnormal obstructive waveforms:

slow upslope
rounded peak
downslope bows away from baseline

15

occlusion located anywhere proximal to the tip of finger causes

pulses to assume obstructive form

16

abnormal peaked waveform qualities

upslope slower than normal
sharp anacrotic notch is present
reflected wave located high on the downslope
characteristics of normal and obstructive waveforms

17

organic (fixed) obstructive disease has

abnormal doppler arterial signals, systolic pressures and PPG tracings

18

Functional (intermittent) obstructive disease has

normal doppler arterial signals, systolic pressures and PPG tracings
has abnormal findings after cold stimulation

19

sumner and strandness say peaked pulse is seen

with patients with raynauds

20

UE digits normal finger/brachial indices

.8-.9

21

Toe/brachial indices

vary from 60-80% if brachial pressure

22

the presence of artificially high ankle pressures from arterial calcinosis usually

negates a toe/ankle P index

23

the pressure index seen with digital artery occlusion is

severely reduced