Procedure: ABPI Flashcards
(37 cards)
How do you explain to a patient what ankle-brachial pressure index is?
A test that compares the blood pressure in your legs to the blood pressure in your arms, to help diagnose peripheral arterial disease
Which 2 questions should you ask the patient before starting the ABPI procedure?
Do you have diabetes?
Are you in any pain?
What position should the patient ideally be in for the ABPI procedure, and why?
Lying on bed completely flat, so that the brachial pulse is at heart level and won’t be artificially influenced by hydrostatic pressure or gravity
Can be lying at 45 degrees but should put pillow under arm so that the brachial pulse is still at heart level, to reduce influence of gravity
What are the contraindications for having an ABPI?
Suspected DVT or superficial thrombophlebitis: Doppler probe could be painful or dislodge the clot
Severe leg pain
Cellulitis
Recent surgery, ulcers, casts, bandages that can’t be compressed
When measuring brachial blood pressure for ABPI, what should you apply first?
Put blood pressure cuff on patient’s arm with tubing facing towards probe
Inflate cuff slightly to make sure you which way to turn dial, warn patient that you are going to check that cuff is working
In ABPI, after putting on the blood pressure cuff how do you locate the brachial pulse?
Palpate the brachial pulse with fingers (don’t need to use stethoscope) to estimate where to use Doppler probe
In ABPI, after palpating the brachial pulse what should you do, and why?
Apply ultrasound gel over where the brachial pulse was palpated
Ultrasound gel is designed to minimise air bubbles between skin and the Doppler probe, so sound waves will travel better
What Doppler probe frequency is used for ABPI?
8Hz
In ABPI, how do you locate the brachial pulse with the Doppler probe?
- Turn on probe
- Slowly move from side to side over the ultrasound gel until you hear waveform
- Hold probe at 45 to 60 degrees to skin to obtain clearest waveform signal
In ABPI, how do you measure the brachial pulse after locating the clearest waveform with the Doppler probe?
- Warn patient that you are going to inflate cuff and it will feel tight
- Inflate blood pressure cuff 20-30mmHg above when waveform is no longer audible
- Slowly deflate cuff to see when waveform becomes audible again: This is the brachial blood pressure
In ABPI, what 2 things should you do after measuring the brachial pulse?
- Remove blood pressure cuff and wipe off ultrasound gel with tissue
- Record brachial systolic pressure
In ABPI, which arm do you use for the brachial systolic pressure?
Measure brachial systolic pressure in both arms and use the highest measurement to calculate both left and right ABPI
In ABPI for a single ankle, how many blood pressures do you measure?
2: Dorsalis pedis and posterior tibial
When measuring ankle blood pressure for ABPI, what should you apply first?
Put on blood pressure cuff with the tubes facing upwards (towards patient)
Inflate cuff slightly to make sure you which way to turn dial, warn patient that you are going to check that cuff is working
In ABPI, what should you do after putting on the blood pressure cuff to locate the dorsalis pedis and posterior tibial pulses?
Palpate with fingers where pulse is strongest, to estimate where to place Doppler probe
In ABPI, how do you locate the dorsalis pedis pulse with the Doppler probe?
- Hold Doppler probe over where dorsalis pulse was palpated (usually over bony prominence)
- Slowly move Doppler probe between 1st dorsal web space and navicular bone to find clearest waveform
- Hold Doppler probe at 45 to 6o degrees and in direction of blood flow (up towards heart)
After finding the dorsalis pedis waveform, how should you measure the dorsalis pedis systolic pressure?
- Warn patient that you are going to inflate cuff and it will feel tight
- Inflate blood pressure cuff 20-30mmHg above when waveform is no longer audible
- Slowly deflate cuff to see when waveform becomes audible again: This is the blood pressure
In ABPI, what 3 things should you do after measuring the dorsalis pedis systolic pressure?
- Deflate blood pressure cuff and wipe off ultrasound gel
- Record dorsalis pedis systolic pressure
- Tell patient that you are now going to measure the posterior tibial systolic pressure
In ABPI, how do you locate where the posterior tibial pulse is strongest?
Palpate with fingers behind medial malleolus and slightly above heel, to estimate where to put Doppler probe
In ABPI, how do you locate the posterior tibial pulse with the Doppler probe?
- Hold Doppler probe over where posterior tibial pulse was palpated (usually over bony prominence)
- Slowly move Doppler probe between back of medial malleolus and heel to find clearest waveform
- Hold Doppler probe at 45 to 6o degrees and in direction of blood flow (up towards heart)
After finding the posterior tibial pulse waveform, how do you measure the systolic blood pressure?
- Inflate cuff 20-30mmHg above when waveform disappears
- Slowly deflate cuff to see when waveform reappears: This is the posterior tibial systolic pressure
After measuring the posterior tibial systolic pressure, what 2 things should you do next?
- Remove blood pressure cuff and wipe off ultrasound gel
- Record posterior tibial systolic pressure
How do you calculate the left ABPI?
Highest left ankle blood pressure (PT or DP)
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Highest brachial blood pressure (left or right arm)
Give ABPI to 2 dp
How do you calculate the right ABPI?
Highest right ankle pressure (PT or DP)
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Highest brachial pressure (left or right arm)
Give ABPI to 2 dp
