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29 Cards in this Set
- Front
- Back
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6 tests/measures used for AI
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Pulses
Doppler ABI Segmental pressure Rubor of dependency Venous filling time |
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What arteries should be assessed when taking peripheral pulses
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Femoral, popliteal, posterior tibial, dorsal pedal
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How are pulses graded?
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0 to 3+ from absent to accentuated
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Why do you need to perform a doppler US if pedal pulses are absent?
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May be difficult to palpate due to edema
Pulse pressures are weak and may be missed by examiner |
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What would make you determine that pulses are absent with doppler US?
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Lack of audible, swooshing noise when over artery
Indicates lack of perfusion |
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Fomula for ABI?
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SBP of LE/SBP of UE
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Examples of more invasive measures that can be ordered to assess AI?
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Transcutaneous oxygen measurement
Arteriogram |
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ABI values: Vessel calcification, normal, moderate AI?
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1.1-1.3
.9-1.1 is nomral .5-.7 is moderate. May try conservative care at first, but possible candidate for revascularization |
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Does an ABI of 1.1 to 1.3 indicate normal perfusion?
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No, it indicates vessel calcification which is common with DM patients
Need to order an arteriogram or transcutaneous oxygen measurement |
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What are segmental pressure measurements?
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Take BP w/ doppler at above malleoli, below knee, and around thigh
Pressure drop of greater than 20 mmHg indicates significant arterial occlusion in adjacent segments Doppler at dorsal pedal and pos tib a. Better at identifying distal occlusions |
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Normal capillary refill time? What does an abnormal time indicate?
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Less than 3 seconds
Delayed with AI Indicator of SURFACE perfusion |
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How do you perform the rubor of dependency test?
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Elevate pts leg to 60 deg for 60 seconds
Pallor occurs within 30 seconds for mild AI and 45-60 for moderate insufficiency Dependent rubor when limb is bought back down immediatley |
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What is dependent rubor? What is the 2 step process of it?
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Reactive hyperemia - Arterioles dilate b/c tissue is deprived of oxygen
When put in dependent position, BF inc's significantly thru the maximally dilated vessels = very red |
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How do you perform Venous Filling Time test? What indicates AI vs. VI?
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Eleveate leg 60 deg for 60 seconds until veins are drained
Place limb in dependent position and record time it takes for superficial veins to fill >20 seconds = AI <5 seconds = VI |
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What tests may you do for AI if the pt is unable to tolerate the ABI test?
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Rubor of dependency
Venous filling time |
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Bad prognostic indicators for AIU?
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Deeper or involve greater tissue loss
Rapid decline in wound status |
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5 tests/measures used to assess VI
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DVT clinical assessment
ABI Trendelenburg's Test Doppler US Venous filling time |
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What is the Clinical Prediction Guideline for DVT?
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Incorporates risk factros for the development of a DVT as well as alternative diagnoses that may produce a false-positive diagnosis of DVT
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Why should an ABI be performed on a suspected VIU?
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AI and VI coexist in 15-25% of all LE ulcers
Presence of AI would contraindicate the use of compression |
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What is the Trendelenburg test used to identify? Deep vs. superficial?
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Vein incompetence.
Superficial = venous distention occuring after tourniquet is released Deep/perforating = Pt stands and venous distention occurs in less than 20 seconds |
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How is the Trendelenburg Test performed?
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Eleveate leg to 45 deg for 60 seconds and note amt. of superficial venous distention
Secure a tourniquet around distal thigh and have pt stand up (deep incompetence) Remove tourniquet (superficial incompetence) |
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3 parts of the Venous Doppler US
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1. Resting test: should have spontaneous sound
2. Augmentation test: quick distal squeeze. Should enhance doppler signal 3. Reflux test: quick proximal squeeze. Signal should disappear and then returned when pressure is released. If compressoin proximal enhances the signal it may indicate valve incompetence |
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AI vs. VI: PAIN
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AI is severe and inc with eleveation
VI is mild and dec with elevation |
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AI vs VI: POSITION
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AI = distal toes, dorsal foot
VI = medial malleolus, medial lower leg |
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AI vs. VI: PRESENTATION
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AI = regular appearance, pale granulation, black eschar, gangrene, little or no drainage
VI = Irregular shape, red/ruddy wound bed, glossy coating over woundbed, copious drainage |
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AI vs. VI: Periwound
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AI = thin, shiny anhydrou skin with loss of hair growth. Thickened, yellow nails
VI = edema, cellulitis/dermatitis with hemosiderin deposition |
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AI vs. VI: Pulses
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AI = dec or absent
VI = Normal. May be dec if co-existing AI |
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AI vs. VI: Temperature
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AI = Dec
VI = Normal |
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Predictors of poor prognostic healing for VI
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Large ulcer size
Longer time (>3 mo) Inc in wound size over 4 weeks of intervention Concomitant AI Older age NOT INDICATORS: gender, race, infection, skin conditions |
