Purpose: This document was originally developed by the WOCN Society's Clinical Practice Wound Subcommittee as a best practice document for clinicians.1 Its purpose is to provide clinicians with relevant information about the ankle brachial index (ABI) and a research-based protocol to use in performing the ABI to insure
reliability and validity of the results. Originated By: WOCN Clinical Practice Wound Subcommittee, 2005 Updated/Revised: WOCN Wound Committee, 2010-2011 Date Completed: Original Publication Date: 2005 Revised: 2011 Lower extremity arterial disease (LEAD) is a chronic, progressive disease. Risk factors for LEAD are advanced age, tobacco use, diabetes, dyslipidemia, hypertension, hyperhomocysteinemia, chronic renal insufficiency, family history of cardiovascular disease and African American ethnicity.2 Current data about prevalence and incidence of LEAD in the U.S. are limited.
According to a hallmark U.S. study (N = 6979), 29% of individuals aged 70 years or older and 29% of individuals aged 50 through 69 years (that have a history of tobacco use or diabetes), had LEAD based on an ABI of less than 0.9.3 More recently, investigators in a population-based study in Sweden (N = 5080), reported the prevalence of LEAD was 18%.4 Approximately half of individuals with
LEAD are undiagnosed because they are asymptomatic or have atypical symptoms and health care providers use unreliable methods to assess for LEAD such as pulse palpation or a history of claudication.2,5–7 It is recommended that health care
providers use valid and reliable, non-invasive tests such as the ABI to detect LEAD.2,8–10 ABI is a noninvasive vascular screening test to identify large vessel,
peripheral arterial disease by comparing systolic blood pressures in the ankle to the higher of the brachial systolic blood pressures, which is the best estimate of central systolic blood pressure.8,11–14 ABI is performed using a
continuous wave Doppler, a sphygmomanometer and pressure cuffs to measure brachial and ankle systolic pressures.14,15 The use of pulse palpation or automated blood pressure devices to measure blood pressures for the ABI are not considered
reliable.16,17 The ABI has high sensitivity and specificity and its accuracy to establish the diagnosis of LEAD has been well established.9,15 ABI is a ratio derived from
dividing the higher of the ankle pressures (i.e., dorsalis pedis and posterior tibial) for each leg by the higher of the right and left arm's brachial systolic pressures.6 If blood flow is normal in the lower extremities, the pressure at the ankle should equal or be slightly higher than that in the arm with an ABI of 1.0 or more. An ABI less than 0.9 indicates
LEAD.2,8,9,11 If performed by an educated professional, using proper equipment and following a research-based procedure, the ABI
obtained using a pocket Doppler is interchangeable with vascular laboratory tests to detect LEAD.8,18 The purpose of the ABI is to support the diagnosis of vascular disease by providing an objective indicator of arterial perfusion to a lower extremity. Before performing ABI, it is important to obtain a thorough history and physical. The
Table addresses relevant factors in assessment and performing the ABI: history/physical findings, considerations, and decision to proceed with ABI. ABI Procedure Relevant Factors in Assessment and Performing
the Ankle Brachial Index (ABI) Relevant Factors in Assessment and Performing the Ankle Brachial Index (ABI) Relevant Factors in Assessment and Performing the Ankle Brachial Index (ABI) Relevant Factors in Assessment and Performing the Ankle Brachial Index (ABI) Place the cuff on the patient's lower leg with
the bottom of the cuff approximately 2-3 cm above the malleolus. 1. Divide the higher of the
dorsalis pedis or posterior tibial systolic pressure for each ankle by the higher of the right and left brachial pressures to obtain the ABI for each leg. 2.
Interpret and compare the ABI values from each leg.2 No title available. Acute deep vein thrombosis (DVT): A thrombus or the formation of a blood clot that causes an outflow obstruction in the deep veins of the extremity. Veins distal to the
obstruction become distended and venous pressure increases resulting in venous stasis. Signs and symptoms include pain, edema, erythema of the extremity and a positive Homan's sign. Adult blood pressure cuff, large: Upper extremity, large, adult blood pressure cuff, which is appropriate for an arm circumference of 32.1-43.4 cm (12.6-17.1 in.). It has a length of 64.39 cm (25.35 in.) and a width of 17.02 cm
(6.70 in.). Arterial insufficiency: Lack of sufficient blood flow in arteries to extremities, which can be caused by cholesterol deposits (atherosclerosis), clots (emboli), or damaged, diseased, or weakened vessels. Compression therapy: Application of sustained external pressure to the affected lower extremity to control edema
and aid the return of venous blood to the heart. May be achieved by static compression (i.e., elastic and/or inelastic wraps, garments, or orthotics with single or multi-components/layers) or dynamic compression (i.e., intermittent pneumatic compression pumps). Doppler scanning: Doppler velocity waveform analysis uses continuous-wave Doppler ultrasound to record arterial pulsations in various lower-extremity
arteries. Dorsalis pedis artery: The continuation of the anterior tibial artery of the lower leg. It starts at the ankle joint, divides into five branches, and supplies various muscles of the foot and toes. The dorsalis pedis pulse can be palpated on the mid-dorsum of the foot, between the first and second metatarsals. Duplex ultrasound: Test combines traditional ultrasound that uses sound waves that bounce off blood vessels to create images with Doppler ultrasonography that examines how sound waves reflect off moving objects such as red blood cells. Non-compressible blood vessels: The process in which vessels become hardened by the deposition of calcium salts in the tissues. Pain scale: A means to measure the existence and intensity of pain. A standardized pain assessment instrument, such as the Wong-Baker Faces Pain Rating Scale or 0-10 Numeric Pain Intensity Scale. Photoplethysmography (PPG): PPG determines blood flow by attaching a photosensor/transducer to the skin, which emits an infrared light that is reflected by the red blood cells in the vessels and is detected by the transducer. The amount of light reflected, corresponds to pulsatile changes and the tissue's blood volume. Toe pressure is obtained by attaching a PPG photosensor to the toe pad to record pulse changes and a small digit pressure cuff is placed at the base of the toe to measure the pressure. Posterior tibial artery: One of the parts of the popliteal artery of the leg. It divides into eight branches, which supply blood to different muscles of the lower leg, foot, and toes. It is situated midway between the medial malleolus and the medial process of the calcaneal tuberosity. The posterior tibial pulse can be palpated in the groove behind the medial malleolus. Purpura: A disorder with bleeding beneath the skin or mucous membranes. It causes black and blue spots (ecchymoses) or pinpoint bleeding. Toe brachial index (TBI): TBI is a noninvasive test of arterial perfusion of the lower extremity that is obtained by comparing the systolic pressure in the great toe or second toe (if great toe is absent) to the higher of the right or left arm's systolic pressures. The TBI is a ratio derived by dividing the toe pressure by the arm pressure. Transcutaneous oxygen measurement: A test to determine the oxygen tension in the skin by placement of a sensor that measures the oxygen pressure at a localized area on the surface of the skin. Venous insufficiency: Failure of the valves of the veins to function that leads to decreased return of venous blood from the legs to the trunk of the body; may produce edema. References1. Wound, Ostomy and Continence Nurses Society. Ankle Brachial Index: Best Practice for Clinicians. Mt. Laurel, NJ: Author; 2005. 2. Wound, Ostomy and Continence Nurses Society. 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Ankle-brachial index screening for peripheral artery disease in asymptomatic patients between 50 and 70 years of age. J Int Med Res. 2009;37:1611–1619. How do you know if you have a blockage with a stoma?You will know when you have a blockage as your bag will be empty when usually it is filling up. Another symptom of a blocked stoma, in addition to your output slowing down, is stomach-ache. You may start to feel waves of cramping and abdominal pain, which may worsen if the symptoms you experience are unresolved.
What findings would you expect to see when assessing a healthy ostomy stoma?A stoma should be pink to red in colour, raised above skin level, and moist. Skin surrounding the stoma should be intact and free from wounds, rashes, or skin breakdown. Notify wound care nurse if you are concerned about peristomal skin.
What causes a stoma to shrink?First 6-8 weeks
The reason for that is whenever the surgeon is forming the stoma he has to handle your bowel. Whenever the surgeon handles the bowel, it causes it to swell. So, it takes about 6-8 weeks for it to shrink and reduce in shape and size.
What does a pale stoma indicate?Major changes in the color of a stoma, including extreme paleness or extremely darkening, are signs that the tissues are not receiving enough blood. An extremely pale stoma means that the blood supply is poor. A purplish, or blackish color is an indication that tissues are dying (referred to as necrosis ).
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