Hands on, Tips and Tricks

PeriFlux 6000 | peripheral pressure made intelligent

44-00317-01

Disclaimer

The information contained in this document is intended to provide general

information only. It is not intended to be, nor does it constitute, medical advice.

Under no circumstances is the information contained in this document to be

interpreted as a recommendation for a particular treatment for specific

individuals. In all cases it is recommended that clinicians perform their own

interpretations of data in conjunction with the clinical assessment of their patient.

Due to Perimed’s commitment to continuous improvement of our products, all

specifications are subject to change without notice.

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• Diagnosing Peripheral Arterial Disease

(PAD), Critical Limb Ischemia (CLI) and Non-

healing Wounds

• Hands on, Tips and Tricks

• Interpreting Curves and Results

• Maintenance and Calibration

Introduction

The aim of this document is to describe the workflow for

the toe and ankle pressure procedure, including some

useful tips and tricks.

Measuring Ankle and Toe pressure

1. Attach the correct sized cuffs on ankles and toes

2. Place laser Doppler probes on toes

Make sure the probes are positione tightly!

1. Wait for a stable base line

4. Inflate cuffs 5. Deflated lineary 6. Perfusion detected

Time (s)

Perfusion

(PU)

Pressure

(mmHg)

200

0

100

200

0

100

v

2010 30 40 50 60

7. Pressure

marker placed

103 mmHg

Simultaneous Recordings

• The arm and both toes/ankle are recorded simultaneously with

3 laser Doppler probes

• Changes in blood pressure will follow the ABI & TBI

1.

2.3.

Choose Correct Cuff Size

ARMS: SC12ANKLES: SC10

Påhlsson HI et al, The cuff width influences the toe blood pressure value, Vasa. 2004;33(4):215-8

TOES: Cuffs 20 % wider than the toe diameter

• When missing the big toe - choose the next digit

• When no toes are left - choose transmetatarsal cuff

Positioning of Cuffs

ARMS: SC12ANKLES: SC10

Always make sure that the cuff is positioned

correctly and tightened appropriately!

• For ankle cuffs – place the cuff just above the

talus (ankle bone)

Cold Feet with Constricted Vessels?

Tid (s)

Perfusion

(PU)

Pressure

(mmHg)

200

0

100

200

0

100v

2010 30 40 50 60

103 mmHg

Do not attempt to measure

pressures if perfusion < 20 PU

Heated Probes Increase the Signal

PROBE 407

Small straight probe without heat

∆ low change

Pressure (mmHg) Pressure (mmHg)

Pe

rfu

sio

n (

PU

)

Pe

rfu

sio

n (

PU

)

PROBE 457

Thermostatic probe with heat

∆ big change

Local heat in laser Doppler probes:

• Increase the signal

• Facilitate interpretation

• Standardize measurements

Aim for Complete Occlusion

• Hold the pressure longer

• Increase the occlusion pressure

• Lift and ”empty” the legs

(or pinch the toes) during occlusion

Pressure (mmHg)

Pulsations at occlusion pressure

Pe

rfu

sio

n (

PU

) Good occlusion

Ankle

Pressure

(-- mmHg)

Toe

Pressure

(26 mmHg)

Diabetic patient with media Sclerosis

and Critical Limb Ischemia (CLI)

Incompressible Arteries

Calcified vessels due

to media sclerosis

become stiff and

impossible to occlude.

Pulsations at occlusion pressure

Good occlusion Toe pressures are a

better alternative in

these patients.

Low Pressures – Correct or Not?

• Confirm a low pressure

– Rule out technical issues

– Identify critical patients

1. Measure toe pressures in sitting position

2. Measure distance d in cm from toes to

heart

3. Calculate compensated toe pressures with

the formula

Toe Pressure in Sitting Position

Toe pressures (mmHg) = Measured value (mmHg) –d

1,36

• When a patient is unable to assume supine position

• To verify low pressure obtained in supine position

Pole Test

Possible to measure values:

Ankles < 45 mmHg

Toes < 55-70 mmHg

H.-I. Påhlesson. et al., The Toe Pole Test for Evaluation of Arterial Insufficiency in Diabetic Patients,

Journal of Vascular Endovascular Surgery, 1999, 18:133-137

Pole Test at toe or ankle level:

1. Elevate the leg until the LD signals drops to biological zero (BZ)

2. Lower the leg slowly until the signal appeares or has increased 10 % above BZ.

3. Record the level over the heart in cm

4. Calculate the pressure - each cm above heart level corresponds to 0.78 mmHg

Best Practice – 3 Repetitions

• Always perform three (3) consecutive measurements

• Maximum variation between two pressures < 10 mmHg

• If the variation is more than 10 mmHg, perform another

measurement

1 145

2 146

3 128

4 143

Four consecutive ankle pressures.

The 3rd pressure differs more than 10 mmHg

compared to the other pressures and is discarded.

Are probesand cuffsproperly

attached?

Is the footcold?

• Heat feet or useheated probe

• Increase inflation pressure

• Hold the pressure longer

• Lift legs or ”pinch” toes

Summary

Is the pressurein the cuffsenough for completeoccusion?

Extremelylow toe

pressure?

Best practice –perform 3 repetions

• Perform Pole Test or measure in sitting position

• Adjust if necessary

Thank You!

PeriFlux 6000 | peripheral pressure made intelligent

www.perimed-instruments.com