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Hands on, tips and tricks using PeriFlux 6000


Published on

The aim of this document is to describe the workflow for
the toe and ankle pressure procedure using Perimeds PeriFlux 6000, including some
useful tips and tricks.

Published in: Health & Medicine
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Hands on, tips and tricks using PeriFlux 6000

  1. 1. Hands on, Tips and Tricks PeriFlux 6000 | peripheral pressure made intelligent 44-00317-01
  2. 2. 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. All information and content in this document is protected by copyright. All rights are reserved. Users are prohibited from modifying, copying, distributing, transmitting, displaying, publishing, selling, licensing, creating derivative works, or using any information available in or through the document for commercial or public purposes. All responsibility for any liability, loss or risk, personal or otherwise, which is incurred as a consequence, directly or indirectly, of the use and application of any of the material in this document is specifically disclaimed.
  3. 3. • 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
  4. 4. Introduction The aim of this document is to describe the workflow for the toe and ankle pressure procedure, including some useful tips and tricks.
  5. 5. 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
  6. 6. 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.
  7. 7. Choose Correct Cuff Size ARMS: SC12 ANKLES: 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
  8. 8. Positioning of Cuffs ARMS: SC12 ANKLES: 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)
  9. 9. Cold Feet with Constricted Vessels? Tid (s) Perfusion (PU) Pressure (mmHg) 200 0 100 200 0 100 v 2010 30 40 50 60 103 mmHg Do not attempt to measure pressures if perfusion < 20 PU
  10. 10. Heated Probes Increase the Signal PROBE 407 Small straight probe without heat ∆ low change Pressure (mmHg) Pressure (mmHg) Perfusion(PU) Perfusion(PU) PROBE 457 Thermostatic probe with heat ∆ big change Local heat in laser Doppler probes: • Increase the signal • Facilitate interpretation • Standardize measurements
  11. 11. 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 Perfusion(PU) Good occlusion
  12. 12. 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.
  13. 13. Low Pressures – Correct or Not? • Confirm a low pressure – Rule out technical issues – Identify critical patients
  14. 14. 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
  15. 15. 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
  16. 16. 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.
  17. 17. Are probes and cuffs properly attached? Is the foot cold? • Heat feet or use heated probe • Increase inflation pressure • Hold the pressure longer • Lift legs or ”pinch” toes Summary Is the pressure in the cuffs enough for complete occusion? Extremely low toe pressure? Best practice – perform 3 repetions • Perform Pole Test or measure in sitting position • Adjust if necessary
  18. 18. Thank You! PeriFlux 6000 | peripheral pressure made intelligent