Investigations

Ankle Brachial Pressure Index

If venous disease is suspected, the patient should have an ankle brachial pressure index (ABPI) performed to assess the arterial circulation. This involves measuring the blood flow in the arteries of the lower leg compared to that in the upper arm and is recorded as ABPI. Evaluation of peripheral circulation of the lower limb is essential in deciding to use compression. Inappropriate high compression bandaging may place the limb at risk of damage. It is generally accepted that ABPI >0.8 allows for compression to be safely applied, however, reduced compression may be applied with ABPI 0.5- 0.8 by an experienced practitioner.

FORMULA: Highest ankle pressure /highest brachial pressure = ABPI

Ankle – brachial index interpretation:

Above 0.90 – Normal

0.71-0.90 – mild obstruction

0.41 – 0.70 – moderate obstruction

0.00 – 0.40 – severe obstruction

Doppler assessment can be performed manually using a hand held Doppler or with an automatic Doppler machine (e.g. DOPPLEX ABILITY)

Further Readingwww.huntleigh-diagnostics.com

Vowden, P. and Vowden, K.R., (2001) Doppler assessment and ABPI: Interpretation in the management of leg ulceration. worldwidewounds.com

http://www.worldwidewounds.com/2001/march/Vowden/Doppler-assessment-and-ABPI.html

BLOOD TESTS

  • FBC – anaemia may delay healing
  • ESR/CRP – markers for inflammation and infection
  • U&Es – dehydration may delay healing
  • HbA1c and FPG – assess for diabetes mellitus and/or control
  • Albumin – low albumin may be associated with protein loss which may delay healing

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