hello I'm anne-marie McLaren I'm a foot
specialist on a wound team in Toronto
Ontario I'd like to demonstrate how to
perform an ankle brachial index using
the ankle pressure divided by the
brachial pressure to perform an ankle
brachial index you will need a handheld
Doppler ultrasound gel and a manual
blood pressure cuff so the next thing is
that you actually want to make sure that
your patient is lying comfortably and
relaxed for about 10 minutes to
stabilize their blood pressure it's also
important to remind your patient not to
speak while you're doing the test
you apply the blood pressure cuff to the
patient's arm taking care that you leave
enough space so that you can still
access your brachial artery
that's the per-click artery here
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and then using your handheld Doppler
we're going to listen for a brachial
pulse and it signo how is it how is it
how does it you can probably hear how to
break you or how they know how it is
helpful now what I want to do is we have
an inflatable hello hello
no blood pressure hello hello hello
hello eliminate the signal when we want
to gently deflate the blood pressure
cuff until we can hear the signal and
you notice we notice the signal around a
hundred the return of the signal is the
brachial measure or the denominator for
the ankle brachial index we would
complete the process on the other arm
and we would compare the left and right
we would choose the highest measure to
be the denominator for our ankle
brachial index calculation now we're
going to use and measure our ankle index
by locating the pulses in the lower limb
in particular we're going to be looking
for the dorsalis pedis pulse which is
located on the dorsum of the foot and
the posterior tibial pulse which is
located just behind the medial malleolus
so I've located the dorsalis pedis pulse
on the dorsum of the foot and I can also
feel the posterior tibial pulse which is
located just behind the medial malleolus
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and I'm going to repeat the procedure by
applying the blood pressure cuff and
we're going to again look for the pulse
signals using hand-held Doppler to
acquire our ankle pressure measurements
so first off I'm going to apply the
blood pressure cuff to the ankle now
we're going to apply some ultrasonic gel
to the dorsalis pedis pulse then we're
going to use our handheld Doppler to
locate the dorsalis pedis signal got a
nice strong signal here now we're going
to repeat like what we did in the arms
with the foot we're going to inflate the
blood pressure cuff until we no longer
hear a signal we're going to gradually
decrease the pressure so we hear a
return signal we can see it returned at
100
now that we've located the posterior
tibial artery we're going to apply a
small amount of ultrasound gel
using a handheld Doppler we're going to
locate the posterior tibial pulse
and its signal now that we have located
the posterior tibial signal we're going
to inflate our blood pressure cuff until
we no longer can hear the signal and
then we're going to gradually release
the blood pressure cuff until the signal
returned and again we saw that at 100
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now we're going to repeat this on the
other ankle we're going to again measure
the dorsalis pedis and the posterior
tibial measure we're going to take the
highest measure and use that as our
numerator for our calculation of the
ankle brachial index
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you
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