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Technologies
- Doppler Ultrasound
- ABI (Ankle Brachial Index)
- Rubor of Dependency
- Pulse Oximetry
- Pressure Mapping
- Videofluoroscopy
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Doppler Ultrasound
- Noninvasive
- Used to detect peripheral blood flow
- Presence or absence of blood flow in a range of positions
- Cannot determine adequate perfusion
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Ankle Brachial Index
- Noninvasive
- Assesses severity of arterial disease
- Positioning with arterial insufficiency
- Elevation Contraindicated
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ABI Readings
- Divide ankle systolic by brachial systolic
> 1.0 = Normal
0.8 -1.0 = Mild Occlusion
0.5 - 0.8 = Moderate Occlusion
< 0.5 = Severe Occlusion |
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Rubor of Dependency
- Tests the adequacy of arterial circulation
- Note color of soles of feet in supine position
- Normal = pinkish color
- Impaired circulation = chalky white
- Elevate legs to @ 45 degrees
- Arterial involvement = greyish white
- Bring to sitting, impaired = bright red
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Positioning for Arterial Insufficiency
- Elevation of extremities vs no elevation
- Use of tilt in strongest circulatory position
- Adequate thigh support
- Open popliteal space
- Foot support
- Avoid constrictive clothing
- Encourage movement
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Positioning for Arterial Insufficiency
- Slight elevation
- Below the heart
- Open knee angle
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Venous Insufficiency
- Elevate extremities
- Multiple positions in space
- Programmed positioning
- Open knee angle slightly
- Compressive hosiery
- Skin checks for breakdown
- Encourage movement-- avoid static positions
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Venous Insufficiency
- Arterial and venous insufficiency can occur simultaneously
- Arterial problems rule decisions about elevation and compression
- Specifically design angle of tilt and elevation
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Pulse Oximetry
- Non-invasive
- Measures pulse rate and 02 saturation
- Sa02 should be 90% or above
- Test Sa02 in proposed positions
- Tilt/Recline/Upright
- Open seat to back angle
- Rotation
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Pressure Mapping
- Identify areas of concern or risk
- Assist in positioning to avoid pressure sores
- @ > 80mmHg May be at risk
- Positioning options
- Tilt in space
- Various seat or foot cushions
- Various wheelchair frames
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Pressure Mapping
Pressure map shows two areas of increased pressure that may cause skin breakdown |