Pressure Ulcers

Ankle Brachial Index

performed with doppler ultrasound

provides information about arterial system

indicator of loss of perfusion in the LE

compares SBP at ankle and arm

screening assessment of peripheral arterial disease can be done with ABI

ABI equation

ankle SBP/ arm SBP

>1.2

falsely elevated, arterial disease, diabetes

1.19-0.95

normal

0.94-0.75

mild arterial disease, intermittenet claudication

0.74-0.50

moderate arterial disease, rest pain

<0.50

severe arterial disease

ABI >1.3 contradiction to

compression therapy

ABI 0.88-0.99

compression therapy with caution

ABI <0.8 contraindicates

compression therapy

peripheral arterial disease

narrowing of blood vessels secondary to atherosclerosis

compromised circulation to extremities

suspect ischemia when SBP is lower at ankle than arm

peripheral arterial disease characteristics

pallor (lack of color)

shiny/dry skin

hair loss

strongly associated with smoking

arterial insufficiency

linked to PAD and intermittent claudication

caused by inadequate perfusion of blood in affected extremity

chronic venous insufficiency

inadequate drainage of venous blood from a body part usually resulting in edema and/or skin abnormalities and ulcerations that persists over long period of time

affects distal LE

chronic venous insufficiency presentation

edema, heaviness

stasis dermatitis

hemosiderin staining

symptoms decrease with elevation

diabetic neuropathy

ulceration located on weight bearing surfaces of the foot

patient unable to sense pain and pressure

loss of intrinsic muscles

decreased or absent sweat and oil production leading to dry inelastic skin

arterial insufficiency ulcer recommendations

rest, limb protection, inspect legs and feet daily, avoid leg elevation, avoid heat pads and soaking feet in hot water, wear appropriately sized shoes and clean socks

venous insufficiency ulcer recommendations

limb protection, risk reduction education, inspect legs and feet daily, compression to control edema, elevate legs above heart, active exercises, wear appropriately sized shoes and clean socks

neuropathic ulcer recommendations