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November 2002

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Subject:
From:
"T.D.Case" <[log in to unmask]>
Reply To:
UVM Flownet <[log in to unmask]>
Date:
Fri, 8 Nov 2002 09:17:57 -0500
Content-Type:
text/plain
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Andy;

Automated blood pressures may be performed by oscillometric devices similar
to those done in ICU's, O.R.'s etc. They are actually quite accurate however
not sensitive for pressures below 60 mmHg. Oscillometric pressures also
provide a mean arterial pressures as well as diastolic pressures. To detect
pressures below 60 mmHg of pressure without traditional Doppler and
monometric devices, there is also what is referred to as the Pole Test. This
simple procedure is based on hydrostatic pressure and requires making a
measuring stick, marked at 13 cm intervals. One places the Doppler on the AT
or PTA and with the patient supine, slowly raises the foot until the signal
disappears, the point which is referred to as Buerger's sign (actually
Buerger's sign is when the foot becomes cadeveric which is assuming the same
physiologic response). The height of elevation is then compared to the
"measuring stick" and each 13 cm of height corresponds to a drop of 10 mmHg
of pressure.

Terry Case

----- Original Message -----
From: "Andy Wallace" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, November 07, 2002 9:44 AM
Subject: Re: Screening device for PVD?


> I now have accurate information concerning this
> screening device.  It is called "Vasocor Vascular
> Diagnostic Center"  They use the Framingham study to
> predict risk of CHD, PVD, and Stroke.  They use
> plethysmography to evaluate arterial compliance which
> they have studies on showing this correlates with
> Athersclerotic burden.  I'm sure this is where the
> person who asked me to investigate this got the
> plethysmography from. The next part is what caught my
> eye.  They are doing Ankle Brachial Indices. However,
> they are using automated BP technology.  I'm
> comfortable with the nursing units using this
> technology for brachial pressures.  I've not heard of
> anyone using the automated BP technology for ankle
> pressures.  I certainly have concerns especially in
> those patients who do have significant disease and
> faint pulses. Does anyone have any experience with
> this equipment or have referrals from a primary care
> MD who uses this equipment.  Do you get too many false
> positives, false negatives??  Thank you again in
> advance for your feedback.
> Andy Wallace RVT, RDCS, RDMS
> Manitowoc, WI
>
>
> --- Andy Wallace <[log in to unmask]> wrote:
> > A sales person got to one of our networks Family
> > Practice physicians and sold him on the idea of a
> > screening device for PVD.  It sounds like the device
> > uses a pneumoplethysmograph in some way.  I'm not
> > sure
> > of what criteria this equipment or perhaps the
> > physician uses to define PVD.  This is supposed to
> > be
> > simple enough to use that CNAs or LPNs with very
> > little training can use it accurately.  I don't
> > believe he is looking to charge for the service only
> > to use as a "possibly" more accurate method than his
> > fingers on distal pulses.  Our vascular surgeon
> > feels
> > this device will over call PVD and we'll end up with
> > a
> > lot of normal segmental pressures on asymptomatic
> > patients.  I've not heard of any "screening" device
> > like this and am looking to see what others
> > experience
> > has been with something like this.  My experience
> > and
> > knowledge tells me the simplest and most accurate
> > method of screening for PVD is ABIs.  Has anyone had
> > any experience with a device of this type?  If not
> > this type, any other simple device that can
> > accurately
> > be used in a Family Practice setting?  I looking to
> > help them provide this service accurately.  I
> > certainly have strong feelings about this but I'm
> > not
> > the one in control of this environment.  I can only
> > try and have a positive impact.  Thank You in
> > advance
> > for any information you might have.
> >
> > Andy Wallace RVT, RDMS, RDCS
> > Manitowoc, WI
> >
> >
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