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Jessica
I sense your frustration but you will measuring the blood pressure of the forefoot and not the toe. That's not the end of the world but you will have to report it for what it is. I can suggest this: if you raise the foot slowly with the PPG sensor on the toe while watching for the disappearance of the signal pulsatility you will be able to estimate the pressure if it is less than approx 60mmHg (and if the patient has a flexible hip and a leg that isn't very short). Multiply the height of the sensor at the point which the waveform goes flat and multiply that height (in cm) by 0.78. If you can't get the waveform to flatten with comfortable elevation of the foot then you know the pressure is at least that high. An ischemic toe will flatten with approx 40 cms of elevation (30mmHg) or less. in my lab a red top and a lg grey top sanitizing wipe dispenser stacked on top of each other are 40 cm tall (see attached picture).
This is called the pole test and was first described in British literature. Of course they used a pole with height marks. My method would be called the sanitizer wipe canister test but I doubt that name will catch on.
Good luck.
Steve Knight BSc RVT RDCS
CVI Vascular Lab
Division of Vascular and Endovascular Surgery
Beth Israel Deaconess Medical Center
110 Francis Street, Ste 5B
Boston, MA
02215
Direct line: 617-632-9962
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________________________________________
From: UVM Flownet [[log in to unmask]] On Behalf Of Jessa Houtkooper [[log in to unmask]]
Sent: Thursday, June 27, 2013 5:14 PM
To: [log in to unmask]
Subject: PPG/ Toe pressures
If a patients toe is too small to accommodate the PPG sensor and a digital cuff, is it appropriate to place the sensor on the toe and inflate the metatarsal cuff to obtain the pressure?
Why or why not?
Jessica Houtkooper BS, RVT
Sent from my iPhone
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