I was taught by some very smart physicians to find out specifically what
question I was trying to answer and then use the best tool available to
answer the question. I find it a worthwhile struggle to accurately
frame the question before using a test. For instance. At times the
question simply is "Is this patients cold foot due to PVD?" (I often get
this from ICU nurses at night who feel a cold foot. Often the question
is "Do we need to do an angiogram on this diabetic patient with foot
ulcers?" Triphasic waveforms at the ankle and adequate toe pressures do
NOT suggest the need for duplex.
Just because we have the technology does not mean we should use it on
everybody - just because you have a sledge hammer doesn't mean that you
should use it on a tack. We must ask the correct question before
resorting to a blanket use of any exam.
T Cunningham wrote:
> As segmental pressures are notoriously inaccurate in the presence of
> calcified arteries (how many elderly, often diabetic, patients don't have
> calcific arteries?)
> the duplex exam is virtually necessary for a good understanding of a
> patient's LEA
> We have found that ABI's, toe plethysmography, and duplex (triplex actually)
> help r/o neuropathy while more accurately defining the PAD if present.
> As far as revenue enhancement - if ABI's, doppler ankle, and toe pressures
> are normal the patient is spared the cost of a duplex exam. And in any case
> the patient is never charged for a full segmental exam.
> T Cunningham, RVT, RDCS