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I think you should stop using PPG waveforms to determine your ABI (use the CW Doppler).  I just eyeball the limb.  If the limb is skinny, use the 10cm, if it's thick, use the 12cm.  Floppy arm, use the 12cm.  You can always use a disclaimer that the exam results may be influenced by body habitus.  I suppose if you want to be incredibly anal-retentive, you could use a tape measure and a calculator to determine whether to use a 10 or 12cm cuff but I doubt that's necessary.

 Matt



-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of pbatlanta1
Sent: Saturday, January 16, 2010 09:56
To: [log in to unmask]
Subject: Cold toes and big arms

After doing some analysis we discovered a fairly high rate of false positives when  
ABI's are performed using PPG probes. Does anyone use heating pads to warm 
patients toes before testing?

Also, does someone have a method for assessing whether a 10cm or 12 cm cuff is 
appropriate for the brachial pressures, rather than just "eye-balling" the arm and 
determining if the cuff is at least 20% wider than the arm?  Additionally, how do 
you determine what an appropriate cuff size is for "flabby" arms, where the 
medial-lateral diameter is much smaller then the anterior-posterior diameter?

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