Well this has certainly opened up some discussion.  Sorry for my late response but I was home with a sick child, instead of at work.

The bigger question was about cuff size, so thank you Don and Matt for the references.  Doesn't seem like there are many references to compare.  At our lab we have people using 12 cm cuffs for ankles and 10 cm cuffs at the arms typically.  In my experience the arms are bigger or about the same size as the ankles and I typically use 12 cm cuffs on the arms (unless quite skinny).  I measure the cuff width to the ankle/distal calf area and if the cuff is 2/3 wider than the area in question I use the 10 cm and if the ankle is wider then I use the 12 cm cuff.  It gets tricky if the ankles are quite large....our thigh cuff is very big.  Anyway, my hopes are to educate everyone on this topic.  We are definately in need of some QA and so I am collecting info from your brains...hope you don't mind :-)

As far as waveforms go...  We do not do PVR in our lab unless we have a complicated Dialysis patient.  We take Doppler waveforms.  We have a maximum size of 30 and we can turn down the gain if need be (if the waveforms are too large for the strip).  We use Parks.  For consistancy/comparison we keep all the waveforms the same size throughout the test.  As for the PPG waveform we don't really have a set standard that everyone uses.  What articles show the importance of waveform size consistancy.

Thank you all for your time!!

Nicole Ball, BS, RVT
President for NNEVS
Frisbie Memorial Hospital
Vascular Lab
Rochester, NH
(w) 603-692-9981

Don Ridgway <[log in to unmask]>
Sent by: UVM Flownet <[log in to unmask]>

02/04/2011 11:22 AM
Please respond to
UVM Flownet <[log in to unmask]>

[log in to unmask]
Re: Arterial Journals

I'd second Bill's response, and I'm mystified by the argle bargle. Simple answers to the two questions, established long ago:

1. Cuff size should be 1.2x limb diameter (a.k.a. 20% bigger than limb diameter).

I found this in the Rumwell/McPharlin Vascular Technology Review, p. 66, and it's the only number I've ever read or heard (with the odd exception of Zwiebel, which gives "at least 50% greater than limb diameter"—no idea where they got that). Of course any good vascular lab has cuffs in all sizes, 1 cm increments, and a tape measure to get the circumference of each level, and a calculator to convert circumference to diameter, so we can choose the exact size cuff for each level. Of course.

2. For plethysmography (air, photo, whatever) and analog Doppler, hanging your hat on waveform height should be done only with great suspicion. What counts is waveform morphology.

Don Ridgway
Semi old school

-----Original Message-----
From: UVM Flownet on behalf of Bill Johnson
Sent: Thu 2/3/2011 9:29 PM
To: [log in to unmask]
Subject: Re: Arterial Journals

Bill Johnson, Port Townsend, WA

I am sorry, but something in this thread raises my hackles (not that I have
hackles).  It seems that after 30 years of noninvasive vascular testing,
technologist credentialing and lab accreditation, we still do not have
standardization of practice of our profession, in my opinion.

Somehow this thread has incorporated photoplethysmographic findings, PVR and
Doppler waveforms without any regard to the lack of standards.  The
standards do exist, and have been established with decent research to back
them, albeit some ">10 years old".  Well, things do change, and if one
wishes to question what is established, I would suggest it is time to
re-evaluate the standards if they do not appear to be acceptable.   Do the
study, present your findings for peer review, and I will possibly even
accept them.
Personally, I would think that it does not matter how old a standard is
until a new standard is shown to be better.  Yes, I am "old school" on that
and I still trust my Doppler ears more than the spectral analyzers, or
PVR/PPG waveforms.  The issues of collateral flow, cuff size vs. limb
diameter, medial calcification, gains and even chart speed all need to be
considered.  We must never remove our brains from our sensors.   I agree
with Terry wholeheartedly.
No offense intended to any on this list.  But seems the issue Nicole asked
had to do with cuff size and adjusting the size of the waveforms we record.
I am still not sure of the answer we gave her, if any.

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