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"óno 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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