How to perform an ankle brachial index - YouTube

Hello, I'm Ann-Marie McLaren. I'm a foot

specialist on a wound team in Toronto,

Ontario. I'd like to demonstrate how to

perform an ankle brachial index using

the ankle pressure divided by the brachial pressure.

To perform an ankle brachial

index, you will need a hand-held Doppler,

ultrasound gel and a manual blood pressure cuff.

So the next thing is that

you actually want to make sure that your

patient is lying comfortably and relaxed

for about 10 minutes to stabilize their blood pressure.

It's also important to remind your

patient not to speak while you're doing the test.

You apply the blood pressure cuff to the

patient's arm, taking care that you leave

enough space so that you can still access your brachial artery.

That's the brachial artery here.

And then, using your hand-held Doppler,

we're going to listen for the brachial pulse.

and its signal.

You can clearly hear the brachial artery signal.

Now what we want to do is

we want to inflate the blood pressure cuff...

to eliminate the signal.

And then we want to gently deflate the blood pressure cuff

until we can hear the signal. And you notice we noticed the

signal around a 100.

The return of the signal is the brachial measure,

or the denominator, for the ankle brachial index.

We would complete the process on

the other arm and we would compare the

left and right. We would choose the

highest measure to be the denominator

for our ankle brachial index calculation.

Now we're going to use and measure our

ankle index by locating the pulses in

the lower limb. In particular we're going

to be looking for the dorsalis pedis

pulse which is located on the dorsum of

the foot and the posterior tibial pulse

which is located just behind the medial malleolus.

So I've located the dorsalis pedis pulse

on the dorsum of the foot. And I can also

feel the posterior tibial pulses which

is located just behind the medial malleolus.

I'm going to repeat the procedure by

applying the blood pressure cuff and

we're going to again look for the pulse

signals using hand-held Doppler to

acquire our ankle pressure measurements.

So first off, I'm going to apply the

blood pressure cuff to the ankle.

Now we're going to apply some ultrasonic gel

to the dorsalis pedis pulse.

And we're going to use our hand-held Doppler

to locate the dorsalis pedis signal.

I've got a nice strong signal here.

Now we're going to repeat like what we did in the arm with the foot.

We're going to inflate the blood pressure cuff

until we no longer hear a signal.

We're going to gradually decrease the pressure

until we hear a return signal.

We can see it returned at a 100.

Now that we've located the posterior

tibial artery, we're going to apply

a small amount of ultrasound gel.

Using a hand-held Doppler, we're going

to locate the posterior tibial pulse and its signal.

Now that we have located the

posterior tibial signal, we're going to

inflate our blood pressure cuff

until we no longer can hear the signal.

And then we're going to gradually release the

blood pressure cuff until the signal returns.

And again, we saw that at 100.

Now we're going to repeat this on the other ankle.

We're going to again measure the dorsalis

pedis and posterior tibial measure.

We're going to take the highest measure and

use that as our numerator for

our calculation of the ankle brachial index.