simpleABI Cuff Link Systems User Guide

Cuff Link Systems

ABI with Exercise Examinations with simpleABI Cuff-LinkTM Systems

Please Read the User Manual first: This is a quick reference guide
Contraindications: Do not perform the exam on someone suspected of having acute deep venous thrombosis, and do not take an arm pressure in an arm with a shunt or dialysis graft.
Background: The ABI with Exercise Exam is typically performed after an ABI has been done, especially if there are risk factors or symptoms, but the resting ABI was normal.

The ABI with Exercise Procedure

Background: Approximately 30% of patients with PAD symptoms but a normal resting diagnosis will have an abnormal diagnosis after exercise. Your practice will improve the clinical diagnosis of patients with PAD by implementing an exercise program in your vascular diagnostic collection.
Opening the exam On the computer desktop, double click the simpleABI icon. When the program opens select FileNewNew ABI with Exercise Report. The report will open and you can enter patient information, risk factors, symptoms, ICD codes, etc.
Attaching cuffs Wrap appropriate cuffs at each site. Attach the hoses from the Cuff-Link control unit to cuffs as shown below. The green connectors go to the arm cuffs and yellow to the ankles. White hoses go to the patient’s right side, blue to the left. NOTE the image is reversed as if you are looking at the patient lying down
Pre-Exercise
Brachial Pressure

1. Begin with the right brachial. Place the Doppler probe at a 45 degree angle to the skin over the radial or brachial artery. Use plenty of gel and slowly move the probe laterally until the best signal is obtained.
2. Press and hold Inflate on the Cuff-Link Remote (shown above) and inflate the cuff until you no longer hear the signal – continue for an additional 10-20 mmHg.
3. Release Inflate and the cuff will automatically deflate at the suggested rate of 2mmHg/second.
4. When you hear the Doppler signal return, pressing Pressure will be store the pressure value in the exam.

Ankle Pressures

1. Press Next on the remote and the system will move to the Dorsalis Pedis (DP) site. Find the arterial signal using the Doppler probe on the dorsalis pedis artery on top of the foot. Obtain the arterial pressure in the same manner you did on the arm. (Hold Inflate until occlusion, release Inflate, press Pressure on Doppler signal return)
2. Press Next and the system will move to the posterior tibial (PT) site. Find the Doppler signal on the posterior tibial artery. Obtain the arterial pressure. (Hold Inflate until occlusion, release Inflate, press Pressure on Doppler signal return)

Waveform

1. Press Next and the system will move to the waveform site. Press and release the button with the Waveform image on the top right of the remote. The cuff will inflate to roughly 85mmHg and deflate to the proper pressure (65mmHg) and hold that while the waveform is obtained. The waveform will start to appear when the cuff has reached 65mmHg. The patient should remain as still as possible during the measurement.

Left Side

1. Repeat the above pressures and waveform sequence for the left side of the patient.

Helpful Hints

Exercise

1. Have the patient perform an exercise to increase blood flow to the extremities
2. PREFERRED have the patient perform 50 dorsiflexions (raising the toes towards the shin).
3. Have the patient perform 50 toe raises (or until exhaustion).
4. Hall walking or treadmill walking may be performed until exhaustion or for up to 5 minutes.

Post-Exercise

1. Repeat Pre-Exercise protocol described on previous page.

When finished, save or print the exam.
Cuff techniques:

• Wrap the cuff snugly.
• Cuffs may be placed over thin clothing or stockings.
• Don’t let the patient try to help by lifting their leg – as they relax their muscles the cuff will become loose.
• Placing a pillow under the patients heels may aid the examination.
• Have the patient remain as still and quiet as possible while taking the waveforms.
• If the patient has tremors that interfere with the waveform, having them perform a few dorsiflexions with their toes before taking the waveform may help.

Doppler techniques:

• Hold the probe like you would a pencil, close to the end.
• Move the probe back and forth laterally over the artery to obtain the best signal.
• Support the probe with your hand resting on the patient so that the probe does not move as the cuff is inflated and deflated.
• One of the keys to a successful exam is being able to keep the probe in place as you inflate and deflate the cuffs.
• If the probe moves, you may not be able to hear the Doppler sounds return and may have to repeat the inflation.

Exam hints:

• Leave cuffs on for hall walking or toe raises, but disconnect tubing.Cuff-Link Control Unit with tubing properly attached

Questions? Call Newman Medical at800-267-5549
MAN-0017-B

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