Importance of Ankle Brachial Pressure Index (ABPI)

Importance of Ankle brachial rack Index (ABPI)Ankle Brachial Pressure Index shew utilise as a tool of tail surveyment in diabetic long-suffering to squeeze vagabond of lower extremity amputation. knowledgeablenessThis essay will reflect on the brilliance of ankle brachial coerce index (ABPI) lend oneself as a tool man performing home judicial decision (FA) to identify diabetic patients who are at insecurity of hind end ulcerationations and respecting vascular impairment in diabetic radix ulcers (DFU) hence preventing lower extremity amputation ( grass). FA helps to detect the level of risk of a diabetic patient developing a break up ulcer (Singh N et al., 2005, Grawford F et al.,2007). When there is no early detection and intervention, foot ulcers deteriorate resulting in amputation of the affected limb (Kerr M, 2012, Young MJ et al., 2008). All diabetic patients should perform annual FA to identify any abnormality (American Diabetes Associaton 2012) and those who are at risk should keep back FA done to a greater extent frequently (Frykberg RG et al., 2006).Gibbs model of formulation (Gibbs 1988) is use in this discussion be instance it is easy to use, simple and is a sizable guidance of locution.25% of diabetic mint will develop foot ulcer ascribable to diabetes (Singh N et al., 2005) while 85% of diabetic patients with foot ulcers can lead to LEA (Pecoraro RE et al., 1990, Margolis DJ et al., 2005). The emotional and fiscal costs of diabetic foot disease are high (Close-Tweedie, 2002). about 400 cases of LEA are performed yearly in Mauritius imputable to leg of Diabetes, costing about Rs 50,000 to Rs 100,000 for each limb amputation (Apsa International 2014, Mauritius Research Council 2012). and 85% of level of amputation can be reduced through a multidisciplinary aggroup by early detection of foot problems, proper FA, empowering patient by giving them comfortablyness education, close monitoring and proper keeping (Internat ional Diabetes Federation 2005, Pecoraro RE, 1990).DESCRIPTIONThe Government of Mauritius is doing much effort to increase the note of life of diabetic people, national digital retinal screening aid and podiatry services are available (Millenium Development Goals lieu invoice 2013). foundation g sleeveent ulcer clinics choose been set up in in altogether regional hospitals in Mauritius. During my training as a foot ulcer nurse I happened to do an ABPI (see accompaniment 1) while doing FA with a patient whom I will call Mr John who has a non mend ulcer in his left hallux. His foot has never been assessed by a health safeguard professional and he was not aware of FA. The ABPI result was 0.7 (see Appendix 2) indicating that he has moderate peripheral arterial disease. He was referred to the vascular surgeon by the treating Doctor. The result was confirmed through a colour semidetached house Doppler showing significant and arterial stenosis below the knee by greater than 60% . The patient underwent revascularization. Proper management of the wound was done, crunch was not applied (Vowden K and Vowden P, 2002) and now the ulcer is showing ripe signs of meliorate.FEELINGSGetting the opportunity to follow the foot ulcer management class made me overwhelm. I was so enthusiastic to learn new shipway and techniques of FA that I will apply with patients acting as a obstruction to protect them from stumbling into the pitfall of foot ramifications hence preventing amputations. Before undertaking the module I was not aware of the importance of FA in preventing LEA. A 10g Semmes Weinstein monofilament is utilize to check loss of sensation in neuropathy and a hand-held doppler use to calculate ABPI to assess the vascular flow was far from my know how. subsequently undertaking the module and wider reading with endeavours, though there were many ups and downs due to time constraint, now I feel more self-confident and pretend more expertise in practicing A BPI while doing FA. Having been able to detect the cause of non healing ulcer of Mr John through an ABPI while doing FA, I entangle precise keen and eventually this has motivated me to learn the module more powerful. I was determined to put ABPI technique into practice in my compass of work so that I can manage patient correctly and refer them to the enamour channel for specific treatment through multidisciplinary team (John Ovretveti, 1996).EVALUATIONI have learnt that foot problems related to diabetes occur very quickly, causing rapid waver breakdown which is often complicated by transmittal (Edmonds et al., 1986) and eventually may lead to LEA (Close-Tweedie J, 2002). Factors influencing wound healing are hyperglycaemia (McInnes, 2001), change in metabolism of carbohydrates, fats and proteins because of insulin deficiency (Cooper, 1990). moreover many factors prevent the normal process of wound healing at cellular level including slow up closure, contraction retarded due to delayed myofibroblast phenotype, granulocytes effect, no collagen synthesis, chemotaxis defects and no growth factors (Close-Tweedie J, 2002). Therefore, if there is decrease in tissue perfusion and oxygenation, wound healing will not take place (Terranova, 1991). fringy arterial Disease (PAD) in the lower extremity is a cast where there is narrowing of arteries in the legs and feet due to accumulation of fatty shopping mall called plaque, inside the walls of arteries. This result in poor blood supply to the muscles and tissues in the legs and feet hereby causing pain, tissue death and even gangrene.It is important to assess the arterial perfusion as impaired circulation contribute to non healing ulcer (Akbari CM, 2003). When assessing diabetic foot, the palpation of ankle pulses should not be used alone to detect arterial disease (Vowden K and Vowden P, 2002) and distal perfusion can only be accurately assessed by the correct application of Doppler (Whiteley et al., 1998). T he ABPI is a simple, quick, non-invasive tool use to identify PAD(Bhasin N and Scott DJA, 2007). However, ABPI is not as easy to perform as it appears.I have done an ABPI with Mr John and this has helped in identifying the cause of the non healing ulcer. This was due to impaired blood circulation and the patient has been directed to the proper highroad to restore the blood flow. Hence this has helped the wound to show good signs of healing. synopsisIt is through performing an ABPI with Mr Brown that the cause of the non healing wound has been detected. I am pondering on how many patients have non healing ulcers due to impaired circulation and FA has not been done including ABPI.So ABPI is done on all diabetic patients with or without foot ulcers who are coming to our clinic for FA and they are beingnessness referred to proper channel for further management. My aim is to prevent diabetic patients to have foot complications and reduce the rate of LEA. ABPI result help us to valuat e the vascular supply, level of ischaemia, level of pain in the leg, determine the chance for patients having vascular disease and guide whether the patient should undergo revascularization or do angioplasty, stenting or bypass surgery of lower extremity. (Grenon SM et al., 2009). By see the ABPI resuIts, now I am sure and certain of what types of bandaging to use, what fecundation materials and medications to use to treat and help healing of ulcers. ABPI also guides us to get back whether debridement of the wound should be done or not and what type of offloading techniques to be implemented.CONCLUSIONThe fundamentals basics for healing of DFU are good perfusion, debridement, infection control, and rack mitigation. To obtain successful outcome in the management of DFU is to get it on the etiological factors (Wu SC et al., 2007). Doing an ABPI help to improve the management of diabetic patients. The ABPI assessment was of great help to know the risk of the foot. For those havin g no ulcers, they are being managed by the correct channel to prevent complications from arising, while those having an ulcer are also diverted to correct pathway of treatment including surgeons and foot wield nurses to manage foot problems correctly under the guidance of all expertise available at the hospital level.ACTION PLANNow having well grasped the module workbook, I have allocated myself with a good time of reflection about how previously diabetic patients, with or without ulcers, were being treated and what was the complication and drawbacks we had in our system. After I have well understood the importance of ABPI during my studentship at the module and from my personal experience gained during the management of diabetic foot ulcer, now I make it a must that all diabetic patients, attending hospital from any sections, have an appointment to screen their foot with an ABPI done. Eventually, canalizing them through the correct pathways for further investigations and managemen t required with the goal to reduce the rate of LEA.However, ABPI is contraindicated when there is excruciating pain in the leg or foot, in the presence of deep venous thrombosis as the thrombus may be dislodged and in patient with renal failure doing dialysis. ABPI results should be interpreted with manage in patients having heavily calcified or incompressible vessels, where they may be deceptively high. (Grenon SM et al., 2009).REFLECTIONIn this work piece of reflection, I have demonstrated how I use ABPI on diabetic patients to reduce the rate of LEA. Observing the result being achieved by this assessment, other members of health care providers insist about the implementation of this typical assessment. We are now more eager to know about the ABPI result on diabetic patients precedent moving forward with any kind of management. I feel happy that my knowledge gained from the module are being put into practice and ABPI assessment has proved to be a great tool to reduce LEA which h as been the aim of the government since long.REFERENCESAkbari CM, Macsata R, Smith BM, Sidawy AN. Overview of the diabetic foot. Semin Vasc Surg 163-11, 2003.American Diabetes Association. Standards of medical checkup feel for in Diabetes-2012. Diabetes Care, Volume 35, Supplement 1, January 2012.Apsa.mu, (2014). Foot Care Clinic Apsa International. online obtainable at http//apsa.mu/services/foot-care-clinic/ Accessed 22 June 2014.Bhasin N and Scott DJA. Ankle Brachial Pressure Index identifying cardiovascular risk and improving diagnostic accuracy. JR Soc Med. Jan 2007 100(1) 45. online unattached at http//www.ncbi.nlm.nih.gov/pmc/articles/PMC1761677/ Accessed 22 June 2014.Close-Tweedie J. Diabetic foot wounds and wound healing a review. Diabetic Foot Vol 5, No 2, 2002.Cooper DM (1990). Optimising wound meliorate a practice within nursings domain. Nursing clinics of northwestward America 25(1) 165-80.Department of Health, 2001. National Service Framework for DiabetesStandar ds. online useable at http//www.gov.uk/government/uploads/attachment_data/file/198836/National_Service_Framework_for_Diabetes.pdf Accessed 04 June 2014.Edmonds ME, Blundell MP, Morris HE et al (1986). The diabetic foot conflict of a foot clinic. The Quarterly Journal of Medicine 232 763-71.Frykberg RG, Zgonis T, Armstrong DG, Driver VR, Giurini JM, Kravitz SR, oaf AS, Lavery LA, Moore JC, Schuberth JM, Wukcih DK, Andersen C, Vanore JV Diabetic Foot Disorders a clinical practice rule of thumb (2006 revision). J Foot Ankle Surgery 45 (Suppl 5) S1-S66, 2006.Gibbs G, 1988. Learning by Doing A Guide to Teaching and Learning Methods. Oxford Oxford Further Education unit (online) Available at https//www.brookes.ac.uk/services/upgrade/study-skills/reflective-gibbs.html Accessed 17 June 2014.Grawford F, Inkstor M, Kleijnen J, Fatey T. Predicting foot ulcers in patients with diabetes A systematic review and meta-analysis. QJ Med 2007 100(2) 65-86.Grenon S. Marlene, Gagnon Joel and Hsiang York. Ankle-Brachial Index for Assessment of Peripheral Arterial Disease. The New England Journal of Medicine 2009 361 e40/ November 2009. online Available at www.nejm.org/doi/ ample/10.1056/NEJMvcm0807012 Accessed 22 June 2014.International Diabetes Federation (2005) Clinical Guidelines Task Force world-wide guidance for Type 2 Diabetes. Brussels.International Working Group on the Diabetic Foot, 2011. online Available at www.iwgdf.org Accessed 18 June 2014.Kerr M. Foot care for people with diabetes the economic case for change. NHS Diabetes, Newcastle-upon-Tyne, 2012.Margolis DJ, Allen-Taylor L, Hoffstad O, Berlin JA. Diabetic neuropathic foot ulcers and amputation. Wound Repair Regen 13230-236,2005.Mauritius Research Council, Ebene. Impact of food quality on human health, Feb 2012. online Available at http//www.mrc.org.mu/document2012/nationalgroup/Impacts%20of%20Food%20Quality%20on%20Human%20Health.pdf Accessed 21 June 2014.McInnes A (2001). Guide to the assessment and managem ent of diabetic foot wounds. The Diabetic Foot 4 (Suppl 1)S1-11.Millennium Development Goals Status Report 2013, Government of the Republic of Mauritius. online Available at http//www.undg.org/docs/13330/Muaritius-MDG-Status-Report-2013.pdf Accessed 21 June 2014.Ovretvet John. tail fin ways to describe a multidisciplinary team. Journal of Interprofessional care, vol 40, no 2, 1996.Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation. Basis for prevention. Diabetes Care, 1990 13(5) 513-21.Singh N, Armstrong DG, Lipsky BA Preventing foot ulcers in patients with diabetes. JAMA 293 217-228, 2005. online Available at www.ncbi.nlm.nih.gov/pubmed/15644549 Accessed 02 June 2014.Vowden Kathryn and Vowden Peter. Hand-held Doppler Ultrasound The assessment of lower limb arterial and venous disease. Huntleigh health care 2002. online Available at www.huntleigh-diagnostics.com. Accessed 21 June 2014.Terranova A (1991). The effects of diabetes mellitus in wound healing. Plasti c Surgical Nursing 11 20-5.Whiteley MS, Fox AD and Horrocks M (1998). Photoplethysmography can replace hand-held Doppler in the measurement of ankle/brachial indices. Ann R Colll Surg Engl 80 (2) 96-98.Wu Stephanie C, Driver Vickie R, Wrobel James SandDavid G Armstrong David G. Foot ulcers in the diabetic patient, prevention and treatment. Vascular Health and Risk trouble Feb 2007 3(1) 6576.Young MJ, McCardle JE, Randlall LE, et al. Improved survival of diabetic foot ulcer patints 1995-2008 possible impact of aggressive cardiovascular risk management. Diabetes Care 2008 31 2143-47.APPENDIX 1 Procedure of performing ABPI by Huntleigh Healthcare 2002Patient is reassured and social occasion is explained. Make sure patient is in supine position, comfortable, relaxed with sufficient rest. An appropriate sized cuff is placed around the upper arm and the brachial systolic blood pressure is measured. The equipment and the arm should be at heart level. When the brachial pulse is felt, ult rasound march gel is applied. The probe of the Doppler should be at an angle of 45 arcdegree and is go till the best argue is obtained. The cuff is expand until the signal disappeared, then is deflated slowly so that the probe is not moved from the line of the artery and at the point where the signal returns, the pressure is enter. The procedure is repeated in the other arm. The highest of the two values of systolic pressure is used for the ABPI calculation. The systolic pressure of the ankle is taken by placing an appropriate sized cuff around the ankle immediately above the malleoli. The equipment should be at heart level. If any ulcer is present, it should be protected with a plastic film. The dorsalis pedis pulse is felt and contact gel is applied. The cuff is inflated until the signal disappear, then is deflated slowly and ensure the probe is not moved from the line of the artery and at the point where the signal returns, the pressure is recorded. The procedure is repeate d for the posterior tibial. The highest systolic pressure reading is used to calculate the ABPI for that leg. Same procedure is applied in the other leg. The ABPI is calculated for each leg using the formula below.ABPI = Highest systolic pressure recorded at the ankle of dorsalis pedis and posterior tibial for that leg divided by the highest systolic brachial pressure of right and left arm.APPENDIX 2 Reading of ABPI by Huntleigh Healthcare 2002ABPI 1.0 to 1.4 is considered as normalABPI ABPI 0.5 and ABPI ABPI 1.4 indicates calcificationPage 1