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hi all.

student here. if a patient has biphasic pulses but capillary refill time, hair growth and nails are normal results what do i conclude from this? i've read biphasic pulses represent moderate arterial elasticity so this decreases vascular status as triphasic represents good/better arterial elasticity.

so confused

 

biphasic = mild/moderate problem
capillary refill time = largely meaningless
hair and nail growth = not reliable indicator

 

Hi Music,
You're not confused, your correct.
Vascular assessments can be subjective. With your patient i would consider them mild-moderate risk of complications. A bi phasic wave form indicates early stages of peripheral arterial disease. As Craig mentioned the other aspects of your assessment are indicators only(along with palpable pulses).
Some people say the Ankle Brachial Index is the most objective measurement for PAD.

 

I think for uni purposes, you're right in thinking about mentioning a decrease in perfusion can be indicated by biphasic waveforms. However, in clinical practice, apart from a damp monophasic waveform or a clear triphasic waveform it's a grey area. I know Nursing Times isn't the greatest source of scientific literature, but at short notice it's the only thing I can find that mentions that we may lose that vessel elasticity as part of the aging process so will often see biphasic waveforms in the absence of any other signs or symptoms of disease (as you're seeing in that case example):

https://www.nursingtimes.net/clinic...-ankle-brachial-pressure-index/205076.article

If they're not symptomatic, no claudication, no delayed healing, and all those other signs are fine, my humble opinion would be no further investigation required (other than ABI and maybe TBI because the ABI would be at increased risk of false elevation from intimal sclerosis).

ABI is alright, but TBI is a better indicator of pedal perfusion if you're really concerned: ABI is more a screening, and in the setting I'm in now, I use the ABI and the waveforms as well as the clinical picture to assess whether to do a TBI, which I'll do if the feet look dodgy or I don't believe the numbers from the ABI eg mono or unclear biphasic waveform.

Just my opinion, good luck!

 

A biphasic pulse with no other symptoms is not a problem. I wonder what percentage of otherwise healthy men over fourth/fifty years have triphasic pulses?

I would forget the capillary refill time unless you think your patient might be suffering from shock.

I would also look at temperature gradient, the colour and condition of the skin and subcutaneous fat and muscle bulk, comparing one side with the other. I might even question the patient about intermittent claudication.

Always recognising that a diabetic with biphasic pulses can still have a foot ulcer.

Good luck,

Bill

PS The answer to the following question will put you at the top of the class. What is actually happening to produce the different sounds?