Pulse oximetry in the evaluation of peripheral vascular disease.

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Does anyone have suggestions/figures for using pulse oximetry in Diabetic patients (in Particular) to assess level of risk in PVD. We understand that if a patient with 60mmhg (not diagnosed as critical ischeamia) gets a wound on their foot, then this can tip them into critical ischeamia....we want an easier way of measuring critical and non-critical ischeamia especially at a first patient contact.

A local vascular surgoen gave this response......'But would you really keep someone with an intact foot but signs suggestive of microvascular disease under follow up in case they sustain an injury? Probably simpler to tell them all to be careful!!! '
does anyone use transcutaneous O2 in this situation??

Julie

 

Have you taken your blood pressure in the leg? there is a formula for PAD. You take the Systolic pressure in the leg and divide it from the Systolic in the Arm. It needs to be above .9
Anything lower than .9 further testing for PAD. I will investigate the O2 pulse oxymeter in the foot.

 

A pulse oximeter will measure the % of O2 in the blood, not the blood pressure. A low O2 saturation can be due to a number of issues including PVD, so will not be that useful. At one stage we conducted a small trial to compare an ABI using a pulse oximeter and doppler. The issue with the oximeter is that if blood flow is very poor it wont record anything. TCPO2 is much more reliable and has lots of literature supporting its use, but is a more expensive machine. And if you are just conducting a screening assessment, test for pulses. If you can palpate them circulation is usually OK. If you have real doubts arrange for a duplex scan.

 

Hi, thanx for your reply, but the problem we have is with PVD where the pulses may be palpable but the patient has an ischeamic ulcer on the toes!! its happening more and more in our diabetic clinics, so measuring the blood flow, or some sort of measure of the 'healthiness' of the tissues in the toes would be helpful...we are beyond palpating the pulses in these patients. measuring the toes pressures is too fiddly for a NP assessment to decide whether they are at risk or not....was looking for an easy and reliable way to do it.