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Usefulness of on demand or routine doppler - ABPI

Discussion in 'General Issues and Discussion Forum' started by David Smith, Dec 1, 2012.

  1. David Smith

    David Smith Well-Known Member

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    I was wondering what your views may be on doing on demand or routine doppler ABPI in addition to clinical evaluation of circulation and vascular condition?

    One of the care homes for people with severe learning difficulties that visit us regularly have asked for routine ABPI - dopler tests. When I enquired WHY? they explained that they had been on a CPD course that recommended regular monitoring of vascular condition and circulation using these test and that they could ask their chiropodist /podiatrist to do them.

    I explained that I did not think regular routine evaluation using doppler - ABPI was necessary when there were no other signs or symptoms of cardio vascular disease or compromised blood circulation that could be seen by simple clinical visual examination. They insisted and so I am doing these tests, which also attract and extra fee on top of the normal chiropody fee.

    Some of the clients do have a lowish ABPI, 0.8 nominal, and biphasic sounds but what would the GP or vascular specialist do with that information when there are no other presentations, signs or symptoms of concomitant morbidities and have no other disease such as diabetes that would increase risk of potential pathologies.

    Your views would be appreciated.

    Dave Smith
  2. Admin2

    Admin2 Administrator Staff Member

  3. Mart

    Mart Well-Known Member

    Sounds like you applied critical reasoning and your care home request did not know enough to realise proper indication fro doing non-invasive vascular testing.



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  4. mburton

    mburton Active Member

    I've been mulling over this one as it raises a few interesting issues. I'm inferring that you are in private practice Dave, and so are in a supply/demand market place within your own professional limits and of course it does the care home and yourself credit that you are both going out out of your way to benefit these patients.
    I share your feeling that ABPI measurement is not appropiate for a routine podiatry appointment. Even though the equipment has improved a lot in recent years, you still need a well rested patient or your readings will not be accurate, and as you say, what will be gained ? We are carrying out a vascular review every time we engage with a patient aren't we, - critical ischaemia and the need for referral on to Vascular Service will be very obvious without wasting time and money on ABPIs.
    On the other hand, I do think a hand-held Doppler to locate DP and PT is very useful in clinic, almost instantly revealing the quality of the arterial supply when pulses, for whatever reason, cannot be palpated. It can also be very reassuring to patients (who may have been told they have PAD) to hear the 'pulse' in their feet.
    You don't mention the age range of these patients - are they in an age range where you would be expecting to find PAD? I'm sure the person who gave the talk to these carers meant well - it may be worth trying to find out who in was and querying their recommendation for ABPIs.
    all the best
  5. jos

    jos Active Member

    Yep, I agree with mburton- I don't think ABPI is necessary.
    Doppler is quick/easy and I would use it if I couldn't palpate a pulse or if I was suspicious of something going on (non healing wounds etc).

    I guess the other question is how would they react to it? I've treated some disabled people in the past and sometimes it is hard enough to get them to sit still for nail care!! If they get agitated with routine treatment, then doing anything too involved (such as ABPI) might cause too much grief for all involved, when it's not really necessary...??
  6. mburton

    mburton Active Member

    As a footnote, have just been reading an article by Desmond Bell in Podiatry Today entitled 'when should you refer a patient for vascular intervention' which is food for thought. Sorry, my IT skills aren't up to attaching a link, but it is in the latest edition - I get it as an email and there is no charge to podiatrists as far as I know.


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