Ankle-brachial Index: A Dirty Word?

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The ankle-brachial index (ABI) is a key component of the lower-extremity vascular exam, recommended and in some cases mandated by clinical practice guidelines on preventing and treating pressure ulcers. The ABI exam more often than not is omitted.

Three possible explanations: 

  • Lack of knowledge:  Many clinicians have never heard of an ABI or don’t know how to measure it.
  • Poor access to equipment:  The vascular Doppler isn’t cheap, and its purchase is often superseded by more frequently used supplies.
  • Lack of time:  The ABI exam can take 15 to 45 minutes.

Although these are valid explanations, they are not justifiable reasons for failing to measure the patient’s ABI.

Wound care experts should focus on sharing their knowledge with staff, with hands-on ABI training sessions. Approach administrators with equipment requests for a vascular Doppler, along with clinical practice guidelines that recommend the ABI exam. Accurately differentiating vascular wounds from pressure wounds may decrease the facilities pressure ulcer prevalence rate.

Other suggestions: 

  • Contract with an outside agency to perform ABI exams for your facility or agency
  • Designate an official ABI staffer to assist with ABIs.
  • Consider using the Lanarkshire Oximetry Index as a substitute for ABIs.

The ABI is a beneficial tool that can help with early detection of peripheral arterial disease, in turn helping to prevent complications and amputations and potentially saving lives.

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