Clinical Application Note - Venous Investigation of the Lower Limb Using PPG 603404-1.pdf
ADVANCED POCKET DOPPLERS
CLINICAL APPLICATION NOTES
NOTE 3 Venous Investigation Of The Lower Limb Using PPG
HOW TO USE THIS APPLICATION NOTE
PATIENT SYMPTOMS Verify that your patient’s symptoms
correspond to one or more of those listed in Figure 1.
DOPPLEX® EQUIPMENT REQUIRED Select the most
appropriate Pocket unit to perform the examination.
For suggestion of suitable equipment, refer to Figure 2.
PROCEDURE Connect your Rheo Dopplex® II to the
Dopplex® Printa II Package or Reporter Software Package
(and a computer), and begin your examination, refer to Figure 3.
EXAMINATION RESULTS Taking careful note of your Rheo
Dopplex® II display and venous waveforms, refer to Figure 5
overleaf and compare your examination results with those
NOTES Refer to Figure 6 overleaf for general notes relating
to this form of examination for venous incompetence.
It is ESSENTIAL that the PPG curve is used to confirm the
TOURNIQUET POSITION Figure 4 suggests position for
● VENOUS ULCERS
● VARICOSE VEINS
● VARICOSE ECZEMA
● VENOUS OEDEMA
● POST-THROMBOTIC SYNDROME
DOPPLEX EQUIPMENT REQUIRED
Rheo Dopplex II.
Printa II or Dopplex® Reporter Software
Remove footware and stockings.
Place foot on insulated mat.
Adjust height to minimise weight on feet.
Obese patients should be reclined to
reduce venous compression.
Fit sensor 10cm above the
medial malleolus (use
length of blue cable).
Ensure patient is relaxed
i.e., pulse rate stable
Tq Pressure mmHg
UT Tq = Upper thigh
AK Tq = Above knee
BK Tq = Below knee
Diagnostic Products Division
If Refill Time (RT) is greater than 25 seconds, then venous
insufficiency is not present or is not significant.
Some venous reflux present
Venous refill from arterial inflow
If Refill Time (RT) is less than 20 seconds then venous reflux is
present. Apply the tourniquet cuff at the appropriate positions to
determine the level of venous insufficiency, (See flowchart
Venous incompetence present
Deep venous obstruction/
DECISION MAKING FLOWCHART FOR VENOUS INCOMPETENCE
Guidelines for RT:
*If obvious varicosities present
then repeat test with alternative
flexion procedures, i.e.1) Plantar-flex: heels while
2) Half Knee bend while
3) Manual calf compressionwith patient standing
Flowchart is for guidance only
Differentiation between deep vein and calf perforator incompetence is not possible with PPG. In these cases, further investigation, i.e.,
Duplex scanning should be undertaken. Patients with gross oedema could produce normal results with venous incompetence present.
References: McEnroe, CS, O’Donnell ThF, Mackey WC. Correlation of clinical findings with venous hemodynamics in 386 patients with chronic venous insufficiency. 156;148-52
Neumann H.A.M., Boersma IDS. Light Reflection Rheography - A Non-invasive diagnostic Tool for Screening for Venous Disease. J. Dermatol Surg Oncol. 1992; AmJ.5urg 18:425-430
Our thanks go to Dr. Mo Aslam, Dept of Surgery. Hammersmith Hospital, London, UK
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NOTE 1 • Arterial Investigation Of The
NOTE 2 • Venous Investigation Of The
Lower Limb Using Doppler
NOTE 3 • Venous Investigation Of The
Lower Limb Using PPG
NOTE 4 • Screening For The Absence Of
An Acute DVT Using PPG
NOTE 5 • Using A Hand Held Doppler To
Assist With PICC Placement
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Diagnostic Products Division
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