Norm of Pulse Volume Recorder Testing of Peripheral Vasculature
The waveform recording demonstrates rapid upstroke or an anacrotic limb, a sharp peak, a brisk decline or catacrotic limb, and a clearly discernible visual diastolic wave. Bilateral consistent augmentation of the pulse amplitude from proximal-to-distal measurement sites is present throughout the waveform recordings.
Usage of Pulse Volume Recorder Testing of Peripheral Vasculature
Assists in the diagnosis, location, and monitoring of the progression of arterial vascular lesions and arterial narrowing; used for preoperative, intraoperative, and postoperative evaluations; aids in the determination of the need for arterial angiography; aids in differentiation of aortoiliac and superficial femoral artery occlusion and neuropathies; assists in the evaluation of the severity of arterial occlusions and the detection of arterial pressure changes in distal extremity vessels that cannot be measured by a Doppler probe; helps evaluate penile blood flow and intercavernous pressure; TFI method used to monitor venous grafts at risk for failing.
Description of Pulse Volume Recorder Testing of Peripheral Vasculature
Pulse volume recording measures pressure changes of arterial vessels and displays the pressure changes as waveforms. Pressure changes are recorded by a transducer during blood pressure cuff inflation and deflation. Segmental air plethysmography records the pulse waveform tracings onto graph paper. These pressure recordings supplement segmental limb pressure studies and are a sensitive indicator of arterial vascular occlusive disease of the distal vessels of the feet and toes. Recordings may be taken before or after segmental limb-pressure measurements. Arterial narrowing distal to a vascular lesion produces a loss of the diastolic wave, a prolonged catacrotic limb (prolonged downstroke tracing), rounding of the normally sharp peak, and a decrease in the slope of the anacrotic limb (vertical ascending limb). Progression of arterial occlusive disease results in a broadened, flattened, lengthened, and dampened waveform with depression in the amplitude of the diastolic wave. A transfer function index (TFI) or pulsatility index ratio (PIR) may be generated by the equipment to demonstrate abnormalities in perfusion via color coding. A variation of the pulse volume recording procedure is pulse volume plethysmography, in which a water-filled cuff is placed around the penis and an assessment of continuous blood flow and intercavernous pressure is taken.
Professional Considerations of Pulse Volume Recorder Testing of Peripheral Vasculature
Consent form NOT required.
- Remove clothing from each extremity.
- Traditional pulse volume recording:
- a. The client is placed in the prone position.
- b. Blood pressure cuffs that have a length of 80% of the limb circumference and a width of 40% of the limb circumference and a pneumatic inflatable bladder that is 20% wider than the limb diameter are selected.
- c. The pressure cuffs are placed bilaterally 2.5 cm above the antecubital crease of the arm, just above the wrist, as high as possible on the thigh, just below the knee, and just above the malleolus of the ankle.
- d. Transmetatarsal and penile pressure recordings may be obtained.
- e. Pulse volume recordings are measured at brachial, radial, ulnar, femoral, popliteal, dorsalis pedis, and posterior tibial levels of each resting extremity.
- f. Pressure changes are recorded by a transducer during cuff inflation and deflation.
- g. Cuff inflation is measured by standard mercury-gravity or aneroid manometer
- h. Cuff deflation is measured by stethoscope, plethysmography, or the Doppler velocity detector, which is the most convenient and sensitive measurement device.
- A segmental air plethysmography records the pulse-waveform tracings onto graph paper.
- j. The same procedure is used for pediatrics.
- Pulse volume plethysmography of penile blood flow:
- a. The procedure may be performed to measure natural variations in blood flow while the client sleeps, or during visual sexual stimulation or during artificial erection.
- b. A cuff filled with water is placed around the penis and connected to a three-way tap. One of the taps is covered with a latex membrane, which displaces in response to penile blood flow. Another tap is connected to a pressure bag positioned 30 cm above the penis. A second cuff is placed around the base of the penis.
- c. As variations in blood flow occur, the displacement of the latex membrane is recorded by a photoplethysmograph. Artificial variations in blood flow may be induced by compression of the penis artery via the base cuff.
- d. Findings are used by the equipment to determine a pulsatility index ratio (PIR), which is a ratio of total vascular resistance in the penis divided by functional impedance at the current heart rate. The PIR along with the transfer function index display a color-coded screen that represents differing perfusion between adjacent cuff segments.
- Remove cuffs.
Client and Family Teaching
- The procedure takes 30 minutes, unless performed during sleep.
- Results are available immediately.
Factors That Affect Results
- Improper size, inflation, or loose cuff application causes inaccurate results.
- False-negative results have been reported in clients with a short segmental occlusion of the superficial femoral artery in which they have developed large femoral collateral circulation. The pulse-volume recording produced a very depressed thigh tracing without discernible augmentation over the occluded site while circulation to the extremity was maintained.
- Pulse-volume recording of peripheral vascular pulses reports 97% accuracy for detecting superficial femoral artery occlusion.