Product Manual

Page 14 of 21
Draft 1.1
Segmental Examination
Purpose: A segmental exam of the leg is an extension of the ABI exam. In this test, you
can attempt to localize the site of an occlusion by taking the pressures and waveforms
at more locations on the leg. By observing the difference in pressure between adjacent
sites on the leg you can tell if there is an occlusion between those sites. A greater than
20mmHg difference between sites is considered positive for a significant stenosis in the
artery between or under the cuff.
Patient Preparation: The patient should be relaxed in a supine position for 5-10 minutes
in a warm room. Explain the examination to the patient. This is an ideal time to enter
patient information.
Setting up
On the computer desktop screen, select the
simpleABI reports icon. When the screen opens
click on the File tab, then New, and then select
the Segmental report. Fill out the patient
information, risk factors, ICD-9 codes, etc.
Wrap appropriate cuffs at each site.
Pressures
Note: Current CPT guidelines (2013) for CPT
code 93923 do not require that pressures be
obtained at each cuff site on the leg if an ABI is
performed using both ankle arteries and PVR waveforms are obtained at each leg cuff.
This can significantly reduce the time necessary for this exam.
Also, it is quicker to use a PPG probe for the pressures. Reimbursement requires that
the ankle pressures be done with a Doppler on both PT and DP. However, you can then
use a PPG sensor on the great toe to then get the pressures at the other sites.
Brachial Pressure: Use the computer cursor and click on the site you would like to
begin with, usually the right brachial. Place the Doppler probe at an angle to the skin
over the radial artery. . *HINT* Hold the probe close to the end. It also helps to rest
your hand on the patient to keep the probe in place. One of the keys to a successful
exam is being able to keep the probe in place as you inflate and deflate. If it moves you
will not be able to hear the Doppler sounds return and you will have to repeat the
inflation. Use the angled vascular adapter (Cheater™) to get the best signal and to keep
the probe from moving during inflation and deflation. Use plenty of ultrasound gel and
move the probe slowly back and forth until the strongest arterial signal is heard.
Press and hold Inflate on the Cuff Link remote and inflate the cuff until you no longer
hear the signal, and continue for an additional 20 mmHg. Release the Inflate button
and the cuff will automatically start to slowly deflate. When you hear the Doppler signal
return press the Pressure button and it will be stored on the screen. Press the Dump
button.
Leg Pressures and waveforms: Press Next on the remote and the system will move
to the Dorsalis Pedis (DP) site. Take an ankle pressure using the Doppler probe on the
dorsalis pedis artery on top of the foot. Inflate the cuff to occlude the artery in the
same manner you did on the arm. (Press Inflate, press Pressure, press Dump).