Use of ankle–brachial pressure index to assess patient suitability for lower limb compression
Compression therapy is a safe, effective treatment for lower leg conditions such as lymphatic insufficiency and venous hypertension. The most common method of arterial assessment is the calculation of a patient's ankle–brachial pressure index (ABPI). The need for ABPI is highlighted in many best practice statement and local policies. ABPI compares the arterial flow of the arms and the legs, providing a ratio used to determine the presence and severity of peripheral artery disease and assess whether a patient is suitable for compression therapy.
This study critically reviews and analyses findings from contemporary literature with the aim of evaluating the effectiveness of the ABPI screening tool.
A structured literature review using a narrative approach was carried out.
Four studies were identified for inclusion, which involved medical, nursing and allied health professional staff in primary and secondary care, with a total of 51 patients. Analysis generated eight themes: appropriateness of the ABPI tool; clinician education; referral process; access to appropriate equipment; lack of time to conduct the assessment; competence; associated costs; and role definition.
It is important to undertake a holistic assessment of the patient, incorporating ABPI assessment where not contraindicated. Further research to explore patient experience and safety when assessing a patient's suitability for lower limb compression therapy is required.
Compression therapy is proven to be a safe and effective treatment for lower leg conditions such as lymphatic insufficiency and venous hypertension. In 2018, approximatively 250 million people across the globe were treated with compression therapy (Fortune Business Insights, 2020).
The most common method of arterial assessment is the calculation of a patient's ankle-brachial pressure index (ABPI) and the measurement and recording of this is embedded within many policies and best practice statements. ABPI compares the arterial flow of the brachial artery in the arm and the dorsalis pedis artery and/or posterior tibial artery in the leg, providing a ratio determining the presence and severity of peripheral artery disease (PAD), therefore assessing an individual's suitability for compression therapy alongside an in-depth holistic leg assessment (Song et al, 2019).
Lower limb disorders and leg ulcers are some of the most common conditions treated in the UK by the NHS (Heatley et al, 2020). It is estimated that 1.5% of the adult population are living with an active leg ulcer and around 80% of these lesions are classed as a venous leg ulcers (VLUs). Managing these patients is thought to cost the NHS around £2 billion each year (Todd, 2019; Heatley et al, 2020; Manchester University NHS Foundation Trust 2020).
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