Toe Blood Pressure (TBP) assessments using
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1. W moor instruments innovation in microvascular assessment Toe Blood Pressure TBP assessments using moorVMS VASC Application note 108 Application Toe Blood Pressure TBP is the measurement of distal limb systolic blood pressure at the toe TBP is particularly useful in patients with noncompressible tibial arteries for example those suffering long standing diabetes renal failure or other disorders where vascular calcification is present Clement TASC II 2008 TBP can be used in patients with peripheral artery disease PAD to assess the severity of ischaemia H yer et al 2013 H yer et al 2014 Ubbink 2004 and ultimately lead to early treatment and or prevention of the formation of ischaemic ulcers in the lower limb TBP measurements have been shown to be possible and reproducible using laser Doppler and automated pressure systems H yer et al 2014 Wahlberg and Gush 2002 In recent publications TBP was shown to have less inter and intraobserver variability than that reported for ABP Pahlsson et al 2008 In addition a recent study showed good correlation between the moorVMS system and strain gauge plethesmography in a wide range of toe pressures in addition to substantial agreement for diagnostic classification of peripheral arterial disease PAD including critical limb ischaemia CLI H yer et al 2013 Routine measurements of TBP can be performed simply and rapidly using the moorVMS VASC system with a predefined stan2. Intra and Inter observer variation European Journal of Vascular and Endovascular Surgery 47 3 pp311 318 Pahisson H 1 Lund K J6rneskog G Gush R Wahlberg E 2008 The validity and reliability of automated and manually measured toe blood pressure in ischemic legs of diabetic patients European journal of Endovascular Surgery 36 pp 576 581 Ubbink D Th 2004 Toe blood pressure measurements in patients suspected of leg ischaemia A new laser Doppler device compared with photoplethysmography European Journal of Endovascular Surgery 27 pp 629 634 Wahlberg E Gush R 2002 A new automated toe blood pressure monitor for assessment of limb ischemia European Journal of Endovascular Surgery 24 pp 304 308 Further Reading www moor co uk information about moorVMS VASC and available probes and pressure cuffs moorVMS LDF user manual for instrument operation and cleaning and handling of optical probes Please feel free to consult sales moor co uk for further advice or Support with issues not covered in this application note and for details of other application notes using the moorVMS VASC system Important Disclaimer This information is provided to further clinical research into diagnostic capabilities of laser Doppler The moorVMS VASC is CE marked for human use but not specifically for clinical diagnosis of TBP assessments Calibrated equipment with a current service record should only be used Notes innovation in microvascu
3. TBP e Site e Mean LBP or TBP mm Hg c The pressure detection point can be selected by the User in the Report Design section from the following options e 1 2 x Biological zero i e LD 1 2 x flux e 2 0 x Biological zero measured during occlusion e 1 5 x Biological zero default setting e 2 5 x Biological zero e Flux PU e 5 0 x Biological zero Sar Skin Perfusion Limb Toe Blood Pressure Pulse Volume PORH ABPI TBPI Report Title moorvMS Limb Toe Blood Pressure Report V Measure Channel and Pressure Chart m Blood Toe Pressure Calculation Setting Running Average fi sec 7 Pressure Detection Point 12 x Biological Zero m Statistics Table V Measure Site IV Value at BP Biological Zero BZ V Measure Channel V Blood or Toe Pressure V Time at Blood or Toe Pressure V Pressure Channel V Value at Blood or Toe Pressure V Deflation Rate V Running Average X Cancel Report format setting fully adjustable enabling you to alsolay as much or as tittle data as you require Practical Suggestions Microvascular blood flow can be affected by many things The following practical suggestions are provided as a guide and are not exhaustive e Perform measurements in a quiet room whilst maintaining a comfortable temperature typically 22 C 24 C Ensure the patient is acclimatised to the room temperature for 30 minutes prior to the measurements e Patients should avoid caffeine alcoho
4. dardized test protocol The user friendly software enables user defined protocols to be set as required for research however the user is not limited to pre defined protocols Equioment Required The following equipment is needed for this application eS moor instruments taser Doppler Vancuar Assesment Main Menu NEW ce VV AK teers it ee N RD ME ad pes ma DIO om mee moorVMS VASC moorVMS VASC PC software Toe Cuff cart optional Inflatable pressure cuff VP1T combined optic and PAD double sided temperature skin probe s adhesive discs Method e Refer to the Practical Suggestions Section of this Application Note for environmental and patient recommendations e Ensure skin probes are calibrated See moorVMS LDF user manual e Measurements should be made with the patient in the supine position depending upon the size and position of the foot the toe would be at or just above heart level de Graff et al 2000 e Place a pressure cuff around the proximal phalanx of the toe e Place skin probes on the toe pulp usually the great toe distal to the cuff e Set the moorVMS VASC software a preferred standardized protocol can be set see example below General Options Report Options Pressure Reports Test Sequence Setup Test Defaults Select Protocol Limb Toe Blood Pressure Limb Toe Blood Pressure ai Duration sec Pressure Rate E Pre inflation Inflation Skin Perfusion Pressure Hold Ti
5. l vigorous exercise and smoking for 24 hours prior to the measurements e During all measurements ask the patient to breathe normally Coughing talking and yawning can all affect microvascular blood flow readings e The patient should be in a comfortable relaxed position and avoid movement during all measurements e Cover the feet legs with a blanket to avoid cooling during acclimatisation and during measurements Related Fields Contact us for Application Notes for Post Occlusion Reactive Hyperaemia PORH Skin Perfusion Pressure SPP Pulse Volume PV and Ankle Brachial Pressure Index ABPI measurements with the moorVMS VASC Publications Clement D 2008 Diagnosis and evaluation of peripheral artery disease non invasive vascular laboratory and imaging techniques Based on the Inter Society Consensus www tasc 2 pad org de Graff J C Ubbink D T Legemate D A de Haan R J Jacobs H M 2000 The usefulness of a laser Doppler in the measurement of toe blood pressures Journal of Vascular Surgery 32 6 pp1172 1178 Heyer C Sandermann J Paludan J P D Pavar S Petersen L J 2013 Diagnostic accuracy of laser Doppler flowmetry versus strain gauge plethysmography for segmental pressure measurement Journal of Vascular Surgery 58 6 pp 1563 1570 Heyer C Paludan J P D Pavar S Biurrun Manresa J A Petersen L J 2014 Reliability of laser Doppler flowmetry curve reading for measurement of toe and ankle pressures
6. lar assessment W moor instruments Moor Instruments Ltd Millwey Axminster Devon EX13 5HU UK tel 44 0 1297 35715 fax 44 0 1297 35716 email sales moor co uk website www moor co uk Issue 3
7. me 15 Deflation Limb Toe Blood Pressure Ed Postdeflation 0 Pulse Volume Measure Site Lett Toe PORH User Defined Protocol ABPI TBPI Limits O 600sec 20 250mmHq 1 10mmHg s or Max moorVMS VASC protocol Setup for Toe Blood Pressure Analysis The TBP report contains the TP chart s in addition to the following information Toe Brachial Pressure Index Example TBPI vme 1 x Flux Selection iv 40 38 Graph 36 32 30 be 28 cs 26 9 VA ae XV Comp 3 a2 3 5 20 Af Inc 216 2 16 ah Dec 14 10 Sequence 3 TBPI 0 83 8 TBP 103 3 mmHg Flux1 6 5 PU 6 ValueBz 1 15 Site Left Toe Pres Ch Pres 05100 95 90 85 80 75 70 65 60 55 50 45 40 35 30 25 20 15 1d Meas Ch Flux1 Pres 180 mmHg ET TT P H Overall TBPI 0 83 ds dL Detlat 2 mmHais Select Sequence No MAA 7 Auto Pressure Add toReport All Channels Time Pres Axis SAVE DATA EXPORT REPORT PREVIEW Close TBP chart of results with easy options to edit save and export data 175 170 165 160 155 150 145 140 135 130 125 120 115 110 1 a Sequence Statistics Table e Measurement site e Deflation mm Ho s e BP or TBP mm Hg e Flux channel e Flux PU e Pressure channel e Flux BZ baseline e Average e Time Ah m ss e Pressure calculation b Site mean Pressure Statistics table following multiple assessments of limb blood pressure LBP or
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