Protocol for accurate assessment of ABPI in patients with leg ulcers

Ankle brachial pressure index (ABPI) calculations are performed by nurses in the assessment of patients with leg ulceration. The measurement of pressure in one arm alone can result in inaccuracy which may be clinically significant. Two vascular nurse technologists performed ABPI measurements on 250 patients with 487 lower limbs. Community nurses replicated the study on 71 patients, assessing 123 lower limbs. The study shows that 22% of patients in the vascular laboratory and 20% in the community had a difference in brachial pressures of > or = 15 mmHg, indicating the presence of arch vessel or upper limb arterial disease. Furthermore, 6% of patients in the laboratory and 2% in the community demonstrated that the difference in brachial pressures affected the ABPI calculation around the value of 0.8, thus potentially influencing their clinical management. ABPI measurements should be performed, taking both brachial pressures for optimum results.