Ankle-brachial index: A dirty word?

Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS

Silence, roving eyes, fidgeting, excuses, a quick subject change—these are typical responses from healthcare clinicians when asked, “What’s the patient’s ankle-brachial index?” You’d think someone had just uttered a dirty word.

The ankle-brachial index (ABI) is a key component of the lower-extremity vascular exam, recommended and in some cases mandated by numerous clinical practice guidelines, including the most recent international guidelines on preventing and treating pressure ulcers.

Nonetheless, the ABI exam more often is omitted than performed. If a patient has an infection, we’d never omit taking his or her temperature. Yet it’s commonplace to skip the ABI exam in patients with lower-extremity wounds. Why?

I’ve come up with three possible explanations:

  • Lack of knowledge: Many clinicians have never heard of an ABI or don’t know how to measure it.
  • Poor access to equipment: The vascular Doppler isn’t on the list of cheapsupplies, and its purchase is oftensuperseded by more frequently used supplies.
  • Lack of time: The ABI exam can take 15 to 45 minutes, depending on the clinician’s skill and how quickly and easily the patient’s pulses can be found.

Although these are all valid explanations, they’re not justifiable reasons for failing to measure the patient’s ABI.

Ideas and solutions

WCCs, DWCs, CWCNs, CWSs, and all other wound care experts should focus on sharing their knowledge with staff and healthcare community education efforts, such as hands-on ABI training sessions. Approach administrators at your healthcare organization with equipment requisitions for vascular Doppler devices, along with clinical practice guidelines that recommend the ABI exam. Explain to administrators that accurately differentiating vascular wounds from pressure wounds may decrease the organization’s pressure ulcer prevalence rate.

Other suggestions:

  • Contract with an outside agency to perform ABI exams for your facility or agency.
  • Designate an official ABI staffer to assist with admissions.
  • Consider using the Lanarkshire Oximetry Index as a substitute for ABIs.

For additional information, visit these other online links:

The ABI is an extremely beneficial tool that can aid early detection of peripheral arterial disease, in turn helping to prevent complications and amputations and potentially saving lives. ABI needs to come off the dirty-word list.

Donna Sardina, RN, MHA, WCC, CWCMS, DWC, OMS


Wound Care Advisor

Cofounder, Wound Care Education Institute

Plainfield, Illinois

DISCLAIMER: All clinical recommendations are intended to assist with determining the appropriate wound therapy for the patient. Responsibility for final decisions and actions related to care of specific patients shall remain the obligation of the institution, its staff, and the patients’ attending physicians. Nothing in this information shall be deemed to constitute the providing of medical care or the diagnosis of any medical condition. Individuals should contact their healthcare providers for medical-related information.

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