Neurovascular assessment and ABPI
Sensation, pulses and Doppler, ABPI and toe pressures worked out for you, capillary refill and temperature.
Recording it
On a clinical note, press Neurovascular assessment. Left and right sit side by side: vibration (128 Hz tuning fork), sharp and blunt, proprioception and ankle reflex; dorsalis pedis and posterior tibial pulses and their Doppler waveforms; temperature by touch and swelling. Leave anything you didn't test blank.
ABPI
Enter the brachial pressure for each arm and the DP and PT pressures for each ankle. The ABPI for each leg is the higher of its two ankle pressures over the higher arm pressure, to two decimal places, worked out as you type, with its usual band:
- above 1.3: arteries may be incompressible (calcified); check toe pressures and waveforms
- 0.9 to 1.3: normal range
- 0.8 to 0.89: mild arterial disease
- 0.5 to 0.79: moderate arterial disease (vascular opinion; only reduced compression, with specialist advice)
- below 0.5: severe arterial disease (refer urgently; no compression)
A toe pressure gives the TBPI (below 0.7 is usually abnormal), useful when ankle arteries are calcified, as in diabetes. Capillary refill over 3 seconds, neither pulse palpable, absent vibration, or more than 2.2 °C between the feet (if you measure skin temperature) are flagged too. These are guides: use your clinical judgement and your local pathway.
The record's Foot health page lists each assessment's ABPI over time.