February is Heart Month, a time to spotlight the importance of cardiovascular health, which is why we’re making our best argument for utilizing ABI’s in your wound care program.  Heart disease is the leading cause of death in the U.S., killing about 1 in 4 people each year, according to the Centers for Disease Control (CDC). Related complications like vascular insufficiency or peripheral artery disease can result in the development of painful non-healing wounds that can develop into an infection or sepsis, putting patients at risk of lower limb amputation.

ABI (Ankle-Brachial Index) is a vital step when working with Venous Leg Ulcers (VLUs), especially when considering the use of compression therapy. Current studies show that only 17% of VLU patients in the US receive adequate compression. When used to treat VLUs, compression therapy has been shown to improve healing rates and reduce ulcer recurrence. 

1. Catch Contraindications 

Use ABI to avoid using compression treatment on severe arterial disease, which would worsen the condition. By completing an ABI first, you can confidently move forward with compression treatment, knowing the patient will benefit. When clinicians rely on the presence of palpable pulse alone, they misclassify 17%-20% of patients who are actually suffering from arterial disease. 

2.Time is Tissue 

By delaying effective treatment, venous ulcers are given the opportunity to expand and risk infection. With information provided by an ABI, you can move quickly and decisively to administer treatment in the form of compression, decrease time to heal, and lower patient costs.

3. Know Your Next Steps 

Once you’ve determined that compression is the proper response, an ABI can tell you what level of compression the wound can tolerate. For ABIs greater than .8, consider a high compression of 30-40mmHg. For ABIs between .6 and .8, consider a compression of less than or equal to 20mmHg. Do not use compression for ABIs less than .6. For ABIs over 1.2, refer the patient for further vascular studies. 

Note: All multi-layer compression application inserts approved by the FDA are based on ABI.

4. Look for LEAD and PAD 

Nearly half of patients with Lower Extremity Arterial Disease (LEAD) go undiagnosed because they are either asymptomatic or are showing atypical symptoms. This is compounded by providers relying on unreliable assessment methods like pulse palpation or history of claudication. Consider using ABI, a reliable and non-invasive test for LEAD, as well as peripheral artery disease (PAD). PAD can not be sufficiently included or excluded based on a clinical examination, and requires confirmation through a test like ABI.

If you would like a FREE poster to display in your program that outlines these 4 ABIs and Compression best practices, email info@thewca.com with the subject line: ABI VLU Poster to request.

References:
www.nps.org.au/australian-prescriber/articles/compression-therapy-for-venous-disease
www.eo2.com/www-eo2-com-compression
www.podiatrytoday.com/guide-compression-dressings-venous-ulcers