How to Measure

Ankle Brachial Index

by Jackie Todd MBA, BS, RN, CWCN, DAPWCA

Ankle Brachial Index (ABI) is a screening tool for significant arterial flow
problems to the extremities. It compares blood flow pressure in the lower leg to
blood flow pressure in the upper arm. Its purpose is to help identify patients for
whom compression therapy would be appropriate. Please note that ABI screening
may not be accurate in patients with diabetes whose veins are calcified.

Improving Quality of Care Based on CMS Guidelines 23

 ABI Measurement Steps
Use the ABI Worksheet on page 26 to record your results.

1 Have the patient remove their shoes and

socks and lie in the supine position for at Posterior
least 10 minutes prior to obtaining blood tibial pulse
pressure readings.

2 Apply blood pressure cuff snugly to the

upper arm with the lower edge of the cuff
one inch above the antecubital space. An
appropriately sized cuff for the arm will usu-
ally be appropriately sized for the ankle.
In the event that arm and ankle sizes are
markedly different, choose cuff sizes that
are appropriate for each site.

3 Apply an adequate amount of Doppler gel

to the antecubital area.
Dorsalis
pedis
4 Turn the Doppler on and place the probe on
the antecubital space at approximately a
60-degree angle to the skin surface. Move
the probe around until the clearest arterial
pulse is heard, and keep the probe in that
position while taking the blood pressure.

5 Inflate the blood pressure cuff to approxi-

mately 20 mmHg above the numerical
reading where the pulse sounds cease.

6 Deflate the cuff atarateof2mmHgpersecond

until the first arterial pulse sound is heard.
Once the number is determined, deflate
the cuff completely and record this sys-
tolic pressure. Remove the gel from the
patient’s skin.

7 
Apply the same blood pressure cuff to
the ankle on the same side of the body.

8 Palpate the area around the medial malleo-

lus to find the posterior tibial arterial pulse.

24 Healthy Skin
 Helpful
9 If the pulse is palpable, apply Doppler gel to the area. If
there is no palpable pulse, apply the Doppler gel, turn
on the Doppler device and use the probe to find the
Hints
pulse. Move it around the general area until the clearest
arterial sound is heard. Keep the probe in that position  ollow the manufacturer’s
F
and take the blood pressure by inflating the cuff and fol- instructions specific to the
lowing the procedure as before when obtaining the arm
Doppler probe you are using.
pressure readings. Record the reading.

10 Doppler device obtain the systolic reading for the pos- Be sure to use enough gel.
terior tibial reading.

 se a cuff size that is right

U
11 Repeat the process for other side of body—brachial,
posterior tibial and dorsalis pedis.
for both the arms and ankles
of the patient.
12 To determine the ABI, divide the higher of the two ankle
pressures by the higher of the two brachial pressures. If Be sure you’re centered on
only one ankle pressure could be obtained, use that one.
the pulse when you take the
Ankle Pressure
reading; if you are off to the
= ABI
Brachial Pressure side the reading will be low.

Be aware that patients with

diabetes commonly have calcified
Interpretation of Findings vessels and abnormally high ABIs.

The following is a guide to interpreting the results of the ABI.

>1.4 Indicates noncompressible vessels
In a small percentage of
> 1.0 Normal patients, one of the ankle
< 0.9 LEAD pressures will be undetectable.
< 0.6 to 0.8 Borderline Use the detectable pressure
<0.5 Severe ischemia
for calculating the ABI.
*Note: In instances where only one extremity can be
accessed, use the available systolic ankle/brachial reading  on’t be discouraged if
D
for calculating ABI. measuring the ABI seems slow or
clumsy at first. Like any procedure
Source: Wound, Ostomy and Continence Nursing Society.
the ABI becomes easier to do with
Ankle Brachial Index: Best Practice for Clinicians
practice.

Improving Quality of Care Based on CMS Guidelines 25

 ABI = Ankle brachial index
ABI Worksheet DP = Dorsalis Pedis
PT = posterior tibial

Highest Right Ankle Pressure Highest Left Ankle Pressure

= ABI = ABI
Highest Right Brachial Pressure Highest Left Brachial Pressure

Right Arm BRACHIAL Systolic Left Arm BRACHIAL Systolic

mmHg mmHg

Right Ankle Systolic Pressure Left Ankle Systolic Pressure

DP m DP m
mHg mHg

PT m PT m
mHg mHg

Right ABI = Ratio of

Higher of the Right Ankle pressures (DP OR PT) mmHg =
Higher Arm Pressure (right or left arm) mmHg

Left ABI = Ratio of

Higher of the Left Ankle pressures (DP OR PT) mmHg =
Higher Arm Pressure (right or left arm) mmHg

26 Healthy Skin