Huntleigh Vascular Assessment Echo-Doppler

The Vascular Doppler probe has a special crystal within it that is used for sending the ultrasound waves into the tissue, and a "receive" crystal is used to "collect" the returning ultrasound waves as they "bounce" off the blood cells. The probe can also sense frequency differences in blood flow. These are heard as an increasing frequency change whether the blood is flowing toward or away from the probe. Doppler s are available that apply this principle of high and low pitch sound with flow to and away from the transducer to obtain direction. The system compares the reflected echoes with the transmitted echoes, and then analyzes the waves, and amplifies them to produce the audible signal heard from the speaker. If the blood is not moving, or the ultrasound path is not on the vessel of interest, no Doppler sound will be heard. Computerization of the data collected, and evaluation of the intensity of signal returned, allows for a graph to be generated that provides information about blood flow volume.

The noninvasive vascular laboratory (the "Blood flow lab") allows patients to be examined using Doppler ultrasound techniques free of the risks and discomforts of injections and/or other invasive maneuvers. These tests allow diagnosis of almost all known or suspected vascular disorders, and testing can often determine the severity of the problems and the need for treatment.

Blockage in the circulation to the arms or legs is known as Peripheral Arterial Disease (PAD), and it is a very common indication for vascular Doppler testing. Doppler arterial exams provide physiologic information about the presence, absence, or severity of PAD for disorders such as hardening of the arteries (atherosclerotic disease), diabetes, peripheral neuropathy, and thoracic outlet syndrome. Duplex arterial studies provide additional information concerning flow characteristics and the extent of narrowing, or stenosis, within the artery.

It is important to recognize that PAD may exist in the presence of a normal peripheral pulse physical exam, a normal Ankle-Brachial Index (the difference between the blood pressure in the arms and legs) and in the absence of claudication (calf pain present only with walking and relieved by rest).

One of the most common causes of chronic pain is the lack of a complete diagnosis. Many people believe that if pain is coming from soft tissue (referring to muscle or nerve) then it should be self-limited and resolve within a reasonable period of time. They also may believe if pain is more severe, or does not go away as expected, then it must be due to a surgical problem. The vast majority of pain disorders, however, are not remedial to surgical intervention. One of the approaches is to use ultrasound studies that image muscle or ligament strains and tears.

See also section on Obsterics-Echo Doppler

dopplex* Vascular Dopplers

Dopplex handheld Doppler range offers even greater performance, quality and value for money. The range now has significantly enhanced features including:

โ€ข Improved probe design with 50% greater efficiency to give increased sensitivity for easier detection of smaller vessels and calcified arteries

• An Easy8 wide beam probe for easy vessel location

• A reuseable Intraoperative Probe for cost effective reassurance during surgery

• Improved:

– audio performance

– battery power management

– carry bag design which includes space for a sphyg and cuff

• Optional accessories include a new battery charger kit and pole stand.

dopplex® D900 Non-directional Doppler

The Dopplex® D900 is a low cost audio only, non-directional Doppler, principally used for ABPI measurements by community nurses and doctors in their role of leg ulcer management.

• Clear audio sounds of blood flow or fetal heart

• Enhanced battery management

• Compatible with the complete range of vascular probes

• When used with Easy8 probe it is excellent for the infrequent user in locating brachial and pedal arteries

• Large carry bag

• Headphones included.

dopplex® SD2 Bi-directional Doppler

The Dopplex® SD2 provides bi-directional vascular information to the vascular professional including the display of flow direction. It is ideal for clinical specialists wishing to conduct advanced Doppler studies.

• Compatible with all high sensitivity vascular probes (audio only with OP2 and OP3)

• Ideal for ABPI assessment

• Provides bi-directional blood flow information

• Enhanced stereo audio output

• Large carry bag

• Stereo headphones included.

dopplex® MD2 Bi-directional Doppler

The Dopplex® MD2 is one of the most advanced pocket Dopplers on the market. It provides the ability for high level vascular assessment, and is ideal for the detection of peripheral arterial disease. When used with the high sensitivity vascular probes it provides quality bi-directional blood flow information. It can be linked to the Dopplex Reporter software package for high quality waveform reports or the Dopplex Printa for single waveform recordings.

• Connects with all High Sensitivity probes (2, 3, 4, 5, 8, 10 MHz)

• Provides bi-directional blood flow information and documentation

• Integral battery management

• Enhanced audio output

• Large carry bag will hold sphyg and cuffs.

# The Mini Dopplex Doppler Non-Directional ideal for low-cost, highly effective non-invasive vascular assessment Non-directional Doppler that provides all the standard features of the traditional Dopper at a lower cost

# Intended for primarily vascular use, it can be used with the widest range of both vascular and obstetric probes for cost-effective examinations

# Ideal for basic assessments in the hospital, physician office or home care setting

# Applications include: ankle pressure index, leg ulcer management, segmental pressure studies, arterial flow screening, venous flow screening, blood flow wave form recording

# Integral speaker

# Comes with your choice of 1 Probe. Probe options; 2, 3, 4, 5, 8 or 10 MHz

# Obstetric capability (audio only)

# 9V Battery Life: 500 x 1 minute examinations (Alkaline batteries preferred)

# Supplied with the following accessories: Gel, neck cord, soft carry pouch and user manual.

The Multi Dopplex II bi-directional doppler is one of the most advanced hand-held units in the world. Its display provides information on flow direction and unit status. Combined with one of the new high-sensitivity probes, it is ideal for assessment of peripheral arterial disease, the diabetic foot and venous problems. The Multi Dopplex II can be used by surgeons, physicians, podiatrists, GP's and wound care specialists who are interested in bi-directional flow and waveforms. It can also display fetal heart rate when using a high-sensitivity 2 MHz probe. For record-keeping, the Multi Dopplex II can be linked to the Dopplex Reporter software package for high-quality waveform reports, or the Dopplex Printa II for single waveform recordings. Includes a 2 MHz fetal heart rate probe. Additional probes are available.

Applications : Peripheral Arterial Disease (PAD), Diabetic related studies and vein related disorders.

Can be used in combination with Doppler reporter software with Dopplex Printa to obtain graphical representation.

This device in combination with OP2HS or OP3HS can be deployed for fetal heartbeat registration.

Super Dopplex II bi-directional can register the blood flow direction on the display. This doppler is ideally suited to conduct elaborate studies.

dopplex® RD2 Bi-directional Doppler and PPG System has four application areas which are addressed by this single unit :

• DVT Screening

• CVI Screening

• ABPI measurements

• Fetal heart detection

• Screening for the absence of DVT using simple dorsiflexion test

• Easy location of probe using the blue guide.

Dopplex RD2 handheld unit combines Digital Photoplethysmography (PPG) with Bi-directional Doppler to make a complete arterial and venous assessment system. It can provide printouts of venous refill curves and blood flow waveforms using Dopplex DR3 software or the Dopplex Printa II package.

DVT Screening with the Dopplex RD2

The Dopplex RD2 unit has been clinically proven to be effective in screening patients for the absence of a Deep Vein Thrombosis (DVT) in the lower limb. Clinical studies have shown that Dopplex RD2 is a reliable screening tool in patients with suspected lower limb DVT and is suitable for bedside and community based practice. (Tan et al, 1999; Hennings et al, 2000).

Recent studies have shown that when the Dopplex RD2 is used in conjunction with D-Dimer, 100% NPV for DVT is obtained. This has also resulted in significant cost savings for the hospital by reducing the number of Duplex scans. (Tovey et al, 2000; Williams et al, 2002).

The RD2 unit is ideal for A&E departments, Medical Assessment Units, GP and Leg Ulcer Clinics.

CVI Screening with the Dopplex RD2

The Dopplex RD2 unit can also be used for assessing Chronic Venous Insufficiency (CVI).

Applications include:

• Rapid assessment of overall venous function. (McEnroe et al, 1988)

• Differentiation between deep and superficial venous insufficiency (Neumann et al, 1992)

• Measurement of ABPI

• Detecting Fetal heart beat (with optional OP2).

dopplex® MD200

The โ€˜NEWโ€™ MD200 is an innovative desktop solution for clinicians requiring a robust, versatile and rechargeable Doppler unit. Using up to eight interchangeable probes, it provides bi-directional measurement of vascular blood flow and high quality reports when linked to the Dopplex Reporter software.

• Mains/battery operation

• Robust design

• Probes are conveniently stored within the unit

• Enhanced battery power management

• Advanced bi-directional unit with printout capability

• LCD showing bi-directional flow, probe frequency and battery status

• Serial port for connection to the Dopplex® Printa or Dopplex® Reporter software package

• Two speakers providing flow separated high quality stereo sound

• Ideal for measurement of ABPI and venous assessment in a clinic environment

• Now available with a locking pole stand.

dopplex® DR3 Software Package

Dopplex Reporter Package is a unique vascular reporting software package for use in conjunction with the Dopplex RD2, MD2 and MD200 units.

It enables complete vascular studies to be undertaken and saved in a patient database, and provides full page documented hard-copy printouts. It is easily installed and does not require any modification to your computer.

Applications available in version 3 include:

• Upper and lower limb arterial pressure and flow studies

• Lower limb venous studies

• Extracranial blood flow studies

• Penile pressure and flow studies

• Podiatry and chiropody studies

• Pre/post operative studies

• PPG venous studies (Rheo only)

• Doppler waveform parameter calculations

• Compatible with Windows 98, 2000 and XP

• USB and serial cables included.

dopplex® Printa II

Dopplex Printa II package is a portable, mains/battery thermal printer, which provides documentation of bi-directional Doppler waveforms when used with Dopplex MD2, RD2 and MD200. PPG curves can also be documented when used with the Dopplex RD2 unit. It is ideal for a clinic where portability is required.

Pole Stand Accessory

Pole stand for Dopplex D900, SD2, MD2, RD2 & MD200.

A convenient way of holding your hand held Doppler and preventing it from disappearing into other departments.

• Options for both hand held and desktop Dopplers

• Provides convenient and height adjustable secure mount on mobile 5 wheel base

• Includes basket for storing gel, probes, cuffs, etc

• Option to mount Dopplex Printa II on pole below Doppler.

dopplex® DFK Diabetic Foot Assessment Kit

The Diabetic Foot Assessment Kit provides the professional vascular or diabetes specialist with a system to help in the assessment of neuropathy, ankle brachial pressure index (ABPI) and toe brachial pressure index (TBPI).

Product includes:

• Bi-directional Doppler (MD2) and probe (VP8HS)

• Neuropen (includes 10g monofilament)

• Trigger operated sphyg with a range of latex free cuffs (arm/ankle, large and small toe)

• Educational DVD

• Hard carry case

• Set of guides (ABPI/TBPI)

• Headphones

• Box of Neuropen tips.

dopplex® ABPI Ankle Brachial Pressure Index Kit

The ABPI Kit contains all the items required to undertake a full ABPI assessment on regular or oedematous limbs and includes two Doppler probes and cuffs. The Easy8 probe helps to locate vessels and also maintain vessel contact during inflation and deflation procedures, and the VP5 is ideal for oedematous limbs.

Pack includes:

• Dopplex® MD2 bi-directional Doppler

• High sensitivity widebeam EZ8 8MHz probe

• High sensitivity VP5HS 5MHz probe

• Large arm/ankle cuff

• Standard arm/ankle cuff

• Sphygmomanometer (quick release)

• ABPI Guide

• Educational CD

• Large carry bag.

dopplex® PAD Peripheral Arterial Disease Assessment Kit

The PAD kit includes all the items required to undertake a basic assessment on patients at risk of arterial disease.

Pack includes:

• Dopplex D900 non-directional Doppler

• High sensitivity widebeam EZ8 probe

• Standard arm / ankle cuff

• Sphygmomanometer

• ABPI guide

• Educational CD

• Large carry bag.

dopplex® Intraoperative Probe

The reusable Dopplex Intraoperative probe can be used to immediately confirm blood flow prior to closing, saving time and costs of a potential re-operation. The High Sensitivity probes are available in packs of 3 and can be re-sterilised by Autoclave, Ethylene Oxide or Steris System 1. This allows spares to be available in case of contamination. The probes have been specially designed to be lightweight, easy to hold, and will replace the use of a standard probe placed in a sterile glove. A special electronic adaptor that resists diathermy interference allows connection to any Vascular Dopplex Advanced Pocket Doppler. The Dopplers can be mounted onto an IV pole using the specially designed pole clamp or the pole stand, which also supports the Dopplex Printa.

Available as:

• A starter pack, which includes adaptor, pole clamp and 3 probes – Order code ISP3

โ€ข A starter pack with Doppler, which includes MD2 bi-directional Doppler, adaptor, pole clamp and 3 probes – Order code ISP3-MD2

โ€ข A starter pack with Doppler, which includes D900 non-directional Doppler, adaptor, pole clamp and 3 probes – Order code ISP3-D900

• A probe pack containing 3 probes – Order code IPP3.

NEW –Extended Applications Assist Series

Ankle & Toe Pressure Index (ABPI / TBPI)

One of the latest applications is a dedicated ABPI/TBPI function. This allows the rapid measurement of brachial and pedal systolic pressures using either Doppler or bi-laterally using arterial photoplethysmography (PPG). The user can then move on and measure toe pressures if calcified arteries are present. The ABPI’s and TBPI’s are automatically calculated and can be saved and printed as a report.

Excercise Test

The exercise test has been introduced so that intermittent claudicants can be correctly assessed. It records the resting pressures from the ABPI test and provides a timer to record the duration and distance of the exercise. Following the exercise, pressures can be recorded and are plotted to show the recovery time. Alternatively Doppler waveforms and pressures can be recorded pre and post exercise providing valuable data to aid the clinician’s diagnosis.

General Test

The new general test allows the clinician to record Doppler waveforms and pressures up to 14 sites. Each site can be customised to undertake complete extracranial studies or those requiring mixed arterial and venous measurements.

Principal Applications

[1] Leg Ulcer Assessment and Lymphoedema

The Dopplexยฎ Assist series is ideal for leg ulcer assessment and is now the product of choice for Tissue Viability Nurses, Clinical Nurse Specialists and clinicians involved in wound care. It can also be used to assess the arterial status of the lymphatic limb. (Doherty et al, 2006). The new ABPI/TBPI application allows rapid measurement of systolic pressures in brachial and pedal vessels using Doppler. The ABPI is then calculated automatically and all data can be stored and printed for patient notes. The level of arterial disease can be determined and the appropriate bandaging regime can be applied. In the case of calcified arteries being present then toe pressures can be measured using arterial PPG sensors. The TBPI is then calculated automatically to determine the level of arterial perfusion in the foot and allow the appropriate referrals to be made.

[2]Diabetic Foot Assessment

Assessment of the diabetic foot is an important part of the annual review of a diabetic patient. It is now recommended to undertake a sensation test using a 10g monofilament and a complete vascular assessment on high risk patients. (NICE, 2004; ETRS, 2003). This takes the form of ABPI’s and the recording of Doppler waveforms. Toe pressures and TBPI’s should also be measured on any diabetic with calcified arteries. (Stuart, 2004).

[3] Assessing Peripheral Vascular Disease (PVD)

Various studies have shown that the ABPI is a good indicator of the presence of arterial disease and can stratify the severity. Patients with an ABPI < 0.9 are twice as likely to have CHD as those with normal ABPI, and with increased risk of MI, stroke and death. Patients with mild to moderate PVD can now be given exercise regimes and prescribed antiplatelet therapies to extend their life expectancy. Many of these patients are intermittent claudicants and their severity of PVD is unclear unless an exercise test is performed. This can be readily performed to determine the extent of the disease, permitting appropriate referrals or treatment.

[4] Assessing Venous Leg Ulcers

Following the measurement of ABPI to exclude significant arterial disease, it is now recommended to undertake venous assessment of recurrent or non-healing ulcers. (ETRS, 2003). This can be easily and rapidly achieved by using the venous package to determine the degree of venous incompetence in the whole leg. By using tourniquets appropriately placed on the legs, the level of superficial or deep venous incompetence can be determined. This information can help to progress the patient onto the correct clinical pathway and refer patients with superficial disease for surgery or sclerotherapy.

[5] Portable Fetal Monitors

The DOPPLEX® ASSIST Range of modular medical systems underpins an commitment to leading edge technology and the production of high quality medical equipment that meet the changing needs of healthcare providers worldwide.

This new product line is designed to give the user maximum flexibility to carry out their tasks anywhere within the hospital, in the community or even at the patient’s home.

FETAL ASSIST is the world’s first truly portable handheld CTG monitor. Being compact and battery operated, it allows patients to be monitored anywhere, at any time. A high quality color display shows the CTG data presented in standard format for easy interpretation.

FETAL ASSIST addresses all the needs of conventional non-invasive monitoring, in the home, community, clinic or hospital. It is also unique in being able to provide continuous monitoring during internal or external patient transfer.

Advanced features include a PCMCIA card facility which allows tele-transmission of data over a telephone line or mobile phone link, memory card, SmartCard reader, integral patient database, trace storage, touch screen trace annotation and data entry.

* Color Graphic Display

* Real Time FHR trace on standard scale formats

* Real Time uterine Activity (contractions) trace on standard scale format

* FHR rate display and 5-level signal quality indicator

* Event marks & automated fetal movement detection

* On-screen clinical event marker & trace annotation

* Comprehensive patient database

* Store over 500 patient records (30 minutes traces) in internal memory

* Store unlimited data on plug-in PCMCIA memory cards.