Q: Is it worth buying an audible, handheld Doppler ultrasound to detect arterial insufficiency?

A: In post-acute and long-term care facilities,  older adults with lower extremity  wounds may have unknown ulcer etiology. Is it arterial, venous or both? Does it have associated neuropathy? Diabetics with arterial vascular disease may not manifest pain.

In some facilities, staff opt for the in-house audible handheld Doppler ultrasound (AHHD), which can provide bedside testing. Information from an AHHD can benefit the patient, but it does not supersede the importance of history taking and examination. 

Arterial ulcers are often painful unless patients have severe neuropathies. Such patients suffer with claudication pain. It may be a stabbing, burning sharp and/or achy pain associated with ambulation. It is relieved with rest. With disease progression,  pain becomes persistent and gnawing. It often causes severe sleep disturbances. For a patient with any wounds, it is also helpful to explore whether the ulcer is healable. 

Noninvasive bedside testing is ideal for older patients in post-acute or long-term care settings. It can allow the wound care expert to rule out peripheral arterial disease. However, it may be falsely high in diabetics (80%) and older adults (20%). A Doppler with 8-MHz or more yields the best results. Just placing the Doppler on the lower extremity vascular system is not enough. Also perform a procedure to check for the ankle-brachial pressure index (ABPI)..

As of today, the arteriogram remains the gold standard for arterial testing and is done when a bypass or arterial dilation procedure is required. 

It may not be a big deal whether or not you have AHHD in your facility, but what is more important is how the healthcare team provides person-centered care. It is best to strive for healthy habits and healing, regardless of the patient.