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
least 10 minutes prior to obtaining blood
pressure readings.

Posterior
tibial pulse

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 usually 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.

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 approximately 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 systolic pressure. Remove the gel from the
patients 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 malleolus to find the posterior tibial arterial pulse.

24 Healthy Skin

Dorsalis
pedis

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
pulse. Move it around the general area until the clearest
arterial sound is heard. Keep the probe in that position
and take the blood pressure by inflating the cuff and following the procedure as before when obtaining the arm
pressure readings. Record the reading.

10 Doppler device obtain the systolic reading for the pos-

Hints

 ollow the manufacturers

F
instructions specific to the
Doppler probe you are using.
Be sure to use enough gel.

terior tibial reading.

11 Repeat the process for other side of bodybrachial,

posterior tibial and dorsalis pedis.

 se a cuff size that is right

U
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
only one ankle pressure could be obtained, use that one.

Ankle Pressure
= ABI
Brachial Pressure

Be aware that patients with

diabetes commonly have calcified
vessels and abnormally high ABIs.

Interpretation of Findings
The following is a guide to interpreting the results of the ABI.
>1.4
Indicates noncompressible vessels
> 1.0 Normal
< 0.9 LEAD
< 0.6 to 0.8 Borderline
<0.5
Severe ischemia
*Note: In instances where only one extremity can be
accessed, use the available systolic ankle/brachial reading
for calculating ABI.
Source: Wound, Ostomy and Continence Nursing Society.
Ankle Brachial Index: Best Practice for Clinicians

Be sure youre centered on

the pulse when you take the
reading; if you are off to the
side the reading will be low.

In a small percentage of

patients, one of the ankle
pressures will be undetectable.
Use the detectable pressure
for calculating the ABI.
 ont be discouraged if
D
measuring the ABI seems slow or
clumsy at first. Like any procedure
the ABI becomes easier to do with
practice.

Improving Quality of Care Based on CMS Guidelines 25

ABI = Ankle brachial index

DP = Dorsalis Pedis
PT = posterior tibial

ABI Worksheet

Highest Left Ankle Pressure

= ABI
Highest Left Brachial Pressure

Highest Right Ankle Pressure

= ABI
Highest Right Brachial Pressure

Right Arm BRACHIAL Systolic

Left Arm BRACHIAL Systolic

mmHg

mmHg

Right Ankle Systolic Pressure

Left Ankle Systolic Pressure

DP
mHg

DP
mHg

PT
mHg

PT
mHg

Right ABI = Ratio of

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

26 Healthy Skin

mmHg =
mmHg

mmHg =
mmHg