Determining a patient’s ABI is a vital part of wound care, but unfortunately this step is often avoided … or even omitted. Here’s why this happens, and how you can change it.

Have you ever faced a seemingly daunting task, and so you do everything in your power to avoid it? Like renewing a driver’s license, for example. Or maybe cleaning out the refrigerator. But then once it’s done, you look back and say, “Hey, that wasn’t so bad!”

That’s kind of how it is when it comes to determining a patient’s ankle-brachial index (ABI). While this is a key component of the lower-extremity vascular exam, it’s often overlooked – and even omitted – just because it seems so overwhelming. Hang in there, folks: we’re here to help make it easier.

Why ABI?

The ABI is recommended – and in some cases mandated – by numerous clinical practice guidelines, including the most recent international guidelines on preventing and treating pressure ulcers.

Unfortunately, skipping the ABI in patients with lower-extremity wounds is common, even though it should be viewed as a standard in wound care – just as taking a patient’s temperature is standard when there are signs of infection.

Why do we resist?

While there’s never a justifiable reason for failing to measure a patient’s ABI, there are certainly some valid explanations. The most common ones generally fall into three categories:

  • Lack of knowledge. Many clinicians have never heard of an ABI, or they simply don’t know how to measure it. Of course, this makes the entire process feel overwhelming and intimidating.
  • Poor access to equipment. The vascular Doppler is costly, and so its purchase is often superseded by more frequently used supplies.
  • Lack of time. The ABI exam can take 15 to 45 minutes, depending on the clinician’s skill and how quickly and easily the patient’s pulses can be found. This can be a deterrent when clinicians are faced with large caseloads and limited time for treatment.

What you can do

As with any other topic in wound care, so much depends on education. WCCs, DWCs and other wound care experts should focus on sharing their knowledge with staff and through educational efforts within the healthcare community.

For example, consider initiating and developing a series of hands-on ABI training sessions. You can also present facility administrators with equipment requisitions for vascular Doppler devices, along with clinical practice guidelines that recommend the ABI exam. Explain and emphasize to administrators that accurately differentiating vascular wounds from pressure wounds may decrease the organization’s pressure ulcer prevalence rate.

Here are additional suggestions:

  • Contract with an outside agency to perform ABI exams for your facility or agency.
  • Designate an official ABI staffer to assist with admissions.
  • Consider using the Lanarkshire Oximetry Index as a substitute for ABIs.

How to learn more

The ABI is a vital tool that helps with early detection of peripheral arterial disease. And this, in turn, helps to prevent complications and amputations, potentially saving lives. Instead of avoiding it, try plunging in and learning more. For additional information, visit these links:

How to Perform the Ankle-Brachial Index (ABI)

Illustration by National Heart Lung and Blood Insitute (NIH) [Public domain], via Wikimedia Commons

What do you think about the ABI?

Are you comfortable with administering ABIs? Does your facility understand the value and need for this process, and do you have proper time and equipment to make it a regular part of assessment? We would like to know about your ABI experiences in the field. Please tell us your stories and leave your comments right here.

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see

Keisha Smith, MA, CWCMS

Keisha Smith, MA, CWCMS, is a freelance digital marketing consultant who works with clients in healthcare, law and behavioral health. Her specialties include content creation, social media and brand clarity. As an eight-time Wild On Wounds conference staff member and an alumna of WCEI's training program for wound care marketing professionals, she loves the exceptional passion of clinicians who treat wounds. She frequently finds herself advising friends and family to keep their minor wounds warm and moist.

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