Person—peripheral vascular disease indicator (foot), code N

Identifying and definitional attributes

• Health, Standard 21/09/2005

Value domain attributes

Representational attributes

Collection and usage attributes

CODE 9    Not stated/inadequately described

This code is not for use in primary data collections.

Data element attributes

Collection and usage attributes

CODE 1   Yes
Record if peripheral vascular disease is present in either foot.

CODE 2   No
Record if peripheral vascular disease is not present in either foot.

If it is mild, peripheral vascular disease can be completely without symptoms. However, compromised blood supply in the long term could cause claudication (pain in the calf after walking for a distance or up an incline or stairs), rest pain or vascular ulceration.

Physical examination is necessary to assess the peripheral vascular circulation. Purplish colour and cold temperature of feet are indications to suspect that the circulation may be impaired.

Palpate pulses:

The simplest method to estimate blood flow and to detect ischaemia to the lower extremities is palpation of the foot pulses (posterior tibial and dorsalis pedis arteries) in both feet. Note whether pulses are present or absent. If pulses in the foot can be clearly felt, the risk of foot ulceration due to vascular disease is small.

Test capillary return:

A helpful confirmation sign of arterial insufficiency is pallor of the involved feet after 1 - 2 min of elevation if venous filling time is delayed beyond the normal limit of 15 sec.

Doppler probe:

If pulses cannot be palpated, apply a small hand-held Doppler, placed over the dorsalis pedis or posterior tibial arteries to detect pulses, quantify the vascular supply and listen to the quality of the signal.

When the foot pulses are very weak or not palpable, the risk assessment could be completed by measuring the ankle brachial index (ankle pressure/ brachial pressure). Normal ankle brachial index is 0.9 - 1.2. An ankle brachial index less than 0.6 indicates compromised peripheral circulation.

Source and reference attributes

National Diabetes Data Working Group

National Diabetes Outcomes Quality Review Initiative (NDOQRIN) data dictionary.

Relational attributes