Evaluation of the palmar circulation by pulse oximetry

Abstract

The usual method of substantiating collateral circulation of the hand is with Allen's test. We used the pulse-detecting capability of the pulse oximeter to assess the presence of collateral circulation of the hand. Thirty-one patients undergoing radial artery cannulation for intraoperative monitoring were evaluated before cannulation with a modified Allen's test and by pulse oximetry. After the collateral circulation of the hand was tested by the modified Allen's test, a pulse oximeter probe was placed on the index finger. Both radial and ulnar arteries were occluded until no perfusion was detected by the pulse oximeter. The test was repeated twice on each hand, once for each artery. The time to reperfusion after arterial release was recorded. Reperfusion times greater than 15 seconds were considered abnormal. This sequence was repeated postoperatively after the radial artery cannulae were removed. A total of 68 tests were performed before cannulation; 3 showed an abnormal Allen's test, a finding confirmed by pulse oximetry evaluation. The Allen's test was indeterminate 13 times. In all of these cases, pulse oximetry demonstrated collateral blood flow. When collateral circulation was determined to be present by Allen's test, it was also found to be present with pulse oximetry. Three days after cannulation was discontinued, 8 patients had abnormal Allen's test results, a finding again confirmed by pulse oximetry evaluation. Of 15 patients with indeterminate Allen's test results, 12 had collateral blood flow determined by pulse oximetry and 3 had abnormal results. The ability of pulse oximetry to detect collateral circulation was significantly different (P less than 0.001) when compared with Allen's test both before and after radial artery cannulation.(ABSTRACT TRUNCATED AT 250 WORDS)