Doppler assessment

There are approximately 739 000 cases of leg ulcers in England, costing the NHS around £3.1 billion per year (National Wound Care Strategy Programme, 2023).

The National Wound Care Strategy Programme (2020) is looking to improve wound care and standardise this across the UK. The programme recommendations aim to improve healing rates and reduce the cost of inappropriate and unsuccessful treatments, as well as reduce clinical time spent on wound care. In 2022, the Commissioning for Quality and Innovation Metrics was introduced in the assessment, diagnosis and treatment of lower leg wounds (NHS England, 2022). According to best practice statements (Wounds UK, 2019), if a patient has a normal ankle-brachial pressure index or toe brachial pressure index, a minimum compression level of 40 mmHg should be commenced, as long as there are no other contraindications for compression therapy. Compression therapy is the most effective treatment for venous leg ulcers (Wounds

Whayman (2014) stated that performing a full leg ulcer assessment is a crucial skill that allows the clinician to accurately determine the cause of the patient’s ulcer and identify any factors that may be delaying wound healing. The aetiology of the wound determines the most appropriate treatment (National Wound Care Strategy Programme, 2023). The Doppler assessment is a tool that provides guidance on identifying the type of leg ulcers and level of compression.

This tool should be used in conjunction with a thorough patient assessment, including:

• medical history
• risk factors
• allergies
• symptoms of venous insufficiency
• effect of symptoms on daily activities and ulcer duration
• physical examination
• additional investigations (eg blood tests, Doppler, swabs) (National Institute for Health and Care Excellence, 2024a)

It is crucial that nurses are educated and trained in leg ulcer assessment (theory and practical) prior to conducting this. The National Wound Care Strategy Programme (2023) has

The required equipment for each method is outlined below:

Manual Doppler:

• couch or bed to allow patient to feel comfortable
• hand-held Doppler machine
• blood pressure cuff
• vapour-permeable dressing or clingfilm
• 5 or 8 MHz probe
• ultrasound gel
• calculator

Toe Doppler:

• couch or bed to allow patient to feel comfortable
• DMX digital Doppler
• EZ8XS Widebeam 8 MHz probe
• arterial plethysmography probe and adaptor
• toe cuffs and inflator
• arm or leg cuffs
• ultrasound gel
• calculator

Automated Doppler:

• couch or bed to allow patient to feel comfortable
• automated Doppler, including blood pressure cuffs and standard thermal paper

The step-by-step procedures for the use of manual, toe and automated Doppler are outlined in Table 1.

Doppler assessment is a safe and non-invasive procedure, but the equipment requires disinfecting after use to minimise the risk of infections.

The Doppler assessment has some limitations, such as devices failing because of low battery and/or a fault. Therefore, Doppler assessments should always be used with clinical judgement to support an appropriate treatment plan. It is essential that healthcare professionals have knowledge of the three type of leg ulcers (venous, arterial and mixed), since applying the wrong level of compression can lead to serious consequences for the lower limb (National Wound Care Strategy Programme, 2023).

After the Doppler assessment is completed, the clinician must interpret the results. The ankle and toe brachial pressure indices involve different interpretations (Table 2).

Nursing and Midwifery Council: standards of proficiency for registered nurses

Part 1: Procedures for assessing people’s needs for person-centred care

1. Use evidence-based, best practice approaches to take a history, observe, recognise and accurately assess people of all ages

1.2 physical health and wellbeing

2. Use evidence-based, best practice approaches to undertake the following procedures:

2.7 undertake a whole body systems assessment including respiratory, circulatory, neurological, musculoskeletal, cardiovascular and skin status

Fletcher J, Buxey K, Conway K et al. Best practice statement: ankle brachial pressure index (ABPI) in practice. 2019. https://www.cambscommunityservices.nhs.uk/docs/default-source/luton-tissue-viability/leg-ulcers/best-practice-statement-ankle-brachial-pressure-index-abpi-practice.pdf?sfvrsn=2 (accessed 11 April 2024)

Fletcher J, Atkin L, Dhoonmoon L et al. Best practice statement: holistic management of venous leg ulceration (second edition). 2022. https://wounds-uk.com/wp-content/uploads/sites/2/2023/02/d9d4688943fa8146f1579be583bbb608.pdf (accessed 11 April 2024)

Guest JF, Fuller GW, Vowden P. Venous leg ulcer management in clinical practice in the UK: costs and outcomes. Int Wound J. 2018;15(1):29-37. https://doi.org/10.1111/iwj.12814 

Huntleigh. Dopplex ATP kit. 2022a. https://www.huntleigh-diagnostics.com/Dopplex-ATP-Kit (accessed 11 April 2024)

Huntleigh. Instructions for use: D900MKII – handheld Doppler. 2022b. https://irp.cdn-website.com/a7c96b08/files/uploaded/793323-03%20D900%20multilang.pdf (accessed 11 April 2024)

National Institute for Health and Care Excellence. How should I assess a person with a suspected venous ulcer? 2024a. https://cks.nice.org.uk/topics/leg-ulcer-venous/diagnosis/assessment/ (accessed 11 April 2024)

National Institute for Health and Care Excellence. How should I interpret ankle brachial pressure index (ABPI) results? 2024b. https://cks.nice.org.uk/topics/leg-ulcer-venous/diagnosis/interpretation-of-abpi/ (accessed 12 April 2024)

National Wound Care Strategy Programme. Lower limb: recommendations for clinical care. 2020.