Impedance Phlebography

Definition

Impedance phlebography is a noninvasive test that uses electrical monitoring to measure blood flow in veins of the leg. Information from this test helps a doctor to detect deep vein thrombosis (blood clots or thrombophlebitis).

Purpose

Impedance phlebography may be done in order to:

• detect blood clots lodged in the deep veins of the leg
• screen patients who are likely to have blood clots in the leg
• detect the source of blood clots in the lungs (pulmonary emboli)

Blood clots in the legs can lead to more serious problems. If a clot breaks loose from a leg vein, it may travel to the lungs and lodge in a blood vessel in the lungs. Blood clots are more likely to occur in people who have recently had leg injuries, surgery, cancer, or a long period of bed rest.

Precautions

Because this test is not invasive, it can be done on all patients. However, the accuracy of the results will be affected if the patient does not breathe normally or keep the leg muscles relaxed. Compression of the veins because of pelvic tumors or decreased blood flow, due to shock or any condition that reduces the amount of blood the heart pumps, may also change the test results.

Description

Impedance phlebography works by measuring the resistance to the transmission of electrical energy (impedance). This resistance changes depending on the volume of blood flowing through the veins. By graphing the impedance, a doctor or technician can tell whether a clot is obstructing blood flow.

Using conductive jelly, the examiner puts electrodes on the patient's calf. These electrodes are connected to an instrument called a plethysmograph, which records the changes in electrical resistance that occur during the test.

The patient lies down and raises one leg at a 30° angle, so that the calf is above the level of the heart. The examiner wraps a pressure cuff around the patient's thigh and inflates it to a pressure of 45–60 cm of water for 45 seconds. The plethysmograph records the electrical changes that correspond to changes in the volume of blood in the vein at the time the pressure is exerted and again three seconds after the cuff is deflated. This procedure is repeated several times in both legs.

This test takes 30–45 minutes. Impedance phlebography is also called an impedance test of blood flow or impedance plethysmography.

Preparation

Patients undergoing this test do not need to alter their diet, change their normal activities, or stop taking any medications. They will wear a surgical gown during the test, and be asked to urinate before the test starts. If keeping the legs elevated causes discomfort, mild pain medication will be given.

Aftercare

The patient may resume normal or postoperative activities after the test.

Risks

Impedance phlebography is painless and safe. It presents no risk to the patient.

Normal results

Normally, inflating the pressure cuff will cause a sharp rise in the pressure in the veins of the calf because blood flow is blocked. When the cuff is released, the pressure decreases rapidly as the blood flows away.

Abnormal results

If a clot is present, the pressure in the calf veins will already be high. It does not become sharply higher when the pressure cuff is tightened. When the pressure cuff is deflated, the clot blocks the flow of blood out of the calf vein. The decrease in pressure is not as rapid as when no clot is present, and the shape of the resulting graph is different.

BOOKS

"Impedance Plethysmography." In Illustrated Guide to Diagnostic Tests, ed. J. A. Lewis. Springhouse, PA: Spring-house Corp., 1994.

OTHER

Griffith, H. Winter. "Complete Guide to Medical Tests." Thrive Online. <http://thriveonline.oxygen.com>.

Tish Davidson

KEY TERMS

Thrombophlebitis—Inflammation of a vein, associated with the formation of a blood clot.