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Modified Allen Test – Clinical Examination
Modified Allen Test – Clinical Examination
Modified Allen Test – Clinical Examination
Allen Test [1]
This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.
Treasure Island (FL): StatPearls Publishing; 2023 Jan-.. The Allen test is used to assess collateral blood flow to the hands, generally in preparation for a procedure that has the potential to disrupt blood flow in either the radial or the ulnar artery
A negative Allen test means that the patient likely does not have an adequate dual blood supply to the hand, which may present a contraindication to the planned procedure or at least suggest that further evaluation is necessary. This activity reviews the Allen test technique and discusses the interprofessional team’s role in applying this maneuver to improve patient outcomes.
Assessment of collateral hand circulation by modified Allen’s test in normal Indian subjects [2]
Assessment of collateral hand circulation by modified Allen’s test in normal Indian subjects. Allen’s test (AT) and Modified Allen’s Test (MAT) are used as screening methods for assessment of the hand circulation
The Purpose of the study was to assess the collateral circulation of hand using MAT in normal Indian subjects and in elderly population to know the prevalence of positivity of Allen’s test.. 900 participants (1800 hands) were divided in two groups
MAT was performed in all participants and results were compared between the two groups.. In group I (n = 450, 900 hands), 313 were males and 137 were females, with mean age of 35.04 years
Palmar Arch Test and AV Fistula [3]
The Palmar Arch Test (PAT), also known as Allen’s Test, is a specialty test performed to evaluate the patency of the arteries in the hand prior to radial or ulnar artery harvesting in artery bypass procedures or before the surgical creation of an upper extremity hemodialysis fistula or graft.. The PAT procedure provides a clinical assessment of the collateral circulation to the hand to determine if arterial harvesting is possible
The blood flow assessment can be performed by different means, with the most popular method being with PPG sensors (Photo-plethysmography).. Additional diagnosis options include digit blood pressure measurements, PVR measurements (Pulse Volume Recording), and Doppler blood flow measurements
The Palmar Arch Test protocol begins by measuring the resting PPG waveforms, then measuring the waveforms after selected compressions (compression of the radial artery, ulnar artery, or both), and finally measuring the waveforms after the release of the selected compression. A similar protocol is applied when using digit pressure, Doppler, or PVR assessment.
Allen Test [4]
This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.
Treasure Island (FL): StatPearls Publishing; 2023 Jan-.. The Allen test is used to assess collateral blood flow to the hands, generally in preparation for a procedure that has the potential to disrupt blood flow in either the radial or the ulnar artery
A negative Allen test means that the patient likely does not have an adequate dual blood supply to the hand, which may present a contraindication to the planned procedure or at least suggest that further evaluation is necessary. This activity reviews the Allen test technique and discusses the interprofessional team’s role in applying this maneuver to improve patient outcomes.
The Allen Test for Blood Flow [5]
Original Editors – Alexander Ghyssels as part of the Vrije Universiteit Brussel Evidence-Based Practice Project. Top Contributors – Sue Safadi, Alexander Ghyssels, Sheik Abdul Khadir, Claire Knott, Rachael Lowe, Scott Cornish, Admin, Kim Jackson, Tarina van der Stockt, Magdalena Hytros, George Prudden, Kai A
Allen as a non-invasive evaluation of the arterial patency of the hand in patients with thromboangitis obliterans. The test has since been adapted as the Modified Allen test (MAT)
The MAT efficiently evaluates the adequacy of the collateral circulation but requires the testing of one hand at a time. The Allen test is a first-line standard test used to assess the arterial blood supply of the hand [4]
Allen’s test [6]
|Purpose||examination of arterial blood flow to the hands|. In medicine, Allen’s test or the Allen test is a medical sign used in physical examination of arterial blood flow to the hands
An altered test, first suggested by Irving S Wright in 1952, has almost universally replaced the original method in contemporary medical practice. The alternative method is often referred to as the modified Allen’s test or modified Allen test.[2]
– The patient is asked to clench both fists tightly for 1 minute at the same time.. – Pressure is applied over both radial arteries simultaneously so as to occlude them.
Step 1: Allen test [7]
– Put on clean, but not necessarily sterile gloves.. The most common site for arterial puncture is the radial artery at the wrist
The Allen test is performed by having the patient clench their fist several times while the operator occludes the radial and ulnar artery at the wrist. The patient then extends their fingers, palm up, which should show a “blanched” hand
If the color of the hand does not return in 5-10 seconds the Allen test is considered positive and arterial puncture should not be attempted at that site. It should be noted that the risks of hand ischemia after arterial puncture are very low and in fact many clinicians do not routinely perform an Allen test
Journal of Reconstructive Microsurgery / Abstract [8]
The Allen test is used to diagnose the relative contribution of the ulnar and radial arteries to each hand. We modified this test to investigate the relative vascular contributions to distal perfusion of the lower extremity
The posterior tibial artery (PT) and dorsalis pedis artery (DP) pulses are compressed. A persistent signal indicates collateral flow through the peroneal artery (PA)
We report a case in which angiography failed to predict reliance on the PT. In this case, performance of the lower-extremity Allen test (LEAT) led to an alternative recipient vessel choice
Evaluation of the palmar circulation by pulse oximetry [9]
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
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 time to reperfusion after arterial release was recorded. Reperfusion times greater than 15 seconds were considered abnormal
The Allen’s test: revisiting the importance of bidirectional testing to determine candidacy and design of radial forearm free flap harvest in the era of trans radial endovascular access procedures – J [10]
The Allen’s test: revisiting the importance of bidirectional testing to determine candidacy and design of radial forearm free flap harvest in the era of trans radial endovascular access procedures. Journal of Otolaryngology – Head & Neck Surgery volume 44, Article number: 47 (2015)
The radial artery, which supplies it, is increasingly being used for endovascular access. Although often asymptomatic it can compromise future free tissue transfer.
The first patient had failure of flap perfusion, presumed secondary to radial artery occlusion from prior endovascular access at the distal radial artery. In the second case, we used the Allen’s test in reverse to identify the same scenario and successfully redesigned the harvest.
Allen Test for Blood Flow: Purpose, Procedure, & Results Explained [11]
Also called a modified Allen test, this is a simple way to measure how well blood flows in your hand. Your doctor may need to check your circulation before they operate on your wrist or a spot nearby, or before other surgeries.
A healthy hand needs both arteries open and working. Some reasons why your doctor may want to perform an Allen test include:
The blood sample is often taken from an artery in your wrist. Because there’s a chance the needle puncture could cause problems to the artery, your doctor may order an Allen test to make sure that the second artery is in good shape.
Allen’s Test: Physical Exam [12]
– Position and stabilize the hand with the palm facing upwards.. – Locate radial and ulnar pulses of hand with palpation:
– Compress both radial and ulnar arteries firmly using three fingers or thumb. – Ask the patient to clench and unclench their fist 10 times, then open the hand into a relaxed, slightly flexed position.
– In the uncooperative or sedated patient, use alternative methods to further assess circulation (finger-pulse plethysmography or doppler flow measurements). – Count the seconds it takes for the palm and thumb to flush (appear pink again)
Is the Allen’s test adequate to safely confirm that a radial artery may be harvested for coronary arterial bypass grafting? [13]
Andrew Ronald and others, Is the Allen’s test adequate to safely confirm that a radial artery may be harvested for coronary arterial bypass grafting?, Interactive CardioVascular and Thoracic Surgery, Volume 4, Issue 4, August 2005, Pages 332–340, https://doi.org/10.1510/icvts.2005.110247. A best evidence topic in cardiac surgery was written according to a structured protocol
Altogether 176 papers were identified using the reported search of which 15 represented the best evidence on the topic. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated
However, if there are concerns about collateral flow then a second confirmatory test such as dynamic Doppler ultrasound or measurement of digital pressure changes with radial artery occlusion can also be used prior to harvest. Newer techniques such as Gadolinium-enhanced magnetic resonance angiography have also been described to confirm adequate collateral circulation prior to radial artery harvest for CABG conduit and whilst in time they might come to represent an ultimate ‘gold standard’ they are clearly too expensive and impracticable for everyday use.
Arterial Access: Arterial Puncture (Radial Artery Puncture) [14]
To obtain arterial blood for blood gas measurements.. When blood is needed and venous or capillary blood samples cannot be obtained
Free-flowing arterial blood; stasis of blood increases lactate.. A 23–25-gauge scalp vein (butterfly) needle or a 23–25-gauge venipuncture needle (safety-engineered self-shielding), 1- or 3-mL syringe, povidone-iodine and alcohol swabs, 4 × 4 gauze pad, gloves, 1:1000 heparin or self-contained blood gas kit, high-intensity fiber optic light for transillumination, or a Doppler ultrasound (optional, can be useful to locate the artery)
For a blood gas, most hospitals have kits with 1-mL syringes coated with heparin. If this is not available, draw a small amount of heparin (1:1000) into the blood gas syringe (coat the surfaces and discard excess heparin from the syringe)
Sources
- https://www.ncbi.nlm.nih.gov/books/NBK507816/#:~:text=Traditionally%2C%20it%20is%20performed%20by,by%20the%20examiner’s%20thumbs%20simultaneously.
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355091/#:~:text=The%20circulation%20of%20the%20hand,the%20basis%20of%20Allen’s%20test.
- https://medtechedge.com/vascular-diagnostic-systems/palmar-arch-test-and-av-fistula/#:~:text=The%20Palmar%20Arch%20Test%20(PAT,extremity%20hemodialysis%20fistula%20or%20graft.
- https://www.ncbi.nlm.nih.gov/books/NBK507816/
- https://www.physio-pedia.com/The_Allen_Test_for_Blood_Flow
- https://en.wikipedia.org/wiki/Allen%27s_test
- https://elentra.healthsci.queensu.ca/assets/modules/abgs/step_1_allen_test.html
- https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0029-1220861.pdf
- https://link.springer.com/article/10.1007/BF01618362
- https://journalotohns.biomedcentral.com/articles/10.1186/s40463-015-0096-0
- https://www.webmd.com/a-to-z-guides/allen-test-overview
- https://www.ebmconsult.com/articles/physica-exam-allens-test
- https://academic.oup.com/icvts/article/4/4/332/895253
- https://accesspediatrics.mhmedical.com/Content.aspx?bookId=1303§ionId=79661701
