II. Epidemiology

  1. Inadequate collateral flow in 3% hospitalized patients

III. Causes of Inadequate Ulnar Circulation

  1. Normal anatomic variant
  2. Hypothenar Hammer Syndrome

IV. Indications

  1. Test wrist collateral Blood Flow
  2. Arterial Puncture for Arterial Blood Gas

V. Technique

  1. Patient elevates hand and makes a fist for 20 seconds
  2. Firm pressure held against radial and ulnar arteries
  3. Patient opens hand and should blanche white
  4. Examiner releases only ulnar compression

VI. Normal Result

  1. Hand color flushes within 5 to 7 seconds

VII. Abnormal result: Inadequate collateral circulation

  1. Hand remains white until radial pressure released
  2. Risk of serious hand ischemia if radial vessel spasm

VIII. Alternative means for assessing collateral circulation

  1. Doppler Ultrasound
  2. Finger plethysmography

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