Allen's test
In medicine, Allen's test, also Allen test, is used to test blood supply to the hand. It is performed prior to radial arterial blood sampling or cannulation.
It is named for Edgar Van Nuys Allen.[1]
Testing for collateral circulation to the hand by evaluating the patency of the radial and ulnar arteries.
The Allen Test
The Allen's test assesses collateral circulation in the hand, in 2 steps.
- Step 1 occludes the radial artery for several minutes and compares the hand color to the other hand. The hand is said to have sufficient collateral circulation through the ulnar artery if there is no change in color.
- Step 2 releasing the radial artery and then occlude the ulnar artery. A change in hand color means the potential for radial artery occlusion is high. That is a positive Allen's test, which contraindicates radial-artery puncture
The modified Allen Test
1) The hand is elevated and the patient/person is asked to make a fist for about 30 seconds.
2) Pressure is applied over the ulnar and the radial arteries so as to occlude both of them.
3) Still elevated, the hand is then opened. It should appear blanched (pallor can be observed at the finger nails).
4) Ulnar pressure is released and the color should return in 7 seconds.
Inference: Ulnar artery supply to the hand is sufficient and it is safe to cannulate/prick the radial
If color does not return or returns after 7–10 seconds, then the ulnar artery supply to the hand is not sufficient and the radial artery therefore cannot be safely pricked/cannulated.
Anatomical basis
The hand is normally supplied by blood from the ulnar and radial arteries. The arteries undergo anastomosis in the hand. Thus, if the blood supply from one of the arteries is cut off, the other artery can supply adequate blood to the hand. A minority of people lack this dual blood supply.
Significance
An uncommon complication of radial arterial blood sampling/cannulation is disruption of the artery (obstruction by clot), placing the hand at risk of ischemia. Those people who lack the dual supply are at much greater risk of ischemia. The risk can be reduced by performing Allen's test beforehand. People who have a single blood supply in one hand often have a dual supply in the other, allowing the practitioner to take blood from the side with dual supply.
Allen's test is also performed prior to heart bypass surgery. The radial artery is occasionally used as a conduit for bypass surgery, and its patency lasts longer in comparison to the saphenous veins. Prior to heart bypass surgery, Allen's test is performed to assess the suitability of the radial artery to be used as a conduit. A result of less than 3 seconds is considered as good and suitable. A result of between 3-5 seconds is equivocal, whereas the radial artery will not be considered for grafting if the result is longer than 5 seconds.
The utility of the Allen's test is questionable,[2] and no direct correlation with reduced ischemic complications of radial artery cannulation have ever been proven. In 1983, Slogoff and colleagues reviewed 1,782 radial artery cannulations and found that 25% of them resulted in complete radial artery occlusion, without apparent adverse effects.[3] A number of reports have been published in which permanent ischemic sequelae occurred even in the presence of a normal Allen's test.[4][5] In addition, the results of Allen's tests do not appear to correlate with distal blood flow as demonstrated by fluorescein dye injections[6] or photoplethysmography.[7]
Modifications to the test have been proposed to improve reliability.[8]
References
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- ↑ Slogoff s, Keats AS, Arlund C. On the safety of radial artery cannulation. Anesthesiology 1983; 59:42-7
- ↑ Thompson SR, Hirschberg A: Allen's test re-examined. Crit Care Med 16:915, 1988
- ↑ Wilkins RG: Radial artery cannulation and ischaemic damage: A review. Anaesthesia 40:896-899, 1985
- ↑ McGregor AD: The Allen test-an investigation of its accuracy by fluorescein angiography. J Hand Surg [Br] 12:82-85, 1987
- ↑ Stead SW, Stirt JA: Assessment of digital blood flow and palmar collateral circulation. Int J Clin Monit Comput 2:29, 1985
- ↑ Lua error in package.lua at line 80: module 'Module:Citation/CS1/Suggestions' not found.
