Limb Occlusion Pressure Assessment Using a Pulse Oximeter?


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Limb Occlusion Pressure Assessment Using A Pulse Oximeter? 
Nicholas M. Licameli, PT,DPT



Look at you! You’ve just completed the online, on-demand BFR Pros course and are a newly qualified blood flow restriction (BFR) provider.  Congratulations and welcome to the club!  You are ready to save the world, one occluded limb at a time!  Then it happens…

The BFR unit that your clinic director assured you she had is actually a manual cuff system!  No!  How are you supposed to properly measure limb occlusion pressure?  Wait!  There’s a pulse oximeter collecting dust on a shelf in the break room!  Can a pulse ox be used to safely and effectively measure LOP? 

We know that best practice for setting blood flow restriction (BFR) application pressure involves use of a computer system or an external doppler ultrasound (DU) to determine the minimum pressure needed to completely restrict arterial flow and occlude venous return, which is known as limb or arterial occlusion pressure (LOP). Exercise is performed at a percentage of these values to increase safety and consistency.  However, these approaches are cost prohibitive and/or require a skilled practitioner for implementation, adding a barrier to safe BFR practice.   

Prior to this paper, one paper has suggested the use of pulse oximetry (PO) (Zeng, 2019) for the upper extremity as an easy-to-use way to standardize applied pressure. PO is worn on the finger and the device shuts off once LOP is met. This study by Lima-Soares (2020) provides additional support for the use of PO to provide a valid measure of LOP.

METHODS: 70 participants (33 M, 37 W, ~23.2 yo) had their LOP determined by a DU (10 MHz) and PO (Oxy Control) simultaneously with two blinded investigators (audio was blocked for both using headphones).  PO was placed on the index finger and DU was placed on the radial artery. The process was repeated for each position with 5 min of rest in-between.

RESULTS: Similar LOP values for all positions between DU and PU, with 60/70 (86%) showing the same AOP values for both methods in sitting, 51/60 (73%) in standing and 57/70 (73%) in supine.  In cases where differences were observed, DU was about 10 mm Hg higher than PO.  Correlations between LOP values in both conditions were very strong at r= 0.955, 0.980, and 0.955 in supine, seated and standing, respectively. The maximal differences between methods was +/- 10 mm Hg.

CONCLUSIONS: PO can be a valid way to assess LOP in healthy adults.

So there you have it, folks!  If all you have is a manual cuff and pulse ox, you’re A-OK!  Just be sure to tell your clinic director to put down her beeper and Blockbuster card and go invest in an automatic cuff!

Adapted from:


Lima-Soares et al. (2020). Determining the arterial occlusion pressure for blood flow restriction pulse


****Remember, the decision to use BFR, or any treatment for that matter, should be based on the pillars of evidence-based practice.


****Remember, the decision to use BFR, or any treatment for that matter, should be based on the pillars of evidence-based practice.

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