Chapter 11: Duplex/color flow imaging UE

Question 1

purpose of duplex imaging of upper extremities

Answer 1

localize stenosis/occlusion
eval degree of stenosis
visualize any aneurysm
hemodyalisis access or arterial bypass graft site
detect AVF's

Question 2

patient positioning for UE duplex

Answer 2

pt supine
extremity close to you
extremity 45 degree angle from body and externally rotated “pledge position”

Question 3

what is duplex scanning

Answer 3

combination of real time B mode gray scale and doppler spectral analysis

Question 4

what is the sample size for acquiring pulsed doppler information

Answer 4

1-1.5mm

Question 5

main use for UE doopler

Answer 5

eval for dialysis access graft

uncommon for UE stenosis/occlusion

Question 6

when looking to assess for hemodyalisis graft where do you start

Answer 6

feel for thrill

Question 7

evaluation of hemodyalisis graft: what do you doppler

Answer 7

inflow artery
arterial anastomosis
body of graft
venous anastomosis
outflow vein

Question 8

what should you assess for when looking at hemodialysis graft

Answer 8

aneyrysms
puncture sites
peri graft fluid
look for color and turbulance

Question 9

dialysis graft examples:

Answer 9

Brescia-Cimino fistula
straight AVF
looped AVF
synthetic graft

Question 10

Brescia-Cimino fistula

Answer 10

fistula of radial artery(inflow) and cephalic vein (outflow)

Question 11

Straight AVF graft

Answer 11

from brachial artery to axillary vein

Question 12

ulnar artery aneuryms can results from

Answer 12

using palm as a hammer

Question 13

subclavian artery aneurysms are associated with

Answer 13

embolization to the digits

Question 14

hemodilaysis graft PSV and EDV

Answer 14

can vary, normally elevated

Question 15

low PSV in graft site could mean

Answer 15

arterial inflow problems

Question 16

most common sites for stenosis of hemodialysis graft site

Answer 16

venous anastomosis and outflow vein

caused by increase arterial pressure or intimal hyperplasia

Question 17

large blood volumes shunted from arterial to venous system can cause

Answer 17

increased venous return which leads to CHF

Question 18

Steal syndrome from hemodialysis graft site is caused by

Answer 18

distal arterial blood flow is reversed into the venous circulation

Question 19

steal syndrome can cause pain where

Answer 19

hands and fingers on exertion

Question 20

with steal syndrome how with the hand look

Answer 20

pallor and coolness of skin distal to shunt

Question 21

to assess for possible steal of graft site:

Answer 21

use PPG to eval flow in at least 2 digits one at a time

apply manual pressure to dialysis access and retake PPG tracings/pressures

Question 22

when assessing for a steal, if flow to the digits improves

Answer 22

there is a steal

Question 23

when assessing for a steal, if flow to the digits does not improve

Answer 23

there is not a steal