Duplex/CDI UE Flashcards by Sarah Van Acker

capabilities

localize stenosis / occlusion
localize aneurysm
post-op f/u - BPG , AVF, STENT

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limitations (1)

limitations specific to AVF (2)

cast/ IVsite
graft angulation
increased collateral formation causes difficulty evaluating the outflow vein

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Pt. position

supine

pledge position, arm rotated out 45 degrees

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Physical principles:

what is ideal sample size for Doppler analysis

1-1.5 mm

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Physical principles:

with CDI frequency of signal is assigned a ____ or _____ of color

hue or shade of color

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Physical principles:

what frequency probe is used

5-7 MHz linear array

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it is uncommon for UE arteries to become ____. Most common artery in UE eval to have this disease process is

stenosed

subclavian artery

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most common indication for UE exam

evaluation of dialysis access grafts

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dyalysis is accomplished by

communication of artery and vein,

creating high blood volume situation

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a thrill is

vibration

it is palpated

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a bruit is

noise

it is auscultated

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what hemodialysis access condition commonly causes a thrill

stenosis

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steps for eval of dialysis access graft :

inflow artery

arterial anastomosis

body of graft

observe aneurysm, puncture sites, peri-

graft fluid

use color to observe flow changes/ turbulence

venous anastomosis

outflow vein

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Brescia-Cimino is connection of what typically

assessment sites include

cephalic vein and radial artery

inflow artery
anastomosis
outflow vein
radial artery Doppler

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Autogenous Fistula is

any artery attached to any adjacent vein that includes native vessels
eg- Brescia Cimino

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identify two types of synthetic dialysis grafts

loop graft _ loop connection between artery and vein

straight graft - runs through arm connects artery and vein

Thrill is usually a sign of stenosis, but in dialysis graft it is a ____ finding

normal

because of the high volume of blood flowing through the anastamosis

what are you r/o in dialysis access

annnnnd how do you accomplish that

steal syndrome
plaque
stenosis
patient anastamosis, inflow and outflow veins

run Doppler through

normal AVF

normal PSV varries, waveform us usually multiphasic

parameters for > 50% stenosis

stenosis PSV : Prox vessel PSV

2:1 ratio

flow acceleration post stenosis turbulance

complete occlusion is proved by

no detection of CDI or Doppler
B-mode shows narrowing

“thump” prox to occlusion

dampened WF distal to occlusion when collateral flow is present

Aneurysm is proved by

dilation of the vessel >1.5 x size of adjacent segment

what is the most common aneurysm site

subclavian artery

usually associated with distal embolization of the digits

ulnar artery aneurysm is called

Hypothenar Hammer Syndrome

occupational injury repetitive use
eg jack hammer
causes aneurysm or thrombosis of ulnar artery (usually at palmar arch)

interpretation of Hemodialysis Access normal waveform

disturbed , low resistance , high velocity flow eg PSV > 150 cm/sec comparison to previous studies is key PHASE NOT USED TO DESCRIBE DIALYSIS AVF -either high resistant or low resistance

interpretation of Hemodialysis Access most common site for stenosis is

outflow vein due to hyperplasia or elevated arterial pressure

interpretation of Hemodialysis Access low PSV in access graft can indicate ______ problems

inflow will look like dampened waveform will indicate problem in the inflow artery

other hemodynamic complications of AVF | 2

CHF | steal syndrome

how can AVF cause CHF

large blood vol in venous circulation can increase venous return = CHF

what is steal syndrome

distal arterial blood flow is reversed (shunted) into venous flow creates pallor and coolness of the skin distal to the shunt and eventually ischemia

explain procedure for eval of steal syndrome

with dialysis access open and functioning use PPG to eval flow to at least 2 digits one at a time manually compress dialysis access and retake digit PPG tracings or Pa

if flow improves after compressing the AVF than it is positive or negative for steal syndrome

positive There will be retrograde flow in outflow arterial vessel below venous anastamosis if flow stays the same during compression than another cause of ischemia should be investigated