Duplex/ color flow imaging UE

Question 1

Localized stenosis

Determine the presence of stenosis

Post - op study: hemodialysis access or arterial bypass graft

Detect AVF’s

Answer 1

Capabilities

Question 2

Limited access to extremity (dressing, Skin staples, or sutures, open wounds IV site)

Pertaining to hemodialysis access grafts

Answer 2

Limited

Question 3

Graft angulation

May be difficult to adequately evaluate outflow vein secondary to increased collateral development

Answer 3

Limited

Question 4

Patient positioning is

Answer 4

Supine

Question 5

Arm is at 45 degree angle from the body, and externally rotated (pledge position)

Answer 5

Patient positioning

Question 6

combination of real-time B - mode imaging (gray scale evaluation) and Doppler spectral analysis

Answer 6

Duplex scanning

Question 7

Doppler information is displayed on image after evaluated for phase (direction toward or away from transducer) and its frequency content (hue or shade of the color)

Answer 7

Doppler color flow imaging

Question 8

for acquiring pulsed Doppler information

Answer 8

Sample size

Question 9

usually the sample size is increased by ________ incrementally if needed

Answer 9

1 - 1.5 mm.

Question 10

What multi frequency transducer is usually utilized?

Answer 10

5-7 MHz linear array transducer

Question 11

Color duplex scanning is also used to evaluate the following:

Answer 11

Subclavian

Axillary

Brachial

Radial

Ulnar

Palomar Arch (if needed)

Question 12

For hemodialysis access auscultate the access for?

Answer 12

Bruit and / or “thrill” (vibration)

Question 13

What is the typical fistula diameter often only

Answer 13

4 or 5 mm.

Question 13

Inflow Artery

Arterial anastomosis

Continue through the body of the graft

Observe for aneurysm, puncture sites, peri - graft fluid

If color is available, observe the image for flow changes, turbulance

Venous anastomosis

Outflow vein

Answer 13

Evaluate dialysis access grafts

Question 14

Inflow Artery

Anastomosis (where artery and vein are connected)

outflow vein

Answer 14

Dialysis access fistula assessment sites

Question 15

Dialysis access examples include:

Answer 15

Brescia - Cimino fistula
straight
looped synthetic grafts

Question 16

Classic Radial artery to the cephalic vein at wrist

Answer 16

Brescia Cimino dialysis access

Question 17

Currently no criteria for classifying disease

Normal peak systolic velocities vary widely with skin temperature changes. Doppler signal quality is usually triphasic

suspect a > 50% stenosis? Observe for charactersitiics of the stenosis profile

Answer 17

Stenosis

Question 18

Observe for lack of Doppler signals (image and or / waveform) and the proverbial “thumb” which is obtained proximal to occlusion

Answer 18

Occlusion

Question 19

Dilation of the vessel from degeneration and / or weakening of the wall

Answer 19

Aneurysm

Question 20

Ulnar artery (distal end) aneurysms can form in response to using the palm has a hammer

Answer 20

Hypothenar hammer syndromeS

Question 21

Subclavian (proximal end) aneurysms often associated with

Answer 21

embolization to the digits

Question 22

Low PSV obtained in access grafts could indicate

Answer 22

Arterial inflow problems

Question 23

Peak systolic velocities (PSV) and end diastolic velocities (EDV) vary as to the type of access

Answer 23

Normally both are elevated
Always monophasic and increased velocities

( PSV > 150 cm/sec)

Question 24

Most common sites for stenosis

Answer 24

Venous anastomosis and outflow vein

Question 25

other hemodynamic complications include

(the large blood volumes in the venous circulation, can increase venous return resulting in?

Answer 25

congestive heart failure

Question 26

The distal arterial blood flow is reversed into venous circulation and cause hand pain on exertion, parllow and coolness of the skin distal to the shunt

Answer 26

Steal syndrome

Question 27

With dialysis access open/ functioning, use PPG to evaluate flow in at least 2 digits, one at a time

Answer 27

Assessments for “steal”

Question 28

APply manual pressure to dialysis access and retake digit PPG tracings and / or pressures

Answer 28

Assessments for “steal”

Question 29

If flow improves there is

Answer 29

A steal

Question 30

If flow stays the same there is probably not a

Answer 30

steal