Final Flashcards
Upper extremity deep veins
Internal jugular vein External jugular vein Brachiocephalic vein Subclavian vein Axillary vein Brachial vein
Upper extremity Superficial Veins
Cephalic vein
Basilic veins
IJV lies lateral to the____
CCA
IJV’s join with the _____ more medially to form
the _________
SCV's Brachiocephalic veins (aka: innominate veins)
EJV lies _______ to the IJV
superficial
EJV’s drain into the __________
SCV’s
what does pulsatile flow reflect?
heart contractions
why may the innominate vein be difficult to visualize?
sternum
air filled lungs
what may help in determining patency when its hard to visualize?
doppler signals
-phasicity is important
the subclavian vein moves laterally from the junction of what?
jugular and branchiocephalic veins
where does the subclavian pass?
under the clavicle
where does the superficial cephalic vein empty?
into the subclavian vein
what does the subclavian run along side?
the subclavian artery
the subclavian (SCV) cannot so compression so what do we do?
this is because of its position so we use duplex to check for patency and phasicity
where does the axillary start?
below the level where the subclavian vein recieves the cephalic vein
wher does the axillary vein travel?
through the axilla
whats different about the axillary artery and vein from others?
they do not travel directly beside eachother, the armpit is one area where the artery and its accompanying vein have some distance for a SHORT WHILE
where does the basilic vein empty?
into the axillary vein (but this is extremely variable)
what do we check in the axillary vein?
use duplex doppler to check for patency, phasicity, and augmentation
when augmenting the axillary vein where do we squeeze?
below the elbow
what are the brachial veins?
2 small paired veins on either side of the artery and may join to form a single vein at the level of the crease
where do the brachial veins split?
below the bend of the elbow, they split to form the radial and ulner paired veins
do we comprss the brachial vein?
yes
what do we use to examine the brachial vein?
duplex doppler to ascertain augmentation and phasicity
what do we assess non compressible veins with?
color and duplex
what do we assess for in veins?
for patency, phasicity, and augment where possible
where do we take compression images?
axillary vein
brachial vein
superficial veins(basilic, cephalic)
what history do we take in a patient for upper extremity?
recent central line or IV usage
Also if patient has cancer or recent injury
what veins show more pulsatility?
veins more proximal to the heart
what may loss of pulsatility indicate?
more central venous obstruction
what may we do to confirm the presence or absence of obstruction?
compare signals with the opposite arm
whats the reason more most clots in the upper extremity?
result of injury to the vein wall
needle punctures or indwelling catheders
what is the usual reason for clot in the lower extremity?
stasis
why are clots in the arm less common?
The upper extremities have no soleal sinuses as seen in the lower extremities
what may a clot in the upper extremity be caused by?
chronic injury to subclavian vein
- TOS
- coagulopathy
- compression by a mass
The sequelae of upper extremity DVT are ______ severe than that of lower extremity
less
pathophysiology is the same
what is the risk for PE in the upper extremity?
10-12%
what is the main pathology that affects the upper limb venous system?
DVT
what are the most common sites for DVT in the upper extremity?
subclavian vein
axillary vein
what does DVT result in, in the upper extremity?
upper limb swelling with distension of the superficial veins
what are the risk factors for upper extermity DVT?
same as lower limb, LOOK AT THESE but there are some extras on another flashcard
what can be a cause of upper extremity DVT?
presence of a central venous cathedar or pacemaker lead
how many people develop thrombosis with central venous catherdar or pacemaker?
26-67%
most are asymptomatic
what are more frequent cases of DVT in upper extremities rather than lower?
- radiation therapy
- malignant obstruction
- effort induces thrombosis
what may cellulitis be associated with?
superficial thrombophlebitis, producing swelling of the limb, pain and redness
what else may lead to upper limb swelling?
Arteriovenous malformations ,if extensive
Long term catheter access for feeding and or drug administration may damage ____________
the axillary or subclavian veins, leading to DVT
when can Phlebitis of the superficial veins(superficial thrombophlebitis) occur?
due to repeated catheter access or intravenous drug abuse
is paget-schroetter syndrome common or rare?
rare
where is paget-schroetter syndrome seen?
young adults due to effort-induced thrombosis of the subclavian vein
why may paget-schroetter syndrome occur?
strenuous upper body exercise or repatative movements like weight lifting
Lymphedema
most common following mastectomy with removal of lymph nodes in the axilla as well as the effects of radiotherapy
what do superficial veins usually anastomose with?
deep veins
what do superficial veins runs through?
2 layers of superficial fascia
are there more valves in deep or superficial veins?
valves are less numerous in the superficial veins
where does the cephalic vein drain?
empties into the subclavian vein above the level of basilic vein
where does the cephalic vein travel?
across the shoulder and down the anterolateral border of the biceps muscles
where is the cephalic vein easily found?
Easiest to find in upper arm first, follow it upward as it dumps into subclavian/axillary vein junction and then follow it downward to below antecubital fossa
is the basilic vein large or small?
large
where does the basilic vein travel?
along the medial border of the biceps, parallel to the brachail vein
for the basilic and cephalic vein so we use heavy or light probe pressure?
light probe pressure
how do you find the basilic vein?
Easiest to find it from the upper arm first, follow it upward as it dumps into the axillary vein, then follow it downward to the anticubital fossa
what are the most common sites for central venous assess device (VAD)?
- subclavian vein
- internal jugular veins
is the IJV superficial or deep?
superficial
which IJV is prefered?
right as it has a straighter course to the heart
if the EJV used?
not preffered only in setting of IJV obstruction and is often tortuous
what is the SCV suitable for?
dialysis
aphresis
catheters
chemotherapy
what is VAD used for?
administer antobiotics, blood products, other fluids
PICC line
Peripherally inserted central catheter
Typically inserted in upper arm veins
Terminates closer to the heart
advantages of PICC line
Decreased complication risk
Can remain in place much longer
Portocath
Inserted under the skin in upper chest-appears as a bump
Inserts into SCV,JV or SVC
advantages of portocath
- Infused agents spread more quickly to body
- Heparin is infused through port to combat thrombus formation
complications of VAD
vein damage non target puncture bleeding air embolism cardiac arrythmia infection
Vein damage
- Appears as irregular intimal surface
- May be extravascular accumulation of blood-hematoma
- Arteriovenous fistula may occur
- Flow between vein and artery
Non target puncture
Hematoma formation
Bleeding
May be diffuse within tissue
Air embolism
Hyperechoic structure within blood stream-acoustic shadow
