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Peripheral Venous Evaluation Flashcards

0
Q

What is key in a venous evaluation?

A

compression

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1
Q

What are you looking for in the venous evaluation?

A

Thrombus ( not stenosis)

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2
Q

Since velocities are not measured do you need an angle correction?

A

no

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3
Q

A venous study in an __________ study.

A

emergent (emergency)

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4
Q

Do we measure velocity in a vein?

A

no - we just want to know if there is flow

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5
Q

When is a DVT acute?

A

within the first 14 days

vein wall is inflamed and thrombus is loosely attached

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6
Q

How does an acute DVT look on US?

A

low echogenicity

distended vein

loss of compressibility

free floating thrombus

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7
Q

New thrombus is _________ or __________mass

A

hypoechoic

anechoic

vein walls will not compress

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8
Q

What does a chronic DVT look like?

A

more echogenic

diffuse wall thickening

scarred vein

size of thrombus is reduced

attached to the vein wall

rigid

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9
Q

Chronic DVT has ____________ and _______________vein protrusions

A

hyperechoic

heterogenous

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10
Q

What is the complication of acute DVT?

A

lethal

Pulmonary Emboli (PE)

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11
Q

What are the main goals of treating DVT

A

Stop the clot from getting bigger

prevent the clot from breaking off and moving to your lungs

reduce your chance of having another blood clot

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12
Q

What are the two blood thinners used to treat DVT?

A

warfarin (pill aka coumadin)

heparin (injection IV tube)

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13
Q

What is a vena cava filter?

A

for people with lots of problems with DVT’s - will catch the clots

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14
Q

What are the risk factors for DVT?

A

Age

post operative

malignancy

Previous DVT*

Immobility

pelvic, hip or bone fracture

MI, Stroke, CHF, respiratory failure

pregnancy

oral contraceptives

trauma

central venous lines, pacemakers (DVT in the arms)

IV drug abuse

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15
Q

What is Virchow’s Triad?

A

Hypercoagulable state of blood

venous stasis (blood pools in the veins)

Vein wall injury

these three things cause DVT

***doctor from 1800’s - DID NOT USE ULTRASOUND

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16
Q

What is a hypercoagulable state?

A

abnormally increased tendency toward blood clotting

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17
Q

What is venous stasis?

A

slow blood flow especially in legs

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18
Q

What are the clinical findings of DVT?

A

tenderness/pain

persistent leg or arm swelling

edema

warmth

redness ( erythema)

asymptomatic

variable and unreliable

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19
Q

With a DVT where does the leg hurt?

A

typically in the back or side

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20
Q

What is homan’s sign?

A

the foot is flexed, if there is a DVT it will produce more pain in the leg

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21
Q

What is the difference between DVT and Insufficiency?

A

DVT Insufficiency

acute limb swelling recurrent limb swelling

recent onset pain varicose veins

local tenderness chronic leg heaviness

limb warmth statis dermatitis

shortness of breath (PE) ulceration

emergent non emergent

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22
Q

What does superficial venous thrombosis look like

A

local erythema

palpable subcutaneous cord

dilated

elongated

torturous

weakness of walls

congenital

NOT DVT*

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23
Q

What are the symptoms of pulmonary embolus?

A

dyspnea (shortness of breath)

chest pain

hemoptysis (blood in sputum)

sweats cough

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24
What are some complications of venous statsis?
ulcerations Gaitor Zone - right above the ankle ulcerations
25
How should a normal vein appear?
thin walls clear lumen compressible
26
What are the different kinds of veins?
deep veins communicating or perforating veins superficial veins
27
See slide 33
diagram
28
What do the deep veins do?
primary channels that transport blood fro the extremity to the heart close association with corresponding arteries
29
what are the deep veins?
external iliac CFV (common femoral vein) SFV (superficial femoral vein that's not actually superficial) or FV (femoral vein) DFV (deep femoral vein) or profunda POP (popliteal)
30
What are the deep veins of the calf?
PTV (posterior tibial vein) Peroneal ATV (anterior tibial vein) paired vessels that accompany artery see slide 36 for picture
31
What is the anatomy of the vein?
veins have valves
32
What is a valve?
folds of the intima bicuspid more numerous in distal leg
33
What veins don't have valves
IVC SVC innominate soleal
34
What does the anterior tibial vein drain?
the dorsum of the foot to form the popliteal vein
35
Where do the posterior tibial veins orginate?
from the plantar veins of the foot receive the Peroneal veins before uniting with the anterior to form popliteal
36
Peroneal drain blood from the _______ ________before they join the _________ _________
lower leg posterior tibial
37
What are soleal sinuses?
large venous reservoirs empty into the posterior tibial or peroneal
38
Where does the gastrocnemius terminate?
paired and accompany arteries terminate at popliteal
39
The popliteal orginates from the _________ and _________
posterior tib peroneal
40
Where is the Hunter's adductor canal?
the hardest part to scan the side of the knee - medial side must compress, hard to do because of the bone in the way
41
How do you recognize the FV?
deep vein buddy's with Superficial Femoral Artery if you see the vein and no artery, you are in the wrong vein
42
How do you recognize the deep femoral or profunda?
unites with the SFV or FV to form the CFV branches off...femoral will continue with the artery slide 58 for image
43
Where is Scarpa's triangle?
Where the aorta and IVC and the iliacs split into the groin
44
What vessels are in the superficial system?
GSV lesser saphenous vein posterior arch vein perforating veins used for bypass grafts
45
What vein lies in Scarpa's triangle medial to the common femoral artery?
common femoral vein
46
What is the longest vein in the body?
greater saphenous
47
Where is the lesser saphenous?
joins the popliteal "stocking vein" superficial vein
48
What is a perforating vein?
connects the superficial and deep veins see slide 75 for picture
49
Which veins are paired?
peroneal veins post tib anterior tib
50
what veins join the popliteal?
lesser or small saphenous vein
51
What might you find in the upper extremity veins?
pain and swelling of the arm or neck palpable cord dilated vein indwelling catheter
52
What are the paired veins in the upper extremity deep system?
radial and ulnar drain the hand
53
What are the veins of the deep venous system of the arm?
deep palmar network radial vein ulnar vein brachial veins axillary vein subclavian vein
54
which vein is difficult to compress in the arm?
subclavian vein due to clavicle
55
the primary root of venous drainage in the upper extremity is the ______________ ____________
superficial system
56
what vein begins on the small finger side of the hand?
basilic vein
57
Which vein comes out on the thumb side?
cephalic vein
58
What are the characteristics of normal veins in the upper extremity?
spontaneous: flow is present w/o augmentation Pulsatility: respiratory phasicity augmentation
59
What was the method of choice before US for looking for clots?
Contrast venography
60
What is photoplethysmography?
uses light to assess reflux and incompetence
61
What happens to the veins during inspiration?
diaphragm moves downward negative chest pressure venous return to the heart INCREASES INCREASES venous flow in the LEGS abdominal pressure DECREASES
62
What transducer are you going to use?
Linear AND vascular 12-5 MHz
63
What is the key to tell if there is a clot?
Compression (aka coaptation) try to be perpendicular do NOT tilt the transducer
64
Do you need angle correction?
not needed because we are not measuring velocity
65
What is the patient position for a venous scan?
reverse trendelenburg - head up feet down have them roll their leg a little - frog position
66
What is formed by the confluence of profunda femoris and femoral vein and also receives the greater saphenous vein?
common femoral vein
66
What vein extends from the groin to the dorsum of the foot?
Great Saphenous
67
What is pulsatility?
because of retrograde transmission of right atrial pressure present in jugular, subclavian, innominate, and SVC
68
What is respiratory phasicity?
blood flow velocity changes with respiration in upper extremity (central veins), venous doppler signal will increase with inspiration and decrease with expiration
69
What is augmentation?
blood flow velocity increases with distal limb compression or with release of proximal limb compression
70
What contracts in order to expand the thorax for inspiration?
the diaphragm
71
What happens to the body during inspiration?
diaphragm moves downward negative chest pressure venous return to the heart increases venous flow in the legs decreases abdominal pressure increases
72
What happens to the body durning expiration?
diaphragm moves upward increasing chest pressure reduces venous return to the heart increases venous flow in the legs abdominal pressure decreases
73
What vessels are in your first picture of venous leg study?
common femoral artery GSV (SFJ) common femoral vein makes a Mickey Mouse sign
74
How far should you go before you compress?
every 2-3 cm
75
Where are the anterior tibial veins located?
small located in the prox calf place transducer on lateral calf travel with anterior tibial artery travels with the anterior tibial artery medial to fibula in prox calf
76
Where are the posterior tibial veins located?
near the medial malleolus (ankle bone) and followed proximally in the calf
77
How are the peroneal veins visualized?
transducer is moved a few cm prox on the calf
78
with doppler the __________flow is heard and normal flow is characterized as ____________
venous spontaneity
79
if the signal is abnormal and continuous the thrombus may lie ________ to the _________
closer heart ex: if CFV doppler is continuous there may be thrombus in the iliac vein
80
What are the venous hemodynamics?
spontaneous phasic with respiration augments w/distal compression competency - no regurg with prox compression NO Pulsatility
81
What cyst do you find behind the knee?
Baker's Cyst
82
What is vein mapping?
to determine the veins suitability for use as a bypass conduit and identify its anatomic route
83
When is vein mapping performed?
before lower extremity arterial bypass or coronary bypass operations
84
What is venous reflux?
insufficience incompetent venous valves
85
What does venous reflux testing do?
identify the presence and location of incompetent venous valves
86
how is a venous reflux test done?
performed with the patient standing
87
when are valves considered incompetent?
if retrograde blood flow is present and lasts greater than 1 second
88
What is spontaneous flow?
Blood that flows without augmentation
89
What three things might fool you into thinking its thrombus?
lymph node hematoma baker's cyst

Vascular (6 decks)

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