Peripheral Venous Evaluation Flashcards
What is key in a venous evaluation?
compression
What are you looking for in the venous evaluation?
Thrombus ( not stenosis)
Since velocities are not measured do you need an angle correction?
no
A venous study in an __________ study.
emergent (emergency)
Do we measure velocity in a vein?
no - we just want to know if there is flow
When is a DVT acute?
within the first 14 days
vein wall is inflamed and thrombus is loosely attached
How does an acute DVT look on US?
low echogenicity
distended vein
loss of compressibility
free floating thrombus
New thrombus is _________ or __________mass
hypoechoic
anechoic
vein walls will not compress
What does a chronic DVT look like?
more echogenic
diffuse wall thickening
scarred vein
size of thrombus is reduced
attached to the vein wall
rigid
Chronic DVT has ____________ and _______________vein protrusions
hyperechoic
heterogenous
What is the complication of acute DVT?
lethal
Pulmonary Emboli (PE)
What are the main goals of treating DVT
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
What are the two blood thinners used to treat DVT?
warfarin (pill aka coumadin)
heparin (injection IV tube)
What is a vena cava filter?
for people with lots of problems with DVT’s - will catch the clots
What are the risk factors for DVT?
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
What is Virchow’s Triad?
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
What is a hypercoagulable state?
abnormally increased tendency toward blood clotting
What is venous stasis?
slow blood flow especially in legs
What are the clinical findings of DVT?
tenderness/pain
persistent leg or arm swelling
edema
warmth
redness ( erythema)
asymptomatic
variable and unreliable
With a DVT where does the leg hurt?
typically in the back or side
What is homan’s sign?
the foot is flexed, if there is a DVT it will produce more pain in the leg
What is the difference between DVT and Insufficiency?
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
What does superficial venous thrombosis look like
local erythema
palpable subcutaneous cord
dilated
elongated
torturous
weakness of walls
congenital
NOT DVT*
What are the symptoms of pulmonary embolus?
dyspnea (shortness of breath)
chest pain
hemoptysis (blood in sputum)
sweats cough
What are some complications of venous statsis?
ulcerations
Gaitor Zone - right above the ankle ulcerations
How should a normal vein appear?
thin walls
clear lumen
compressible
What are the different kinds of veins?
deep veins
communicating or perforating veins
superficial veins
See slide 33
diagram
What do the deep veins do?
primary channels that transport blood fro the extremity to the heart
close association with corresponding arteries
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)
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
What is the anatomy of the vein?
veins have valves
What is a valve?
folds of the intima
bicuspid
more numerous in distal leg
What veins don’t have valves
IVC
SVC
innominate
soleal
What does the anterior tibial vein drain?
the dorsum of the foot to form the popliteal vein
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
Peroneal drain blood from the _______ ________before they join the _________ _________
lower leg
posterior tibial
What are soleal sinuses?
large venous reservoirs
empty into the posterior tibial or peroneal
Where does the gastrocnemius terminate?
paired and accompany arteries
terminate at popliteal
The popliteal orginates from the _________ and _________
posterior tib
peroneal
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
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
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
Where is Scarpa’s triangle?
Where the aorta and IVC and the iliacs split into the groin
What vessels are in the superficial system?
GSV
lesser saphenous vein
posterior arch vein
perforating veins
used for bypass grafts
What vein lies in Scarpa’s triangle medial to the common femoral artery?
common femoral vein
What is the longest vein in the body?
greater saphenous
Where is the lesser saphenous?
joins the popliteal
“stocking vein”
superficial vein
What is a perforating vein?
connects the superficial and deep veins
see slide 75 for picture
Which veins are paired?
peroneal veins
post tib
anterior tib
what veins join the popliteal?
lesser or small saphenous vein
What might you find in the upper extremity veins?
pain and swelling of the arm or neck
palpable cord
dilated vein
indwelling catheter
What are the paired veins in the upper extremity deep system?
radial and ulnar drain the hand
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
which vein is difficult to compress in the arm?
subclavian vein due to clavicle
the primary root of venous drainage in the upper extremity is the ______________ ____________
superficial system
what vein begins on the small finger side of the hand?
basilic vein
Which vein comes out on the thumb side?
cephalic vein
What are the characteristics of normal veins in the upper extremity?
spontaneous: flow is present w/o augmentation
Pulsatility:
respiratory phasicity
augmentation
What was the method of choice before US for looking for clots?
Contrast venography
What is photoplethysmography?
uses light to assess reflux and incompetence
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
What transducer are you going to use?
Linear AND vascular
12-5 MHz
What is the key to tell if there is a clot?
Compression (aka coaptation)
try to be perpendicular
do NOT tilt the transducer
Do you need angle correction?
not needed because we are not measuring velocity
What is the patient position for a venous scan?
reverse trendelenburg - head up feet down
have them roll their leg a little - frog position
What is formed by the confluence of profunda femoris and femoral vein and also receives the greater saphenous vein?
common femoral vein
What vein extends from the groin to the dorsum of the foot?
Great Saphenous
What is pulsatility?
because of retrograde transmission of right atrial pressure
present in jugular, subclavian, innominate, and SVC
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
What is augmentation?
blood flow velocity increases with distal limb compression or with release of proximal limb compression
What contracts in order to expand the thorax for inspiration?
the diaphragm
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
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
What vessels are in your first picture of venous leg study?
common femoral artery GSV (SFJ)
common femoral vein
makes a Mickey Mouse sign
How far should you go before you compress?
every 2-3 cm
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
Where are the posterior tibial veins located?
near the medial malleolus (ankle bone) and followed proximally in the calf
How are the peroneal veins visualized?
transducer is moved a few cm prox on the calf
with doppler the __________flow is heard and normal flow is characterized as ____________
venous
spontaneity
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
What are the venous hemodynamics?
spontaneous
phasic with respiration
augments w/distal compression
competency - no regurg with prox compression
NO Pulsatility
What cyst do you find behind the knee?
Baker’s Cyst
What is vein mapping?
to determine the veins suitability for use as a bypass conduit and identify its anatomic route
When is vein mapping performed?
before lower extremity arterial bypass or coronary bypass operations
What is venous reflux?
insufficience
incompetent venous valves
What does venous reflux testing do?
identify the presence and location of incompetent venous valves
how is a venous reflux test done?
performed with the patient standing
when are valves considered incompetent?
if retrograde blood flow is present and lasts greater than 1 second
What is spontaneous flow?
Blood that flows without augmentation
What three things might fool you into thinking its thrombus?
lymph node
hematoma
baker’s cyst
