upper exremity vein protocol

Question 1

patient positioning- upper extremity veins?

Answer 1

• examined with bed flat and patient in supine
• It is especially important that the bed be flat while the jugular and subclavian veins are examined because they will collapse if the head of the bed is up
• Once these vessels are imaged, the bed can be raised to allow for imaging of the arm veins

Question 2

external jugular vein in relation to the internal jugular vein?

Answer 2

external jugular vein lies superficial and posterior to the internal jugular

Question 3

where does the external jugular meet the internal jugular?

Answer 3

low in the neck to form the subclavian and brachiocephalic veins

Question 4

Following the brachiocephalic (innominate) vein is usually difficult because of?

Answer 4

the sternum and air-filled lings that block ultrasound

Question 5

what kind of probe can improve visualization of the brachiocephalic vein region?

Answer 5

small footprint probes that operate at lower frequencies

Question 6

what kind of flow is normal at the innominate vein?

Answer 6

• pulsatile phasic flow is normal due to proximity to the heart

Question 7

subclavian vein course?

Answer 7

moves from its junction with th jugular and brachiocephalic veins toward the arm as it passes under the clavicle

Question 8

what is the subclavian vein?

Answer 8

• a large deep vein that runs alongside the subclavian artery at a deeper caudal location

Question 9

One way to check for collapsibility of the subclavian vein?

Answer 9

• examiner has patient take a quick breath in with lips pursed, this allows vein to collapse while doppler is on
• there will be a “spike like augmentation” of the flow patters

Question 10

with the subclavian vein a nonphasic flow patters indicated?

Answer 10

a more proximal obstruction

• compare the flow patterned with opposite side
• image the vein with colour doppler in its length

Question 11

Absence or diminished subclavian vein flow or change in flow due to deep inspiration is indicated for?

Answer 11

central venous stenosis or occlusion

Question 12

what is the cephalic vein?

Answer 12

• a superficial cein that empties into the subclavian vein and travels superficially without an accompanying artery
• runs across the shoulder and down the anterior-lateral border of the biceps muscle

Question 13

where is the median cubital vein located?

Answer 13

• at the level of the anticubital fossa
• there is a branch-median cubital vein that will connect the cepalic to the basilic vein that travels in the medial portion of the arm

Question 14

After communicating with the median cubital vein, what vein continues into the forearm?

Answer 14

the cephalic vein

Question 15

There are commonly two branches of the cephalic vein in the forearm, what are they?

Answer 15

• one will tracel down the volar (palmar) aspect of the forearm to the wrist
• one will roll onto the dorsal aspect of the forearm as it approaches the wrist

Question 16

median cubital vein connects what?

Answer 16

the superficial veins at the elbow level

Question 17

where does the subclavian vein become the axillary vein?

Answer 17

• below the level where the subclavian vein receives the cephalic vein
• the subclavian becomes the axillary

Question 18

where is the axillary vein located?

Answer 18

• travels through the axilla- compressible and augmentable

- in most parts of the body the deep vein will travel directly alongside the artery of the same name

Question 19

where is the brachial vein located?

Answer 19

• continues down the arm as 2 small paired veins on either side of the brachial artery

Question 20

the brachial veins form?

Answer 20

a short single vein at the antecubital fossa

Question 21

what happens to the brachial vein at the antecubital fossa?

Answer 21

At this level, the Brachial veins split into a pair of Radial and a pair of Ulnar veins that accompany the artery of the same name

Question 22

radial veins course?

Answer 22

course along the volar aspect of the forearm on the radial side towards the thumb (lateral)

Question 23

what accompanies the radial veins?

Answer 23

2 very small veins that accompany the artery all the way into the hand near the thumb

Question 24

Ulnar veins located?

Answer 24

From the level of the brachial vein, the ulnar veins travel along the volar aspect of the forearm and enter the hand at the wrist on the ulnar side (medial)

Question 25

To examine the Basilic vein we?

Answer 25

we go back to the midportion of the upper arm and find its distal end from the axillary vein

Question 26

The Basilic V will travel without an artery along the?

Answer 26

medial forearm and will, for a time, parallel the Brachial veins-appears larger

Question 27

At a point near the anticubital fossa what is seen?

Answer 27

the Basilic vein joins with the Median cubital vein, which crosses over the top of the Brachial artery and vein like a freeway overpass to eventually connect to the Cephalic vein

Question 28

basilic vein vs. brachial vein?

Answer 28

• Basilic V is larger, singular and more medial than the brachial veins
• It is compressible,use light probe pressure for color image