Vasc- DVT protocol Flashcards
The main goals in diagnosing venous thrombosis are to determine what? (2)
- presence of absence of thrombus
2. risk for the thrombus dislodging and travelling to lungs (PE)
what are the 2 biggest disadvantages to venous imaging?
- operator dependent
2. lack of standardized training and protocols
3 factors that will dramatically influence the quality of the study?
- equipment selection
- proper patient positioning
- proper education and examination techniques
what transducer should you use for superficial veins (saphenous and arm veins)?
- high frequency linear probe
10-18Mhz
what transducer should you use for most of deep veins of the legs and arms?
- midrange linear transducer
- 5-9Mhz
what transducer should you use for iliac veins and large legs?
- lower frequency phased array probe
2-5MHz
OR
- curvilinear (2MHz)
when imaging the lower extremity what position should the bed be in?
- tilted in a reversed Trendelenburg position
patient positioning head vs feet?
the head should be at least 20 degrees higher than the feet
augmentation will rule out non-occlusive DVT? T or F?
False
- augmentation will NOT rule out non-occlusive DVT
during the compession technique- start at the groin crease, completely compress the vein using a rhythmic, ____, ____, ____ motion?
compress, release, slide motion
- this allows vein to fill with blood in between compressions
a few cm’s below the SFJ, what will you find?
the distal common femoral vein
after the point of the distal common femoral vein is known as what?
the femoral vein
the deep femoral vein dumps into?
the femoral vein
the confluence should be compressed to rule out?
clot in the deep femoral vein and the femoral vein (FA, FV, DFV, DFA)
The femoral vein travels the entire length of the thigh along side what vessel?
femoral artery
where to start compressions for the popliteal vein?
- start at the knee crease
- the midpoint of the popliteal vein where the short saphenous vein and gastrocnemius vein dump in
What is included in the trifurcation?
- distal pop v
- anterior tibial trunk
- tibial-peroneal trunk
anterior tibial veins protocol?
- very low risk for DVT
- not usually included in exams except at the trifurcation level
where does the gastronemius vein dump into?
- a single trunk that dumps into the popliteal vein just inferior to the level where the SSV dumps in
what is the soleus sinus?
dilated venous structure located within the soleus muscle
why might a clot form in the soleus sinus?
because of stagnation of blood when the calf muscle in inactive
evaluation of the soleus sinus is important because?
- most blood clots that extent up into the pop v originate there
Where is the GSV compressed?
- in the groin crease
- follow a medial approach on the leg to the ankle at the level anterior to the medial malleolus
Proximally the GSV runs within what?
2 echogenic fascia
the short saphenous vein should be compressed from the?
- popliteal fossa where it dumps into the popliteal vein
- slide along the posterior calf to the level of the lateral malleolus
does the SSV always dump into the pop v?
no, it may continue in a superficial level cephalad toward the thigh
where may the SSV dump into? (3)
- femoral vein
- vein of giacomini
- GSV
what is augmentation?
a maneuver used to assess for DVT complete obstruction
purpose of the valsalva maneuver?
- proves the competence of valves and is used to assess coaptation of the valve leaflets
in the setting of incompetent valves what will be seen?
- reflux of flow on the other side of the baseline because the valve does not close and stop the flow during respiratory movement, instead it reverses direction
If the SFJ is incompetent, the patient is at risk for?
primary varicose veins
venous reflux ultrasound is done with the patient in what position? why?
- standing position
- helps to dilate the veins and they stay distended with blood longer
- visualization is better
- weight should be shifted onto the leg that is not being imaged
