Vasc- DVT protocol

Question 1

The main goals in diagnosing venous thrombosis are to determine what? (2)

Answer 1

1. presence of absence of thrombus

2. risk for the thrombus dislodging and travelling to lungs (PE)

Question 2

what are the 2 biggest disadvantages to venous imaging?

Answer 2

1. operator dependent

2. lack of standardized training and protocols

Question 3

3 factors that will dramatically influence the quality of the study?

Answer 3

1. equipment selection
2. proper patient positioning
3. proper education and examination techniques

Question 4

what transducer should you use for superficial veins (saphenous and arm veins)?

Answer 4

• high frequency linear probe

10-18Mhz

Question 5

what transducer should you use for most of deep veins of the legs and arms?

Answer 5

• midrange linear transducer

- 5-9Mhz

Question 6

what transducer should you use for iliac veins and large legs?

Answer 6

• lower frequency phased array probe
  2-5MHz

OR

• curvilinear (2MHz)

Question 7

when imaging the lower extremity what position should the bed be in?

Answer 7

• tilted in a reversed Trendelenburg position

Question 8

patient positioning head vs feet?

Answer 8

the head should be at least 20 degrees higher than the feet

Question 9

augmentation will rule out non-occlusive DVT? T or F?

Answer 9

False

• augmentation will NOT rule out non-occlusive DVT

Question 10

during the compession technique- start at the groin crease, completely compress the vein using a rhythmic, ____, ____, ____ motion?

Answer 10

compress, release, slide motion

• this allows vein to fill with blood in between compressions

Question 11

a few cm’s below the SFJ, what will you find?

Answer 11

the distal common femoral vein

Question 12

after the point of the distal common femoral vein is known as what?

Answer 12

the femoral vein

Question 13

the deep femoral vein dumps into?

Answer 13

the femoral vein

Question 14

the confluence should be compressed to rule out?

Answer 14

clot in the deep femoral vein and the femoral vein (FA, FV, DFV, DFA)

Question 15

The femoral vein travels the entire length of the thigh along side what vessel?

Answer 15

femoral artery

Question 16

where to start compressions for the popliteal vein?

Answer 16

• start at the knee crease

- the midpoint of the popliteal vein where the short saphenous vein and gastrocnemius vein dump in

Question 17

What is included in the trifurcation?

Answer 17

1. distal pop v
2. anterior tibial trunk
3. tibial-peroneal trunk

Question 18

anterior tibial veins protocol?

Answer 18

• very low risk for DVT

- not usually included in exams except at the trifurcation level

Question 19

where does the gastronemius vein dump into?

Answer 19

• a single trunk that dumps into the popliteal vein just inferior to the level where the SSV dumps in

Question 20

what is the soleus sinus?

Answer 20

dilated venous structure located within the soleus muscle

Question 21

why might a clot form in the soleus sinus?

Answer 21

because of stagnation of blood when the calf muscle in inactive

Question 22

evaluation of the soleus sinus is important because?

Answer 22

• most blood clots that extent up into the pop v originate there

Question 23

Where is the GSV compressed?

Answer 23

• in the groin crease

- follow a medial approach on the leg to the ankle at the level anterior to the medial malleolus

Question 24

Proximally the GSV runs within what?

Answer 24

2 echogenic fascia

Question 25

the short saphenous vein should be compressed from the?

Answer 25

• popliteal fossa where it dumps into the popliteal vein

- slide along the posterior calf to the level of the lateral malleolus

Question 26

does the SSV always dump into the pop v?

Answer 26

no, it may continue in a superficial level cephalad toward the thigh

Question 27

where may the SSV dump into? (3)

Answer 27

• femoral vein
• vein of giacomini
• GSV

Question 28

what is augmentation?

Answer 28

a maneuver used to assess for DVT complete obstruction

Question 29

purpose of the valsalva maneuver?

Answer 29

• proves the competence of valves and is used to assess coaptation of the valve leaflets

Question 30

in the setting of incompetent valves what will be seen?

Answer 30

• 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

Question 31

If the SFJ is incompetent, the patient is at risk for?

Answer 31

primary varicose veins

Question 32

venous reflux ultrasound is done with the patient in what position? why?

Answer 32

• 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