Vascular Ch. 18 Flashcards
3 differences in protocol techniques for upper extremity and lower extremity
- thrombi in lower extremity often caused by stasis: NOT SO IN THE UPPER EXTEMITY (NO SOLEAL SINUSES) 2. superficial veins affected more in arms than in legs 3. venous anatomy of upper extremity is more variable than lower extremity
Why is thrombi in LOWER extremity often caused by stasis and not so in the upper extremity
no soleal sinus
Does superficial thrombosis have greater clinical significance in arm than the leg
yes
Facial swelling or dilated chest wall collaterals is suggestive of
superior vena cava thrombosis
PE symptoms include
chest pain, tachypnea, tachycardia
Why is upper extremity thrombosis more common
injury to vessel wall
What causes injury to vessel wall in upper extremity
more frequent introduction of needles and catheters into arm veins
What is PICC and does it cause thrombosis
peripherally inserted central catheter, yes
Where is catheter inserted and positioned
through basilic or cephalic vein, positioned near right atrium
What is paget-schroetter syndrome
venous thrombosis associated with compression of subclavian vein at the thoracic outlet
Another name for Paget-Schroetter syndrome
effort thrombosis
Typical patients of paget-schroetter syndrome
young, athletic, muscular males
What position do you examine internal jugular and subclavian veins
lying flat, supine
Why does the patient need to lay flat for IJV and subclavian vein
removes the impact of hydrostatic pressure which tends to collapse these veins
Are compressions performed with brachiocephalic veins
no
What is the landmark for the subclavian vein
the cephalic vein because it terminates into subclavian after it passes under clavicle
Why should color and spectral doppler be documented for subclavian vein
most helpful to document patency and doppler signals will be both pulsatile and phasic
In the cephalic vein, thrombus at this level will have
the same gray scale appearance as thrombus within the brachial vein
Normal vein walls will ______ with transducer pressure
completely compress (performed in transverse)
In diagnosis, normal vein walls should be
smooth, thin, anechoic vessel lumen
What changes SLIGHTLY with respiration
vein diameter
Superficial vein thrombus will have same appearance as
DVT
What is the appearance of superficial vein thrombosis
hypoechoic areas may be present around vein due to inflammation
_______ forming around a catheter may cause doppler signals to ________
nonocclusive thrombus, become continuous
Spectral doppler waveforms should demonstrate
respiratory phasicity, augmentation with distal compression, and pulsatility (common near heart)
What vessels may have pulsatility
IJV, subclavian and brachiocephalic veins
Color and spectral doppler flow for COMPLETE thrombus
no signal or color filling will be obtained
What may result in continuous flow
partial thrombus, proximal thrombus, extrinsic compression
What are commonly encountered in the arm
indwelling venous catheters
How do catheters appear within vessel lumen
bright, straight, parallel echoes
How does thrombus appear around catheters surface
echogenic material
Spectral doppler with venous catheter
diminished and/or continuous
Treatment considerations for thrombus around catheter
anticoagulation, catheter removal, thrombolytic therapy
Upper extremity veins may not be compressible at every level due to their course ______, but should be compressed when possible
behind bones
Doppler is even more vital in evaluation when
compression is not possible
Which is true regarding thrombus in the legs
more in arms
What frequently causes thrombus in upper extremity
injuries to vessel walls
Venous thrombus associated with compression of subclavian vein at the thoracic outlet
paget-schroetter syndrome
Landmark for axillary
cephalic vein
What is normally most helpful to document patency in subclavian vein
color and spectral doppler
All of the following are normal grayscale findings except
hyperechoic
Hyperechoic tissue adjacent to thrombus in superficial vein due to
inflammation
IJV and subclavian veins examined with patient lying flat
potentially collapse, removed impact from hydrostatic pressure
Catheters appear as
bright, straight, parallel echoes within vessel lumen
Thrombus in the cephalic vein has same gray scale appearance as thrombus in
brachial vein
Doppler should be symmetrical
can’t compress it
Nonocclusive thrombus forming around catheter may cause
doppler signal to become continuous
What are the 5 treatments for venous catheters
anticoagulants, catheter removal, thrombolytic therapy, conservative treatment, surgical compression of thoracic inlet with or without venous reconstruction
3 upper extremity vessels with pulsatility
IJV, subclavian, brachiocephalic
