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Venous exam #1 Flashcards

1
Q

What are the 3 functions of veins?

A
  1. Bring deoxygenated blood from the tissues back to the heart.
  2. Stores blood.
  3. Thermoregulate.
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2
Q

What are the 3 types of veins?

A
  1. Deep veins.
  2. Superficial veins.
  3. Perforating veins.
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3
Q

What are the deep veins?

A
  • They are veins that course deep below the fascia in the muscular compartments of the leg.
  • They run along the side of an artery.
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4
Q

What are superficial veins?

A
  • They are veins that course above the fascia and close to the skins surface.
  • They DO NOT run along side of an artery.
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5
Q

What are perforating veins?

A
  • They are veins that connect deep veins to superficial veins.
  • Blood flows from the superficial to the deep systems via the perforators.
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6
Q

What are some deep veins in the LE?

A
  • CFV
  • DFV
  • FV
  • POPV
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7
Q

What are some superficial veins in the LE?

A

-GSV

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8
Q

What are the two optimal bed positions for scanning?

A
  • Semi-Fowler

- Reverse Trendelenburg

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9
Q

Describe Semi-Fowler?

A

30-45 degree head raise.

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10
Q

Describe Reverse Trendelenburg?

A
  • Legs lower than heart

- It results in venous blood pooling in the leg.

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11
Q

What does it mean if a vein is only partially compressible or non-compressible?

A

It means there is a presence of a DVT (deep vein thrombosis) which is also known as a blood clot.

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12
Q

The lower extremity venous ultrasound exam is best started at what location?

A

Upper thigh at crease.

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13
Q

What is the best way to search for the common femoral vein in the groin?

A

Transverse view lateral to medial.

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14
Q 
What is the most medial structure to the groin?
A. CFV
B. CFA
C. DFV
D. Lymph Node
A

A. Common femoral vein

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15
Q

When doing venous compressions of the CFV at the SFJ, you notice that both the CFV and the great saphenous veins are fully compressible, where should you move the probe next?

A

Proximally. above the SFJ.

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16
Q

What is the best way to compress a vein with a transducer?

A

Transverse view.

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17
Q

If you can full compress a vein, what does it mean?

A

There is no DVT.

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18
Q

When doing venous compressions, how often/where should you compress the vein?

A

Every inch of the vein that you’re checking.

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19
Q

What supplies the pelvic organs?

A

Internal Illiac.

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20
Q

What is the longest vein in the LE?

A

Great Saphenous Vein; runs from goin to ankle.

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21
Q

What are some of the deep veins below the knee?

A
  • POPV
  • Tibio-Peroneal Trunk
  • GASTROCV’S
  • PTV’S
  • PERV’S
  • ATV’S
  • SOLEAL V
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22
Q

What are some of the superficial veins?

A

Small Saphenous Vein

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23
Q

Which below knee veins are paired?

A
  • GASTROC V
  • PTV
  • PERV
  • ATV
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24
Q

What is another word that is used for the gastrocnemius veins?

A

Sural.

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25
Q

Where is the main drainage for blood returning from the calf?

A

POPV

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26
Q

Are gastrocnemius veins superficial or deep to the popliteal veins?

A

superficial.

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27
Q

What does the PTV and the PERV form when they merge in the proximal calf?

A

Tibioperoneal Trunk.

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28
Q

What veins runs along the tibia?

A

PTV

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29
Q

What veins run along the fibula?

A

PERV.

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30
Q

What is one of the main reservoirs for the calf?

A

Soleal Sinus Veins.

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31
Q

When does blood flow into the soleal sinus veins?

A

Only when the calf muscles contract.

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32
Q

What veins are the only ones that aren’t paired?

A

Soleal veins.

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33
Q

What are the 5 NORMAL wave forms?

A
  • spontaneous
  • Phasic
  • Augmentable
  • Competent
  • Non-pulsatile.
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34
Q

What is spontaneity?

A

-Venous signal should be heard without assistance. (should be heard at all sites except for the calf.)

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35
Q

What is phasicity?

A
  • Venous doppler signal should vary with respiration.
  • There shouldn’t be any signal with inspiration.
  • signal should return or augment with expiration.
  • sounds similar to waves/ocean.
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36
Q

What is reduced phasicity/non-phasic?

A
  • Flow does not change with respiration variations.
  • Also called continuous flow.
  • Presence of a thrombus.
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37
Q

What is augmentation?

A
  • Increase venous flow with distal compression.
  • DIstal augmentation is squeezing the leg distal to the probe.
  • The valsalva maneuver is a type of augmentation.
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38
Q

What is the valsalva maneuver?

A

Deep inspiration followed by bearing down to create an abrupt cessation of flow.

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39
Q

What is pulsatility?

A
  • Normal venous flow should NOT be pulsatile.

- Not usually present unless venous hypertension or congestive heart failure is present.

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40
Q

What is competency?

A

-Describes the functionality of the venous valves.

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41
Q

What does it mean when valves are described as competent?

A

Valves open and close properly.

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42
Q

What does it mean when valves are described as incompetent?

A

Valves do not close and blood flows caudad (towards the feet).

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43
Q

How do the valves in the leg vary?

A

The more distal in the leg, the more valves.

the more proximal, the fewer the valves.

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44
Q 
Which one of these veins do not accompany an artery?
A. Femoral
B. Gastrocnemius
C.Great Saphenous
D.Peroneal
A

C. Great Saphenous.

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45
Q

Blood normally flows from the deep to the superficial system through the perforating veins: True or false.

A

False, its the other way around. flow flows from the superficial system to the deep via perforators.

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46
Q

Augmentation should____ venous flow.

A

Increase.

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47
Q

Paired leg veins, especially below are a rare occurrence; true or false?

A

False

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48
Q

The common femoral vein begins when which of the following veins joins the femoral vein?

A

Deep femoral.

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49
Q 
Which of the following veins is most likely to have no valves?
A. Popliteal
B. Posterior Tibial
C. Femoral
D. Illiac
A

Illiac

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50
Q

Duplication of the femoral vein is more common than duplication of the popliteal; true or false?

A

False.

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51
Q

Normal criteria for lower extremity venous doppler waveforms includes:

A

Spontaneous flow, which is phasic and augments.

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52
Q

Duplex means “two”. What are the two components or parts of a vascular duplex scan?

A
  1. Doppler

2. Image

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53
Q

Thrombus formation in the _____ veins is rare because they are outside the calf muscles.

A

Anterior Tibial Veins.

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54
Q

The _____ veins lie within the ____ muscle and empty into the posteior tibial or peroneal veins.

A

Soleal, Soleal.

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55
Q

In the present of a DVT proximal to the level you are scanning. the venous Doppler waveform would demonstrate?

A

Reduced phasicity with respirations with a reduced augmentation.

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56
Q

When you have a patient hold their breath and “push” this is called____

A

Valsalva Maneuver

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57
Q

The formerly named superficial femoral vein has been renamed _____.

A

Femoral Vein.

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58
Q

List the two sets of paired veins that come together to form the tibioperoneal trunk:

A
  1. Posterior Tibial Vein

2. Peroneal Vein

59
Q

The sural veins are also known as what?

60
Q

The Primary mechanism for the formation of venous thrombus is:

A

Virchows Triad.

61
Q

Name the other screening test used for DVT besides the well score:

62
Q

What is the study of blood flow characteristics called?

A

Hemodynamics.

63
Q

veins need to prevent the bidirectional flow to help blood get back to the heart against the force of gravity and do this by:

A
  • Skeletal muscle contraction.
  • Venous valves.
  • Compliance
  • Respiratory function
  • Pressure gradients
  • Motor tone
  • Cardiac function
64
Q

What is capacitance?

A

It allows for the venous system to conform to varying blood volumes.

65
Q

what does it mean when veins are called the capacitance vessels?

A

It means they are reservoir/storage tanks of the bodies blood.

66
Q

Veins store how much of the body’s blood?

A

2/3’s of the body’s blood.

67
Q

Arteries store how much of the body’s blood?

68
Q

Where is the remaining 3-4% of the blood stored?

A

Capillaries.

69
Q

What is venous compliance?

A

The ability of veins to expand, contract and collapse.

70
Q

What does a large blood volume stored in the veins do to the pressure?

A

Only a small change in pressure.

71
Q

When is there less resistance to blood flow?

A

When a vein is dilated or distended. This causes the vein to take a more circular shape.

72
Q

When is there more resistance to blood flow?

A

When the vein is partially empty. This causes the vein to take on an elliptical shape.

73
Q

What happens when the venous flow increases?

A

Volume and pressure decrease.

74
Q

What happens when the venous flow decreases?

A

Volume and pressure increase.

75
Q

What is transmural pressure?

A

It is the difference between the pressure within the vein and the pressure of the tissue outside the vein.

76
Q

what is the force occurring from outside the vein called?

A

Tissue pressure.

77
Q

What is the force occurring within the vein called?

A

Intraluminal pressure.

78
Q

What is the pressure difference between the inside and the outside of a vein called?

A

Transmural pressure.

79
Q

Veins have a low pressure and are collapsible therefore, making their shape determined by what?

A

Transmural pressure.

80
Q

What shape will veins have if transmural pressure is low?

A

Veins will have a dumbell/elliptical shape.

81
Q

What shape will veins have if transmural pressure is high?

A

Veins will have a circular shape.

82
Q

How is the transmural pressure when one is supine?

A

Transmural pressure is low.

83
Q

How is the transmural pressure when one is standing?

A

Transmural pressure is high/increases.

84
Q

What is the major force that affects our venous system?

A

Hydrostatic pressure.

85
Q

What is hydrostatic pressure?

A

Pressure from gravity on a column of blood.

86
Q

What is the reference point in the human body to determine hydrostatic pressure?

A

The right atrium of the heart because it is zero.

87
Q

What is the equation of hydrostatic pressure?

A

HP= P (density of blood) x G (acceleration due to gravity) x H (the height of the column of blood)

88
Q

what are 4 factors that affect hydrostatic pressure?

A
  1. Body position
  2. Height
  3. The heart itself
  4. Resistance across the arterioles.
89
Q

When will hydrostatic pressure going to be greater?

A

It will be greater when standing and less if supine.

90
Q

What has the greatest effect on venous blood return to the heart?

A

Changes in the thorax and abdominal pressure.

91
Q

What happen during inspiration?

A
  • Diaphragm descends.
  • Pressure in the abdominal cavity increases.
  • Volume of blood decreases.
  • IVC collapses reducing lower extremity outflow
92
Q

What happens during expiration?

A
  • Diaphragm ascends.
  • Chest pressure increases.
  • Abdominal pressure decreases.
  • Abdominal blood volume increases.
  • An increase in blood flow to the extremities.
93
Q

During inspiration, there is an increase in pressure in the leg veins because…

A

Valves are shut.

94
Q

During expiration, there is a decrease in pressure in the leg veins because…

A

Valves are open.

95
Q

What two muscles are responsible for the “calf pump”

A

Gastrocnemius and soleal muscles.

96
Q

What is the purpose of venous valves?

A

Aid in the return of blood flow to the heart and to prevent back flow.

97
Q

Why is there more valves the further you move from the heart?

A

To compensate for the increase in hydrostatic pressure and force of gravity.

98
Q

What is a venous thrombosis?

A

It is a blood clot that forms in the vein.

99
Q

What is a blood clot?

A

A thick viscous or coagulated mass of blood.

100
Q

What is a DVT?

A

It is a blood clot that forms in one of the deep veins.

101
Q

What is a Pulmonary Embolism?

A

A blood clot that travels to the lungs.

102
Q

What is a thrombosis?

A

Formation of a blood clot in the heart or blood vessels.

103
Q

What is thrombophlebitis?

A

Inflammation of a vein ASSOCIATED with a blood clot.

104
Q

What is phlebitis?

A

Inflammation of a vein wall.

105
Q

What is Virchow triad?

A

Primary mechanism for the formation of venous thrombosis.

106
Q

What is Rudolph Virchow known for?

A
  • Father of cellular pathology
  • Related enlarged lymph nodes to cancer
  • Defined the mechanism of PE
107
Q

What are the 3 parts of ‘Virchows Triad?

A
  • Stasis
  • Trauma (vessel injury)
  • Hypercoaguability
108
Q

What does Stasis mean?

A

Immobility.

109
Q

What are different examples of stasis?

A
  • Prolonged airline flight or car ride
  • Obesity
  • Heart or respiratory failure
  • Pregnancy
  • Stroke
  • Advanced age
  • Recent surgery/bedrest
  • Varicose veins
110
Q

List two characteristics of acute DVT?

A

Dilated vein and a soft echo.

111
Q

Venous symptoms of a DVT include all the following except:

A. Heaviness
B. Swelling
C. Cramping pain
D. All of the above are symptoms of a DVT

A

C. Cramping pain

112
Q

What is the primary complication of DVT?

A

Pulmonary embolism

113
Q 
All of these are symptoms of a PE except:
A. Shortness of breath 
B. Dyspnea
C. Hemoptysis
D. Stroke
114
Q

Why is the risk from an isolated superficial vein thrombosis unlikely to result in a PE?

A

Due to the depth under the skins surface and the fact that muscles don’t squeeze superficial veins.

115
Q

You are scanning a patient’s leg and see that the femoral vein is not fully compressing and there are intraluminal echoes that are hypo-echoic. What process is most likely happening inside the femoral vein?

A

Newly formed thrombus.

116
Q

What are different examples of trauma (aka vessel wall injury)?

A
  • Surgery
  • Trauma
  • Catheters/lines
  • IV drug use
  • Previous venous thrombosis
117
Q

What does hypercoaguability mean?

A

Increased blood clotting.

118
Q

What are 2 ways people become hypercoagulable?

A
  • Inherited blood disorders = genetic blood disorders passed down from parents
  • Acquired hypercoagulability = non-genetic forms of hypercoagulability
119
Q

What are some examples of inherited blood disorders?

A
  • Factor V Leiden
  • Anti-thrombin deficiency
  • Protein C or S deficiency
  • Prothrombin 20210 mutation
120
Q

What are some examples of an acquired hypercoagulability?

A
  • Oral contraceptives/birth controls
  • Hormone therapy/estrogen therapy
  • Pregnancy
  • Malignancy
121
Q

What are the signs of a DVT?

A
  • Pain
  • Tenderness
  • Swelling
  • Palpable cord
122
Q

The difference between the signs and symptoms of venous and arterial DVT:

A

Venous

  • Pain – ache, heaviness & relieved with elevation
  • Swelling – ankle, calf, thigh (feet usually spared)
  • Ulceration in the gaiter area, usually not very painful

Arterial

  • Pain – cramping pain or weakness when walking that is relieved with rest
  • Swelling – none (usually)
  • Ulceration distally on the feet or toes, extremely painful
123
Q

What are the risk factors for a DVT?

A
  • History of DVT
  • Pregnancy
  • Surgery/trauma
  • Immobilization
  • Cancer
  • Oral contraceptives
  • Hormone replacement therapy
  • Obesity
  • Stroke
  • CHF
  • Long distance travel
  • Varicose veins
  • Age
124
Q

What is the most common inherited hypercoagulable condition?

A

Factor V Leiden

125
Q

Why is pregnancy a risk factor?

A
  • Increased venous pressure because the baby is compressing the IVC therefore resulting in decreased flow from the lower extremities
  • A DVT and PE can happen during all trimesters and 6-12 months post partum
126
Q

Why is aging a risk factor?

A
  • Bedrest
  • Immobilization
  • Accumulation of risk factors
127
Q

What is a pulmonary embolism?

A

A dislodged piece of clot that travels to the lungs blocking the pulmonary artery therefore depriving the lung tissue from blood.

128
Q

What is the primary complication of a DVT?

A

PE which is responsible for 200,000 deaths annually.

129
Q

What are the symptoms of a PE?

A
  • Chest pain
  • Dyspnea (SOB)
  • Hemoptysis (coughing up blood)
  • Tachypnea (rapid breathing)
  • Dyspnea (difficulty breathing)
  • Syncope (fainting)
  • Tachycardia (rapid heart rate)
130
Q

What is an SVT?

A

A thrombus that forms in a superficial vein.

131
Q

What is the risk of a PE from a SVT?

A

Risk of PE low from a SVT due to depth under skins surface and the fact that muscles don’t squeeze superficial veins.

132
Q

What are the two criteria for a vein to DEFINITELY have a thrombus?

A

The presence of echogenic material within the lumen and lack of full compression must both occur to DEFINITIVELY determine if there is a thrombus.

133
Q

What are the characteristics of a totally occlusive DVT?

A
  • DVT that consumes the entire lumen.
  • No flow is seen.
  • Vessel is non-compressible.
134
Q

What are the characteristics of a partially/non-occlusive DVT?

A
  • DVT that is not completely filling the vein
  • Some flow is seen
  • Vessel is partially compressible
135
Q

What are the characteristics of a normal doppler?

A
  • Spontaneous
  • Phasic
  • Augments
136
Q

What are the characteristic of an abnormal doppler?

A
  • Not spontaneous
  • Reduce augmentation.
  • Continuous or reduced phasic flow.
137
Q

Why is duplex imaging beneficial?

A

It is beneficial because not only the presence of thrombus can be determined but the characteristic/age.

138
Q

What is an acute thrombus?

A

a newly formed thrombus.

139
Q

What are the characteristics of an acute thrombus?

A
  • poorly adhered to a wall.
  • spongy
  • dilated
  • unstable
140
Q

What is a chronic thrombus?

A

a thrombus 6 months or older.

141
Q

What happens when fibroblast invades a thrombus?

A

It turns the clot into fibrous tissue.

142
Q

What is recanalization?

A

Blood regaining flow and flowing around a clot.

143
Q

What is a sub-acute thrombus?

A

Thrombus that is in between the acute stage and chronic.

Venous Procedure (5 decks)

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