Venous week 11

Question 1

What does the thyrocervical branch into?

Answer 1

• Transverse scapular
• Anterior jugular vien and arch
• External jugular

Question 2

What is the primary cause of upper extremity DVT’s?

Answer 2

IV’s and central lines.

Question 3

What is the second cause of a DVT?

Answer 3

Effort thrombosis

Question 4

What are some effort thrombosis?

Answer 4

• Paget-von Shrötters syndrome
• Thoracic Outlet Compression (TOC) (1-2 % of patients)

Question 5

What are the upper extremty causes for a DVT?

Answer 5

1. IV’s and central catheters
2. Effort thrombosis
3. Tumors
4. IV drug abuse
5. Post-op complications

Question 6

What is the physical assessment for edema?

Answer 6

• Entire ARM – (Where is obstruction?)
• SVC SYNDROME (What is location of edema?)
• AT IV SITE – Infiltration
• HAND EDEMA = Lymphadema

Question 7

What is the physical assesment for pain?

Answer 7

• Heaviness / ache typical for DVT
• Hand pain – Arterial embolus?

Question 8

What SVC syndrome?

Answer 8

The superior vena cava is obstructed which causes venous collaterals.

Question 9

What is a portacatheter?

Answer 9

A long-term central venous catheter with subcutaneous ports.

Question 10

A hickman catheter is usually placed where?

Answer 10

In the SVC thorugh the subclavian vein.

Question 11

What is a PICC line?

Answer 11

PERIPHERALLY INSERTED CENTRAL CATHETER

Question 12

What happens after a PICC line is removed?

Answer 12

A fibrin sheath often remains in the vein.

Question 13

What is a fibrin sheath made of?

Answer 13

It is essentially a cast of the line made from deposits of fibrin from the circulating blood

Question 14

How does fibrin sheath form?

Answer 14

◦A venous catheter is a foreign substance.

◦Plasma proteins (fibrin and fibronectin) coat the catheter’s surface.

◦This promotes the adherence of blood platelets and bacteria.

◦Staph. bacteria adheres to the fibronectin which stimulates platelet activation and the compliment/ coagulation cascade.

◦The end result is either a fibrin sheath or thrombus.

Question 15

What are the complications of fibrin sheath?

Answer 15

◦The fibrin sheath forms an adhesive “sock” around the end and sides of the catheter.

◦The substance surrounding the catheter is thick and glue-like and difficult to remove.

◦It can form within 24hrs after placement and most CVC’s are encased by 5-7 days.

◦Withdrawal of blood is impeded if the end of the catheter is covered.

◦Infusions must escape through the sheath possibly causing thrombus formation.

Question 16

When taking down a patients history, what are some important things to ask?

Answer 16

◦Introductions/Ask the patient why he/she is being tested.

◦Symptoms? Look at order/ indications

◦History of DVT?

◦Trauma or surgery?

◦Central lines- current or previous

◦IV’s?

◦Dialysis access complications?

◦Recent weight lifting? Arm exercise?

◦Does the history match any of Virchow’s triad?

Question 17

How should a patient be position for a scan for the BCV, SCV, IJV?

Answer 17

Supine.

Question 18

What are the symptoms of PE?

Answer 18

• Swelling
• Pain
• Inflammation at IV site
• Preop
  
  • Vein mapping for le bpg or cabg
  • Vein mapping for dialysis access
• Malfunctioning central line

Question 19

If you start to scan in the IJV mid neck in trans, where should you move?

Answer 19

Scan distally and proximally.

Question 20

How should you point the probe in order to see the BCV?

Answer 20

Point the probe down.

Question 21

How should you scan the SCV?

Answer 21

Turn probe at clavicle, pointing end towards the armpit, to line up with the proximal sublavian vein in long view.

Question 22

How will the proximal SCV be displayed on the screen?

Answer 22

Prox. SCV will be horizontal on scnreen with bright echo below which is the pleura.

Question 23

What is the pleura?

Answer 23

One of the two membranes around the lungs.

Question 24

What are the two types of pleura?

Answer 24

Visceral and parietal.

Question 25

What is the visceral pleura?

Answer 25

envelopes the lungs.

Question 26

What is the parietal pleura?

Answer 26

Lines the inner chest wall.

Question 27

Where should you move the probe to see the distal SCV?

Answer 27

Move probe over the clavicle.

Question 28

Where do the two brachial veins split?

Answer 28

Anticubital fossa

Question 29

What is the technqiue used to scan the subcalvian and axillary to see veins compress?

Answer 29

The sniff test.

Question 30

What does a normal UE venous exam doppler look like?

Answer 30

• Spontaneous
• Phasic
• Augmentablebelow the axilla.
• Pulsatile above the axilla.

Question 31

What are some arm vein variations?

Answer 31

• High radial/ulnar vein bifurcation
• High bifurcation of basilic vein
• Double basilic or cephalic vein
• Median nerve looks like a very small occluded brachial vein just above the artery on the screen