venous week 7 Flashcards
What is accreditation?
Process that ensures high quality vascular testing.
How often must an institution be re-accredited?
Must get re-accredited every 3 years.
In some states Medicare and third party insurers now require patients to get their exams done at accredited labs for what?
Reimbursement.
What are the types of accreditation?
- Extracranial cerebrovascular (Carotid duplex)
- Intracranial cerebrovascular (Transcranial Doppler)
- Peripheral arterial (LE and UE arterial exams)
- Peripheral venous (LE and UE venous exams)
- Visceral vascular (Abdominal)
What are the 3 guidelines and protocols that labs must follow in order to achieve accreditation according to IAC?
- Techniques used (position, equipment, optimization of equipment, ect.)
- Documentations (how exams are documented)
- Protocols for each exam.
What is the accreditation process?
- Submit accreditation application
- Once submitted all necessary material, it is then peer reviewed by the board of directors.
- Accreditation is either granted, denied, delayed, or a visit is required.
What must an accreditation application include in order to be considered?
- Must include details on all aspects of daily lab operations.
- Must include case studies
Once an accreditation application has been submitted, who is it reviewed by?
Board of directors.
What does “accreditation granted” signify?
Accreditation is approved and given to the institution.
What does “accreditation delay” signify?
There is a delay in accreditation for further review.
What does “accreditation-require visit” signify?
IAC comes out to the actual lab to observe.
What does “accreditation denied” signify?
Per IAC website, no accreditation is immediately denied a site visit or delay is first received.
What does IAC stand for?
Inter-societal Accreditation Commission.
Why are protocols in a lab beneficial?
- Help maintain quality assurance in a lab.
- Help with a cohesion for follow up exams.
Are the protocols the same for each lab?
No, they vary from one another.
What is the IAC protocol for the LE venous duplex?
-Transverse grayscale image with and without compressions must include at a minimum:
CFV, SFJ, Prox. Mid. Distal FV, POPV, PTV, PERV, additional images to document areas of suspected thrombus and any additional images (if required by lab protocol)
-Spectral doppler waveforms demostrating spontaneous, phasic and augmental flow inslcuidng a minimum:
RT & LT CFV, POPV, any additional waveforms if required by lab protocol.
(For unilateral exams, both the RT< CFV waveforms are required)
What is considered fully compressibile?
*normal compressibility*
The near and far walls fully touch and the vein is completely compressed.
What does partial compressability mean?
The vein only compresses partially down.
What does non-compressible mean?
The vein doesn’t compress at all.
What does it mean if the vein is partially and non-compressible?
There is a precense of a DVT.
What are the characterisitics of a normal venous doppler waveform signal?
- Spontaneous
- Phasic
- Augmentable
- Competency
- Non-Pulsatile
Where should spontaneous “automatic” venous signal be heard at?
It should be heard at all sites except for the calf.
What kind of flow should you hear when the doppler is sampled inside the vein?
Automatic flow.
What does phasicity mean?
Venous doppler signal should vary with respirations.
How is normal phasicity seen?
- No signal or reduced signal with inspiration.
- Signal should return or augment with expiration.
- Sounds familiar to waves/ocean.
What does reduced phasicity/non-phasic indicate?
Presence of thrombus and/or extrinsic compression to the vein.
What are the characterisitic of reduced phasicity/non-phasic?
- Flow doesn’t change with respiration
What is reduced phasicity/non-phasic also known as?
Continuous flow.
What does augmentation mean?
Increase in venous flow with distal compression.
What is an example of augmentation?
Valsalva maneuver.
What is the valsalva maneuver?
a technique where you have the patient hold their breath and “push”
This is what a normal augmentation looks like:
This is what an abnormal augmentation looks like:
Should normal venous flow be pulsatile?
No.
When is pulsatility seen in venous flow?
- venous hypertension
- congestive heart failure
What do you do if a doppler demostrates pulsatility?
Suggest a hypervolemic state.
Why is it important to know how to interpret the results from a a venous duplex exam?
- To be able to verbally give a preliminary report to the DR.
- To be able to formulate a written or typed out preliminary report for the patients chart.
What are the two parts to a good intrepration?
- Findings/analysis
- Impression
What are the findings/analysis you should have?
- Compressibility
- Doppler waveform analysis
- Any incident findings.
What is the impression you should have as your intrepretation?
- Overall summary of your findings.
EX: No evidence of acute DVT or venous obstruction in the right LE.
What should you state in your analysis?
- State the compressibility
- State which veins and the extent of the abnormalities.
- State Doppler waveform analysis and in which veins
What are the type of things you should include in the impression?
- State the presence or absence of thrombus
- State age of thrombus if present
- State the location of the thrombus
What should you put in the comments in a report?
- Any limitations:
- If any area was not visualized.
- State what veins were not assessed ad the reason.
- If any area was not visualized.
what does “+” mean in the legend?
Means “present” or “normal”
what does “-”
means “reduced”
What does “Ø” mean?
means “absent” or “not present”
What does T mean?
Totally occlusive
What does P mean?
Partially occlusive
Why are follow-up exams used?
to check for:
- Progression
- Recanalization
- Resolution
- No change
Whats piece of information is very important for you to document?
Always document that the preliminary report was given to pager # or Dr, and if the results were relayed.
