Week 5 Part 2

Question 1

Acute thrombus

Answer 1

faintly echogenic, almost invisible
attached to a vein wall over a short area, so it may be a snakelike clot swaying back and forth
at risk for emboli
lumen will expand in cases of occlusive DVT
some compression of walls is possible

Question 2

Chronic thrombus

Answer 2

complete dissolution of clot over time
lumen contracts
incompressible walls
may become more solid, firmer and more echogenic
becomes better attached over time
less threat of embolization
large collaterals will develop

Question 3

With an acute thrombus, collaterals will not really have formed. What happens until the collaterals are formed?

Answer 3

an increase in velocity and flow in the saphenous veins or profunda femoris

Question 4

What are complications of DVT? (5)

Answer 4

PE
recurrent DVT
incompetent valves
varicose veins
chronic venous insufficiency

Question 5

Pulmonary Embolism symptoms

Answer 5

symptoms- difficulty breathing, chest pain on inspirations and palpitations
Clinically- low blood O/cyanosis, rapid breathing and HR

Question 6

How are PE’s diagnosed?

Answer 6

D-dimer test, CT, pumonary angiography, pulse oximetry (first test)

Question 7

How are PE’s treated?

Answer 7

anticoagulent therapy-heparin and warfarin

surgical intervention- pulmonary thrombectomy

Question 8

Pulse oximetry:

Answer 8

simplest, noninvasive way to monitor the percentage of hemoglobin that is saturated with oxygen
places on finger and infrared light is transmitted into tissue

Question 9

In pulse oximetry, a saturation level of what is abnormal?

Answer 9

<95%

can be caused by other lung/heart problems, or PE

Question 10

Post thrombotic syndrome (PT’s)

Answer 10

vein walls are permanently damaged in 60% of cases
valve leaflets are immobile and fixed to wall
venous reflux
venous stasis is worse in standing position

Question 11

Chronic venous obstruction manifests as:

Answer 11

chronic leg swelling, ankle pigmentation and ulcer formations (these can form spontaneously or a trauma inflammatory reaction in tissue)

Question 12

What causes brown skin pigmentation?

Answer 12

metabolic breakdown of hemoglobin

Question 13

A complication of PTS is the persistent chronic _______ in venous pressure

Answer 13

elevations

Question 14

Primary vs. secondary varicose veins:

Answer 14

Primary- hx of DVT is rare and it’s a result of valvular incompetence at SFJ
Secondary- associated with obstruction (DVT) or incompetence of the deep venous system valves

Question 15

When thrombus is visualized, what images need to be taken:

Answer 15

compression images
doppler with augmentation
CD
presence or absence of flow
routine images

Question 16

What are pitfalls for diagnosing DVT?

Answer 16

swollen, oedematous legs
obesity
dual femoral and popliteal veins 
non-occlusive can be missed if vein isn't adequately seen 
multiple calf veins and variable anatomy
iliacs may not be seen due to gas and obesity
calcified arterial system
pregnancy

Question 17

Why does pregnancy increase the risk of a DVT?

Answer 17

changes to coagulation system
hormonal effects and pressure from enlarging uterus
c-sections
physiological changes to venous flow in legs

Question 18

DVT’s only occur in the upper extremitiies 10% of the time. What’s the most common cause of this?

Answer 18

placement of VAD

injury to vein wall

Question 19

What’s the usual cause for DVT in the lower extremities?

Answer 19

stasis

upper extremities don’t have soleal sinuses which is why it’s not common to have a DVT

Question 20

Signs/symptoms if the SCV is obstructed:

Answer 20

arm and facial edema
head fullness
blurred vision
vertigo/dyspnea

Question 21

When a normal person “sniffs”, the IJV or SCV will decrease in diameter and will show an increase in flow velocity. True or false

Answer 21

True– patients with central BCV or SVC obstruction won’t have this response

Question 22

What are causes of upper extremity DVT?

Answer 22

presence of a central venous catheter or pacemaker lead*

radiation therapy, malignant obstruction and effort induced thrombosis are more frequently with UEDVT

Question 23

Is upper or lower DVT more severe?

Answer 23

lower– less risk for PE in upper

Question 24

In Paget-Schroetter syndrome, patients develop a spontaneous UEDVT in what arm? (dominant or non)

Answer 24

dominant

heavy exertion causes microtrauma to the vessel intima and leads to coagulation issues

Question 25

What gets compressed with TOS?

Answer 25

brachial nerves, subclavian artery, subclavian vein

Question 26

TOS patients have pain that radiates into the thumb. True or false

Answer 26

False– 4th and 5th digits

Question 27

What bony structures are sometimes found in TOS patients?

Answer 27

cervical ribs, long trv processes of C-spine

Question 28

What can be associated with idiopathic TOS?

Answer 28

occult cancers– ie. lymphoma, lung cancer or compression by lymph nodes

Question 29

Primary UEDVT is

Answer 29

effort induced or idiopathic

Question 30

Secondary UEDVT:

Answer 30

develops in patients with central venous catheters, pacemakers or cancer
catheter related thrombosis

Question 31

Why can catheters cause DVT?

Answer 31

vessel wall is damaged, catheter may impede blood flow causing stasis
(incorrect placement of catheters likely cause this issue)

Question 32

Where should catheters be placed to avoid secondary UEDVT?

Answer 32

lower third of SVC by junction of RA as blood is the most rapid in SVC

Question 33

Where’s the most common access site for central venous access?

Answer 33

SCV and IJV – they feed it in through here to the SCV

Question 34

Out of SCV and IJV for a VAD, which one is preferred?

Answer 34

rt. IJV because of it’s straight course to the heart

Question 35

EJV is the preferred insertion site for a VAD. True or false

Answer 35

False–only if the IJV is obstructed. it’s often tortuous

Question 36

What are some complications of VAD?

Answer 36

vein damage
AVF
non target puncture
bleeding
air embolism
cardiac arrhythmia
infection