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Venous Final > Wks 11-14 > Flashcards

Wks 11-14 Flashcards

1
Q

Brachiocephalic vein vs artery

A

BCV has right and left branches

BCA on has right branch

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2
Q

Central veins

A

BCV, SCV

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3
Q

Which BCV is longer

A

Left because vena cava lies more to the right side compared to aorta

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4
Q

Thyrocervical branches

A

Transverse scapular
Anterior jugular vein and arch
External jugular

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5
Q

Primary cause of UE DVT

A

IVs and catheters

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6
Q

Secondary cause of UE DVT

A

effort thrombosis

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7
Q

Effort thrombosis

A

Aka paget-van shrotters syndrome.

Strong, young athletic people who put too much stain on area

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8
Q

Thoracic outlet compression

A

Vein artery and nerve compressed by clavicle and 1sr rib

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9
Q

Causes of UE DVT

A 
IVs/catheters
Effort thrombosis 
Thoracic outlet compression
Tumors
IV drug use
Post-op complications
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10
Q

Anatomical variations

A

Normal anatomy layout is different. Patient might have SCV over rib instead of under

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11
Q

Physical assessment of UE

A

Edema
Pain
Dilated superficial shoulder veins

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12
Q

Edema

A

Entire arm effected could be subclavian obstruction
SVC syndrome-facial edema
At IV site-infiltration
Hand edema-lymphadema

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13
Q

Pain (phys assess)

A

Heaviness
Aches pain
Hand pain possible arterial embolus

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14
Q

SVC syndrome

A

Superior vena cava obstructed
Venous collaterals form
Dilated chest veins, very visible and VERY likely DVT

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15
Q

Hickman catheter

A

3 ports or 2 ports
Catheter fed into SCV into SVC
End of port sticks outside patients chest area

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16
Q

Portacath

A

Long term central venous catheter with subcutaneous parts.

All parts are underneath skin

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17
Q

PICC

A

Peripherally inserted central catheter

Catheter threaded from arm all the way to Superior vena cava.

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18
Q

Advantages of PICC

A

Longer term 3 months-1 year
At home option
Use basilic vein for ease of patient mobility

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19
Q

Disadvantages of PICC

A

Stasis often occurs since PICC is same side as vein

Slows venous drainage

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20
Q

PICC removal reasons

A

If thrombus forms
Infection
Damaged line

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21
Q

Fibrin sheath

A

Deposits of fibrin formed from the circulation blood

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22
Q

Fibrin sheath after line removal

A

Fibrin sheath remains in the vein
Almost like a snake leaving behind shedded skin
Appears on image same as the real line

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23
Q

Fibrin sheath formation

A

Catheter is foreign substance so plasma proteins coat catheters surface.
Promoted the adherence of blood platelets and bacteria.
Staph bacteria sticks to fibronectin which activates the coagulation

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24
Q

Fibrin sheath complications

A

thick and glue like
difficult to remove
Forms within 24 hours after placement, fully surrounded in 5-7 days

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25
Q

Pertinent history

A 
Confirm test
Symptoms 
History of DVT
Surgery or trauma
IVs or catheters 
Triad symptoms
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26
Q

Patient prep

A

Supine for neck area
Cover non scanning body area
Patient is not an arm rest
Patients arm can lay on your lap

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27
Q

Veins collapsing

A

If patient is upright veins will collapse due to pressure

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28
Q

Symptoms of PE

A 
Swelling
Pain
Inflammation of IV site
Preop 
Malfunctioning central lines
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29
Q

Protocol for IJV

A

Start in mid neck in trans

Scan distally and proximal

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30
Q

Protocol for BCV

A

Probe points deep towards chest
RT BCV will be vertical
LT BCV will be slightly pointed to right of pt

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31
Q

Prox SCV on screen

A

Horizontal

Bright echo below due to pleural

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32
Q

Pleura

A

Membranes around lungs

Visceral and parietal

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33
Q

Cephalic vein past clavicle

A

Cephalic vein junctions occurs just past clavicle

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34
Q

Radial and ulnar unlikely to be scanned

A

Areas at low DVT risk

Catheters not placed there due to artery closeness

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35
Q

Sniff test

A

Technique available if veins are hard to compress

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36
Q

Respiration

A

UE inhales increases chest pressure

Exhale halts flow

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37
Q

Normal UE Doppler

A 
Spontaneous 
Pulsatile above axillary
Phasic with pulsatility
Augment below axillary-lower response than LE
Similar side to side
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38
Q

Why is normal Doppler pulsitile

A

Due to reflected waveforms from closeness to heart

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39
Q

Subclavian vs suprascapular

A

Don’t mistake suprascapular vein for SCV

SCV is horizontal on screen!!

40
Q

Techniques for competency

A

Augment
Patient cough
Sniff test
Compare to opposite side

41
Q

vein variations

A

Many variations in UE
2 brachial veins for artery
3 brachial veins
Etc

42
Q

Median nerve

A

Near brachial vein

Has stripes/streaks/striations

43
Q

Superficial veins

A

Basilic and cephalic
Within fascia near skin surface
Nice catheter locations

44
Q

Abnormal for brachiocephalic vein

A

Nonphasic
Non pulsatile especially compared to other side
Velocity, low is occlusion. High is stenosis
Retrograde flow in IJV sign of prox BCV obstruction

45
Q

IJV obstruction

A

Facial vein collaterals

Superior thyroid collaterals

46
Q

Determining thrombus age

A

Acute-dilated vessel with soft echos
Indeterminate-not as dilated; soft echos
Chronic-not dilated, bright echos

47
Q

Signs of thrombus

A

Non compressible
Lack of color
No flow
Collaterals seen

48
Q

Occluded vein Doppler

A

Doppler changes when vein is completely ocludded
No flow in thrombus area
Distal waves are non pulsatile and non phasic

49
Q

Pitfalls to US testing

A

Poor identification of veins
Compressing difficulties due to structures and lack of skill
Good collaterals seen may cause normal flow distal

50
Q

Mirror image

A

Artifact
True vessel is superficial
Mirror image deeper
Caused by pleura being bright enough to cause a reflection type occurrence p

51
Q

PE in upper

A

Less likely compared to LE due to no calf muscle pump

0-25% reported

52
Q

Treatment of UE DVT

A 
Rest
Heat
Elevation
External compression
Anticoagulant 
Catheter removal
Stents
53
Q

Totally occluded UE vein

A

Will have swelling distal to that section

54
Q

Patient with bilateral arm and neck swelling and prominent superficial chest veins likely has

A

Superior vena cava syndrome

55
Q

Pager-schrotters syndrome AKA

A

Effort thrombosis

56
Q

Which superficial vein joins the axillary to become subclavian

A

Cephalic vein

57
Q

Best position for venous duplex to detect DVT in central veins

A

Supine

58
Q

Best position for sonographer to examine central veins

A

At patients head

59
Q

Ways normal venous signal in proximal deep veins is different than in LE

A

Pulsatile
Phasic
Less reaction to augments due to low volume

60
Q

Paired veins

A

Brachial
Radial
Ulnar

61
Q

Venous flow is typically

A

Towards the heart

62
Q

What is seen after a line is removed from central veins often resembling the line itself

A

Fibrin sheath

63
Q

Common PICC location

A

Basilic

64
Q

PICC stands for

A

Peripherally inserted central catheter

65
Q

Common IV locations

A

Basilic and cephalic

66
Q

Maneuver to obtain respiratory variation in central vein

A

Sniff test

Or small cough

67
Q

True or false

DVT in UE treated differently than LE

A

False

68
Q

Young patient complains of acute swelling and pain in right arm.
What’s a good question to ask

A

Any recent heavy lifting

Strenuous activities using a that arm

69
Q

Most common cause of superior vena cava syndrome

A

Malignancy

70
Q

Size veins to be marked

A

Great her than 2mm

71
Q

Vein mapping purpose

A

Assess supervisor vins for length, diameter, condition

Used prior to ablation of varicose veins

72
Q

Superficial veins used for

A

Bypass grafts
Dialysis fistula
CABG coronary art bypass graft

73
Q

Preferred veins for grafts?

A

Natural veins, last longer. But could become aneurysmal due to now having arterial pressure

74
Q

Which veins are mapped

A

Gsv **
Ssv
Cephalic or basilic (last resort)

75
Q

GSV location

A

Starts by inside ankle bone (medial malleolus)

Travels the whole length of leg into groin area

76
Q

Patient position for vein mapping

A

Exaggerated reverse trendelunburg

77
Q

Vein mapping requires

A

Very delicate touch. Superficial veins are easy to collapse

78
Q

Vein mapping technique

A 
Follow connections to deep system
Scan entire vein
Measure diameter, find suitable sized vein
Mark vessels over 2mm
Find the best vessel, no stenosis
79
Q

Location of GSV on screen

A

Within fascia near top of screen

Vessel outside fascia could be a branch

80
Q

Mapping locations

A 
Gsv:
Groin
P thigh
M thigh
D thigh
Knee
P calf
M calf
D calf
Ankle
81
Q

Small saphenous vein

A

Located between lateral malleolus and Achilles’ tendon. Runs up the back of calf to pop.
Looks like an eye on screen

82
Q

Giacomini vein

A

When SSV continues above popliteal

83
Q

Mapping SSV

A 
Above knee for giacomini
Knee
P calf
M calf
D calf
Ankle
84
Q

Condition of veins during mapping that are bad use of graft options

A

Varicose veins
Stenosis
Thrombosed
Sclerosed

85
Q

Graft options

A

Natural vein
Synthetic or man made materials-gortex, Dacron
Radial artery for coronary graft

86
Q

Why would synthetic grafts be used

A

When patient has had multiple grafts done and no longer has any other viable sections

87
Q

Anterior jugular vein is enlarged with flow moving from right to left neck is due to

A

Right brachiocephalic vein is thromobosed

88
Q

PPG reflux exam purpose

A

Evaluate venous valve incompetence

Deep vs superficial venous incompetence

89
Q

PPG reflux exam technique/setup

A 
Patient on edge of bed
Feet dangling
PPG places on inner gaiter area 
Baseline
Compress calf with both hands 5 Times
90
Q

Normal results for PPG reflux test

A

Calf squeeze will show decrease in wave
Slow and steady rise back to baseline, over 20sec
Shows that venous system is allowing enough time for leg to fill back up

91
Q

Abnormal PPG reflux results

A

Recovery time under 20 secs
No venous emptying during calf squeeze
Indicates deep and or superficial vein incompetence

92
Q

Tourniquet test

A

Abnormal PPG reflux test will result in Tourniquet test.
Used to occlude the GSV at thigh so only deep veins will be tested
Repeat PPG reflux test.
Still abnormal then move tourniquet to calf and repeat

93
Q

Chronic venous insufficiency causes

A 
Primary varicose vein. No underlying disease
Secondary varicose veins. Post thrombus
DVT
Valve incompetence 
Venous claudication
94
Q

Symptoms of CVI

A

Ambulatory venous hypertension
Hyperpigmentation
Lipodermatosclerosis
Ulceration

95
Q

Duplex exam for CVI

A

Deep venous system
Saphenous vein
Varicose vein
Perforators

Venous Final (1 decks)

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