The Venous Protocols

How do veins collapse?

the vessel walls collapse with light or moderate pressure by transducer on skin

Phasic low velocity Doppler signals augment with?

distal limb compresssion

The CFV changes in size with?

with respiration

Technical Aspects of Venous Duplex Imaging:

• maintain patient safety

• review patient’s chart

• patient history

• explain procedure to patient

  • know proper patient positioning for various examinations

What do you do to help the blood flow to the legs?

raise the bed and angle the bed forward

-Reverse Trendelenburg

What does AIDET mean?

• acknowledge 

• introduce yourself

• duration of the exam

• explain

• thanks

While conducting the gray-scale imaging and compression maneuver portion of the venous duplex imaging examination, the transverse view is used to?

its used to locate the veins and is mandatory for an accurate examination and interpretation

What is the most important diagnostic critera?

compressing the veins, to check for blood clots

We compress the vein every ______ cm to make sure that there is no blood clots

2 cm

What veins are in the deep vein thrombosis study?

• CFV

• Saph-Fem junction

• PFV prox

• SFV prox, mid, and distal

• pop v.

• gastrocnemius v’s

• PTVs

  • Peroneal v

What two veins will be evaluated for a venous insufficiency study and for vein mapping?

GSV and SSV

What veins are in the upper venous protocol?

• subclavian v

• axillary v

• brachial v prox, mid, and distal

• radial v

• ulnar v

• cephalic v

• basilic v

What does spontaneity mean?

flow present without compression maneuver

What is phasicity?

flow that varies with respiratory activity

What two veins may or may not be spontaneous and phasic?

PTVs and Peroneal V

What does pulpability mean?

present in proximal upper extremity only

What is augmentation?

increased flow with distal augmentation or release of proximal compression (Valsalva)

What is competency?

no flow immediately after augment flow or at the beginning of proximal compression 

Characteristics of a normal venous spectral doppler signal from a lower extremity:

• spontaneous flow

• respiratory phasicity

• pulsatility

• augmentation

• competency

What is spontaneous flow?

is continuous and present without augmentation

What is respiratory phasicity?

means that the blood flow velocity changes with respiration (usually not found in calf veins)

Where is pulsatility found in veins?

only in the upper extremity veins

Why should pulsatile signals be present in the jugular, subclavian, innominate, and SVC?

because of retrograde transmission of right atrial pressure and movement artifact from cardiac contractions

What is augmentation?

blood flow velocity increases with distal limb compression or with the release of proximal limb compression (limited in the upper extremity examination)

What is competency?

flow stops after augmentation when valves close

Transverse Compressions protocol:

-must compress every 2cm

-some labs do frozen images

-other labs do CINE LOOP compressions

Protocol long axis color:

long axis

-open vein on both ends/lengthen vessel

-blue color flow from vessel wall to vessel wall

Spontaneous:

if not, perform DA

Spectral Proctocol:

-do not have to angle correct

-avoid putting the angle on the valves

-make sure the veins are blue

What are we looking when scanning venous?

-deep vein thrombosis

-superficial thrombophlebitis

-competent valves

What are the 3 components of interpretation criteria for determining presence of DVT or SVT?

1. the vein is free of echogenic material

2. the vein is fully collapsed while applying transducer pressure on the skin

3. the vein is patent and demonstrates normal venous spectral doppler signal

The lower extremity experiences what type of flow?

phasic flow

-it changes with respiration

Increase of flow is with?

expiration 

Decrease of flow is with?

inspiration

Opposite is true for the upper extremity

Decrease is with:

Increase in flow:

expiration

inspiration

Abnormal Spntaneity:

no flow without compression maneuver

Abnormal Phasicity:

no plasticity or continuous flow present

Abnormal Pulsatility:

present in lower extremity

Abnormal augmentation:

decreased augmentation 

Abnormal competency:

retrograde flow present after distal compression or on proximal compression (now termed incompetent)

Is pulsatile flow normal in the upper extremity?

yes

Pulsatile flow is abnormal in the 

lower extremity

Pulsatile flow indicates:

fluid overload

-CHF

-rapid IV infusion

-venous insufficiency

-or distal obstruction

-(DVT distal to point of interrogation)

What type of flow is abnormal in both lower and upper extremities?

continuous flow

What does continuous flow indicate?

proximal obstruction