upper extremity

what are the three factors for virchows triad

1. hypercoagulability

2. vein wall injury

3. venous stasis

what are the risk factors for DVT

over 40 yrs old

malignancy

previous DVT or PE

immobilization

fracture of the shoulder

myocardial infarction

pregnancy

symptoms of a DVT

arm swelling

pain or tenderness

venous distention

increased temp or redness

superficial venous dilation

peripheral veins return _____ blood to the heart

deoxygenated

venous system of the extremities consist of ____, ___, and ____ veins

superficial, deep, perforating

what veins provide channels between superficial and deep veins

perforating veins

venous blood goes from ___ to ____

superficial; deep

what are the valves made of

folds of intima

what are the layers of the vein from outermost to inner

adventitia, media, intima

are the valves of the vein bicuspid or tricuspid

bicuspid

where are venous valves located

near vein confluences

where are venous valves more numerous

distal leg

what do the venous valves help to maintain

unidirectional blood flow from peripheral veins to central veins

what do the venous valves help fight against

hydrostatic pressure

what veins drain the hand

superficial and deep palmar venous arches

T/F: radial veins accompany radial artery and ulnar veins accompany ulnar artery in the forearm

true

where is the typical place for the radial and ulnar veins to join

antecubital fossa

what do the radial and ulnar veins join to form

brachial veins

brachial veins are ___ veins that travel with the brachial artery in the ___ arm

paired; upper

T/F: the axillary vein is a paired vein

false; single vein

where does the axillary vein begin

where the basilic vein joins the brachial veins in the upper arm

where does the axillary vein terminate

beneath the clavicle at outer border of the first rib

what joins the axillary vein near its termination

cephalic vein

what vein is a continuation of the axillary vein

subclavian vein

the subclavian vein extends from the outer border of the ___ ___ to the inner end of the ___

1st rib; clavicle

at the inner end of the clavicle the subclavian vein joins what

internal jugular vein

what does the internal jugular vein and subclavian vein join to form

innominate vein

the subclavian vein lies beneath the clavicle and is ___ and ___ to the subclavian artery

inferior and anterior

on the right side the right innominate vein courses almost ___ downward joining the left innominate vein just below the first rib

vertically

when the right and left innominate veins join what do they become

superior vena cava

the right innominate vein lay _____ and to the ________ of the innominate artery

superficial; right

the right innominate vein receives what 3 veins

right vertebral, internal mammary, and inferior thyroid veins

which innominate vein is longer

left

what does the left innominate vein receive

left vertebral, internal mammary, inferior thyroid, left superior intercostal veins

what is the primary route of drainage in the upper extremity

superficial veins

the superficial veins lay beneath the skin and between two layers of ___ _____ and outside deep ____ fascia

superficial fascia; investing

where does the cephalic vein begin

thumb side of the dorsum of the hand

where does the cephalic vein join the axillary vein

just below the clavicle

where does the basilic vein originate

small finger side of the dorsum of the hand

is the basilic vein small or large

large

the basilic vein courses ____ along the inner side of the biceps muscle

medially

what does the basilic vein join in the upper arm

brachial

in the upper extremity pulsatile signals should be present in the___, ___, ___, and ___ because of retrograde transmission of right atrial pressure

jugular, subclavian. innominate, SVC

in the upper extremity venous doppler signal will ___ with inspiration

increase

in the upper extremity venous doppler signal will ___ with expiration

decrease

when using color flow on the veins in the arm what is the best way to do it

sag/longitudinal

what is a DVT characterized by

abnormal coagulation of red blood cells

T/F: Thrombi can be isolated to one vein or be in multiple veins

true

what is the condition in which a venous thrombus dislodges
from the vein wall, and propagates to the arteries of
the lungs, and causes a pulmonary embolism

VTE - venous thromboembolism

when is a thrombus considered chronic

being over a week old

T/F: acute DVT are only asymptomatic

false

what is phlegmasia alba dolens

swollen painful white leg

what is phlegmasia cerulea dolens

swollen painful cyanotic leg

what are common anticoagulants

heparin, warfarin, and lovenox

what do antiplatelet agents do when taking them 

prevent further clot formation by decreasing platelet aggregation

a ____ DVT is more dense and often calcified

chronic

does an acute DVT or chronic have more of a chance for propogating a PE

acute

a ___ DVT gives symptoms typically to the entire extremity

chronic

what can be caused by venous obstruction and or incompetent venous valves

venous hypertension

what can the presence of a thrombus on or around venous valves cause

damage to them, making them incompetent

_____ varicose veins are congenital, stemming
from an inherent weakness of the venous walls, and
occur without coexisting deep venous disease

primary

______ varicose veins occur secondary to
pathology (chronic DVT) of the deep venous system

secondary 

Clot formation that exists in the superficial venous
system is known as a

superficial venous thrombosis (SVT)

what is a common location for an SVT

in or around venous valves 

the presence of chronic SVT can cause ___ ___

valvular incompetence

______ flow is continuous and present without augmentation maneuvers

spontaneous

what means that the blood flow velocity changes with respiration

respiratory phasicity

______ signals should be present in the jugular,
subclavian, innominate, and SVC

pulsatile

there are approximately ______ fatal PE’s each year

300,000

upper extremity DVT is approximately __ % of all DVTs

4

what is a high risk factor for DVT is the arm

indwelling catheters

what term is used for the state of unmoving blood

stasis

venous valves fight against the effect of ____ ____

hydrostatic pressure

compressions of the arms for a DVT should be every ___ - ___ cm 

2;4

perforating veins carry blood from the ____ veins to the ____ veins 

superficial; deep

what is a medical condition in which blood clots form in the deep veins in the arm; typically subclavian caused by the 1st rib 

paget-shrotter syndrome 

what is another name for paget-shorter syndrome

venous thoracic outlet syndrome

what is paget-shorter syndrome usually seen

in younger patients after repeated strenuous activity of the shoulders and arms

what originates from the union of the subclavian vein with the internal jugular vein

innominate/ brachiocephalic vein

which innominate vein is longer

the left

the left and right innominate/brachiocephalic vein join to form the ____

SVC

this vein is located in the neck that lies lateral to the carotid artery

internal jugular vein

this vein lies in the neck posterior to the internal jugular

external jugular vein

what vein is made by the union of the axillary and cephalic vein

subclavian vein

why are the subclavian veins hard to compress

the clavicle

what is the most common place to get a venous aneurysm

subclavian vein

what is the short vein found in the axilla of the arm

axillary vein

what is the axillary vein made by

brachial and basilic

is the axillary or the subclavian vein more pulsatile

subclavian

the radial and ulnar veins form the ___ veins at the elbow

brachial

There are often two veins that run on either side of
the radial artery and anastomose freely with each
other. It forms in the hand from the deep palmar
venous arch

radial veins

They arise from the deep venous palmar arch and run
superiorly in the deep anterior compartment of the
forearm. They have a companion artery. They terminate in the cubital fossa to form the brachial veins 

ulnar veins

what system carries more blood in the arms

superficial

the superficial veins in the arm do or do not travel with a companion artery

do not 

what is the most used superficial vein for line placement

basilic

Originates on the small finger side of the dorsum of
the hand and enters brachial veins in the upper
arm

basilic vein

Originates on the thumb side of the hand and joins the
axillary vein before it enters the subclavian vein.

cephalic 

what is an arteriovenous fistula used for

dialysis

what does an arteriovenous fistula connect

an artery and vein usually in the upper extremity