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Adv. Vas. Son.
Test 1 Venous imaging of upper extremities
| Question | Answer |
|---|---|
| What is the 1st difference between lower and upper extremity scans? | Thrombi in LE often caused by stasis; not so in UE (no soleal sinuses) |
| What is the 2nd difference between lower and upper extremity scans? | Superficial veins affected more in arms than in legs, also superficial thrombosis may have greater clinical significance in arm |
| What is the 3rd difference between lower and upper extremity scans? | Venous anatomy of upper extremity is more variable than lower extremity |
| What are venous symptoms? | Pain & swelling in arm/neck (may be unilateral), SOB, CP, PE, local erythema, palpable cord, dilated super veins of arm/shoulder, facial swell or dilated chest vessel collatorals, catheter infusion, pre-op ass. for hemodialysis access placement |
| What is Virchow's triad? | Hypercoagulabiltiy, venous stasis, vessel wall injury |
| Intimal injury is a common reason for upper DVT, what can cause intimal injuries? | Indwelling venous catheter, pacer wire, and stents |
| How can stasis cause DVT? | Thoracic outlet compression, or effect induced compression, or compression by mass |
| What are other reasons for DVT? | Radiation induced fibrosis, venipuncture, and IV drug abuse |
| What 2 TDs are recommended for Upper extremity scans? | Mid range (5-10 MHz) linear array- used for IJV, Brachiocephalic, Subclavian, Axillary, Basillic, and Brachial High Freq (10-18 MHz)- used for more superficial veins (cephalic) & small forearm veins (radial & ulnar) |
| Can a curved or sector array be useful in Upper extremity scans? | Yes can be useful for deeper vessels near clavicle and sternum |
| What are the DEEP veins? | Radial/Ulnar(usually 2), Brachial (sometimes 2), Axillary, Subclavian, Internal jugular, Innominate(brachiocephalic), and SVC |
| What are the SUPERFICIAL veins? | Cephalic, Basilic, Median cubital(connection between the cephalic and basilic) |
| What are the CENTRAL veins? | External jugular, Anterior jugular, Jugular arch vein, Inferior thyroid, and Internal mammary |
| What is commonly seen in the jugular vein? | Reverberation artficat and Rouleax (slow flow) |
| What is it important that a comparison be made with the contralateral subclavian vein? | Because the subclavian waveform assessment is cirtical and required by the IAC |
| When scanning the subclavian what happens to the vessel if you get the PT to take a quick breath in through pursed lips- like sucking through a straw? | The subclavian will collapse |
| How should the flow be in the distal subclavian and Prox axillary veins? | Phasic and pulsatile |
| What are facts about the forearm veins? Radial/Ulnar(deep) & Cephalic/Brachial(superficial) | Often only done if PT is symptomatic, Pre-op assessment for hemodialysis access placement(scan only super), Pre-op for vein harvest for arterial bypass (determine patency and size) |
| What side is the Radial on? | Thumb side |
| What side is the Ulnar on? | Pinky side |
| What are NORMAL upper extremity veins interpretation? | Veins central to ax veins have pulsatility, phasicity, & central flow direction. Complete color fill in. No clot seen, walls smooth w/anechoic lumen. Vein diameter will change slightly w/resp. Sub vein flows are symm w/other vein. Vs ↓ axilla compress |
| What are ABNORMAL upper extremity veins interpretation? | See a clot. Presense of echogenic material. Absence of spontaneous flow or pulsatility in Prox Vs. Lack of coapt of any V ↓ axilla, Abscene of color flow |
| What is an important ABNORMAL interpretation of upper extremity veins? | Persistent retrograde flow in IJV or EJV suggest obstruction in innominate vein. |
| Describe an ACUTE thrombus. | Poorly attached, Dilated vessel, and Spongy texture |
| Describe a CHRONIC thrombus. | Brightly echogenic, well attached, and contracted vessel |
| What is the criteria for venous thrombosis in upper extremities? summary | Visualization of thrombus, Lack of vein collapse, No flow: color and spectral, and Abnormal flow patterns and flow direction in central veins |
| What are the treatments for clots? | Anticoagulation, Catherter removal, Thrombolytic therapy, Surgical intervention, and Conservative treatment |
| Where are Venous Catheters usually encountered? | Indwelling venous catheters are commonly encountered in the arm |
| What do catheters appear as? | Appear as bright, straight, parallel echoes within the vessel lumen. |
| What may develop around the catheters? | A thrombus, appears as echogenic material around the catheter surface, Spectral Doppler signals will be diminished &/or continuous |
| What must happen to the Catheter is it becomes thrombosed? | It must be removed |
| What does PICC mean? | Peripherally inserted central catheter- must also be evaluated for thrombus |
| Upper Extremity venous thrombosis occurs in _____ of PTs with indwelling catheters? | 15-30% |
| What is Paget-Schroetter syndrome? | Spontanous thrombosis of subclavian-axillary vein |
| What is also known as "Effort Induced" thrombosis? | Paget-Schroetter syndrome, it is repeated extrinsic compression of the sunclavian and axillary veins and can lead to thrombosis of these vessels |
| Who are the typical patients of Paget-Schroetter syndrome? | Young, athletic, muscular males |
| What is Superior Vena Cava syndrome? | Occlusion or compression of SVC, Venous inflow may be compromised w/ thrombosis or extrinsic compression in the SVC. -Identify abnormal venous flow bilaterally, ↑ed venous pressure, Edema of neck, face & arms, usually bilateral due to venous congestion |
Created by:
EmilyGriffin
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