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Upper Extremity Venous Protocol

Structure Scan Plane Label-Identify RT & Images Stored


LT Appropriately
Transverse IJV Gray Scale- without compression
Internal Dual Screen W/COMP Gray Scale-with compression
Jugular Vein Sagittal IJV Color Doppler
IJV Color & Spectral Doppler
Innominate Sagittal INNOM V Gray Scale
with Internal INNOM V Color Doppler
Jugular and INNOM V Color & Spectral Doppler
Subclavian
Confluence
Sagittal SUBCL V CENTRAL Gray Scale
Subclavian
SUBCL V CENTRAL Color Doppler
Vein Central
SUBCL V CENTRAL Color & Spectral Doppler
Subclavian Sagittal SUBCL V MID Gray Scale
Vein SUBCL V MID Color Doppler
Mid SUBCL V MID Color & Spectral Doppler
Subclavian Sagittal SUBCL V PERIPH Gray Scale
Vein SUBCL V PERIPH Color Doppler
Peripheral SUBCL V PERIPH Color & Spectral Doppler
Transverse AXIL V Gray Scale- without compression
Dual Screen W/COMP Gray Scale-with compression
Axillary Vein Sagittal AXIL V Color Doppler
AXIL V Color & Spectral Doppler with
augmentation
Transverse BRACH V Gray Scale- without compression
Dual Screen W/COMP Gray Scale-with compression
Brachial
Sagittal BRACH V Color Doppler
Veins
BRACH V Color & Spectral Doppler with
augmentation
Transverse BASIL V Gray Scale- without compression
Dual Screen W/COMP Gray Scale-with compression
Basilic Vein Sagittal BASIL V Color Doppler
BASIL V Color & Spectral Doppler with
augmentation
Transverse CEPH V Gray Scale- without compression
Dual Screen W/COMP Gray Scale-with compression
Cephalic Vein Sagittal CEPH V Color Doppler
CEPH V Color & Spectral Doppler with
augmentation
Transverse RAD V Gray Scale- without compression
Dual Screen W/COMP Gray Scale-with compression
Radial Veins Sagittal RAD V Color Doppler
RAD V Color & Spectral Doppler with
augmentation
Transverse ULN V Gray Scale- without compression
Dual Screen W/COMP Gray Scale-with compression
Ulnar Veins Sagittal ULN V Color Doppler
ULN V Color & Spectral Doppler
w/augmentation
Scan through and verify patent venous system before augmenting

Anatomical/Image Correlation

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Upper Extremity Venous Protocol

Artery Vein Vein with


Artery Vein with Doppler
Compressi
Tips on
Patient set-up - very important for ease of completing the examination (for the
sonographer and patient) multiple positions used throughout exam
Have the patient turn their neck slightly away from the side being evaluated
when evaluating the IJV.
When scanning the right arm, allow enough room on the side of patient closest
to you for the patient to rest their arm on the bed.
When scanning the left arm, position the patient as close to you as safely
possible.
If patient is unable to raise arm for axillary images, ask for assistance.
When referring to the venous system, the term central means closer to the heart,
and the term peripheral means farther from the heart
Deep veins always accompany an artery
Only compress veins in the transverse view (unable to compress innominate or
subclavian veins)
Presence of a venous catheter should be noted on sagittal gray scale and color
images to evaluate for thrombus formation

Color and Spectral Doppler


Veins should fill completely with color angle or square box, or use power Doppler
if needed
No angle correct is needed
Gate should be placed in center of vessel
Respiratory phasicity and cardiac pulsatility should be seen in the internal jugular,
innominate, and subclavian veins
If proximal (more central) obstruction is suspected, evaluate the contralateral
subclavian vein for symmetry of spectral waveforms
Spectral waveforms in the other UE veins should be phasic and augment with distal
compression

Thrombus Present
Do not augment distal to the location of the thrombus
Document thrombus with color & spectral Doppler
Document exact location of thrombus
Determine if thrombus is occlusive or non-occlusive

Duplicated Veins
The brachial, radial, and ulnar veins are normally duplicated, or paired
Always document both in transverse, and one or both with color Doppler
If thrombus is evident in one or both veins complete documentation is required
If no evidence of thrombus document only one with spectral Doppler

Labs
D-dimer if increased may indicate thrombus formation

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