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April 2020

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Subject:
From:
Larry Needleman <[log in to unmask]>
Reply To:
UVM Flownet <[log in to unmask]>
Date:
Sat, 25 Apr 2020 11:30:01 -0400
Content-Type:
text/plain
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text/plain (57 lines)
Passed by Jefferson COVID Thrombosis Group
Guidance 6 : Deep Vein Thrombosis Assessment 

•Asymptomatic Patient: Lower Extremity Screening Ultrasound is not recommended​
•Venous US for Symptomatic patients with objective signs such as leg swelling, tenderness, increased warmth, increased circumference > 2 cm

•Sonographer or vascular technologist or physician should confirm symptoms with clinical team/clinical notes before going to patient bedside.​

•PPE and cleaning as defined by protocol​
•Protocol for minimize contact with patient.​
•No calf imaging (unless calf symptoms that referring wishes to evaluate). ​
•Unilateral scan unless both legs symptomatic. ​
•Scan most affected leg first​

IMPORTANT
•Stop when acute DVT and proximal extent is confirmed​


1.CFV to popliteal vein (start at inguinal ligament, end at tibioperoneal trunk where PTV and peroneal veins come together). ​
2.No calf except for rare symptomatic calf that requires imaging (not swollen leg/calf only) - confirm with referring physician.​
3.Scan entire vein compressing every 1-2 cm down leg. ​
•CFV without and with compression​
•Femoral without and with compression ​
•Popliteal without and with compression​
4.CFV spectral Doppler from long axis picture​
5.Document gray scale without and with compression: CFV, proximal FV, mid FV, distal FV, popliteal vein. Document CFV spectral Doppler.​


1.Once acute DVT is found:  stop scanning distally (keep scanning if indeterminate or chronic scar).​
•If top (end) of clot is seen, STOP​
•If top of clot is not seen, such as in some CFV acute DVT, document external iliac vein​
•With curved array, take additional  additional gray scale and color Doppler images of external iliac vein above inguinal ligament and abdominal side wall​
2.If CFV waveform is absolutely flat, no undulations or phasic variation, document external iliac vein​
•With curved array, take additional  additional gray scale and color Doppler images and spectral Doppler image  of external iliac vein above inguinal ligament and abdominal side wall​
3.Add color if visualization of vein difficult only​
4.Popliteal spectral Doppler for selected patients only​
•Add popliteal spectral Doppler if visualization limited (more than 3 cm of a vein is not visualized). ​
•Add popliteal Doppler if CFV spectral Doppler is not performed (e.g. overlying bandage or lines)​
 
 
QUICK GUIDE
1.No DVT + phasic CFV waveform: evaluate CFV, femoral vein, popliteal vein: stop​
2.No DVT + flat CFV waveform: evaluate EIV​
3.Acute DVT + upper end seen: stop​
4.Acute CFV + upper end not seen: evaluate EIV​
5.Scarring or equivocal: continue scan​
6.Technical Issues​
•Use color Doppler to improve visualization, help evaluate equivocal images​
•Get popliteal waveform if no CFV waveform​
•Get popliteal waveform if significant (more than 3 cm portions of vein) not visualized​

  
 

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