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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 11:39:17 -0400
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text/plain
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Here's an UPPER EXTREMITY DVT protocol.

PHILOSOPHY. Shorten exposure. CLOT and STOP

SCAN TIL FIND ACUTE CLOT AND STOP. REALLY STOP!!!! 
START CENTRALLY. If you normally do not scan innominate, forget the protocol part that says scan innominate. Start at subclavian and don't go centrally

UPPER EXTREMITY VENOUS PROTOCOL FOR COVID POSITIVE 

(Generally unilateral, if bilateral symptoms start with side with line or most symptomatic side first. Do second side if 1st side is normal) 

Central subclavian vein: gray scale, color and spectral Doppler 
If acute DVT and see end of clot and normal  spectral Doppler: STOP 
If acute DVT and no end of clot: scan innominate with  gray scale and color Doppler 
If blunted waveform without DVT:  scan innominate with gray scale and color Doppler 

If normal: scan Peripheral/mid Subclavian 
Peripheral subclavian vein gray scale without and with compression. Sweep color medial-lateral for mid and peripheral subclavian vein 
If acute DVT: STOP 

If normal: scan axillary vein 
Axillary vein: gray scale without and with compression and color Doppler 
If acute DVT: STOP 

If normal:  
No peripheral line: STOP 

Peripheral line: continue scan to arm 
If peripheral line and central veins normal scan peripheral veins starting with vein with line 
If acute DVT or superficial thrombosis: STOP 
If no arm thrombus scan all three upper arm veins.  
If particular swelling in the hand and negative otherwise, scan forearm. 

No jugular vein unless facial swelling 
Long axis color toward head and towards confluence of other central veins. 

DOCUMENTATION 
Central subclavian: long axis gray scale, color and spectral Doppler 
(If necessary) Innominate long axis gray scale and color Doppler 
Mid subclavian: long axis color only 
Peripheral subclavian: short axis without and with compression, long axis color Doppler 
Axillary: short axis without and with compression, long axis color Doppler 
(If necessary) Peripheral veins short axis without and with compression.  
If normal one set of without and with compression images for cephalic, basilic, brachial  
If thrombus, consider long axis of thrombus 

(If necessary) Internal jugular long axis color 
Color angled centrally and  
Color angled toward head 
If thrombus, consider gray scale long axis and/or without and with compression 


 


 


 

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