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UVMFLOWNET  June 1997

UVMFLOWNET June 1997

Subject:

Re: venous study for dvt

From:

"Jim Baun, RVT" <[log in to unmask]>

Reply-To:

UVM Flownet <[log in to unmask]>

Date:

Wed, 25 Jun 1997 23:15:35 -0400

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (58 lines)

In a message dated 97-06-24 21:44:55 EDT, you write:

<< One of the techs here attended a seminar where the speaker stated that
 when performing a non-invasive venous study for dvt you need not bother
 with the proximal compressions for incompence >>

Terry,

I would strongly disagree with the theory that when performing a Lower
Extremity Venous Duplex examination, the examiner can be content to simply
"r/o DVT".  I know there is contention between various sonography turfs, i.e.
the Radiology based practices and the Vascular Surgery practices on what
constitutes an appropriate peripheral venous examination but, getting back to
the bottom line, we're ultimately talking about quality of patient care.  I
think it is essential, especially if we're striving to be percieved as
"professionals" in the health care industry, that we take the responsibility
for providing information to the referring physician that is pertinent to the
patient's clinical situation whether we do this individually or through our
supervising physicians. It absolutely is NOT enough to report out "No
evidence of DVT in the femoral or politeal veins.(period).  Typically these
patients are referred with complaints of pain and/or swelling in the leg,
sometimes acute, sometimes chronic, sometime hot, sometimes not.  The pain
may be intermittent, constant, calf only, whole leg, localized to the femoral
canal, etc, etc.  Obviously, if DVT in the proximal leg is diagnosed, the
patient will be admitted, put on bedrest,  and heparinzed for 5-7 days, sent
home on Coumadin and followed on a regular basis.  That's the easy one.
 However, if the patient suffers from calf vein thrombosis, saphenous
thrombosis, chronic venous insufficiency, post-phlebitic syndrome, localized
or difffuse valvular incompetence, or severe varicose veins arising from
incompetent perforators, it doesn't mean that the patient can't be treated.

Reporting out "no DVT" is a non-diagnosis.  It excludes a potentially
life-threatening condition, however, it does not answer the real question
that the referring physician wanted answered, i.e. "Why is this patient's leg
swollen and/or painful?".  With contemporary duplex systems we can ALWAYS:
 1) determine whether the etiology of the leg complaints is venous in nature
and, if it is; 2) assess the type, level and severity of the venous problem.
 (OK, it may be impossible in the 300+ pounders.)  In so doing, we are
providing the care giver with information he/she needs to manage the patient
appropriately.  The Vascular Surgeons I practice with roll their eyes and
shake their heads when a patient comes into our office with a report from the
Radiology Department across the street.  They simply "r/o DVT".  Then I get
to repeat the study, at full expense to the patient or carrier (some will not
reimburse twice for the same study within a given time period)  so my docs
can intitiate appropriate treatment.  Many times they can make the diagnosis
without the duplex.

I guess an historic corolarry would be "directed" abdominal sonograms.  I
remember the days when we only looked at gallbladders and bile ducts in
patients with suspected cholelithiasis.  Enough successful malpractice suits
changed that.  We have the tools to do a lot more than exclude a single,
acute condition that might kill a patient with leg complaints.  Obviously, if
a diagnosis of acute DVT is made, then it is usually unecessary to go any
further with the study.  However only reporting on the status the of deep
veins groin to politeal is a woefully inadequate use of our capabilities.

Jim Baun RDMS, RVT

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