Just a note to add to Ann Marie’s “spot on” positioning recommendation……when evaluating the central veins (IJV, BCV, SCV), have the patient lie supine, or as supine as possible for just that segment of the exam to fill those veins .
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From: Denise Levy
Sent: Thursday, February 4, 2021 1:34 AM
To: [log in to unmask]
Subject: Re: Upper extremity vein mapping
Ann Marie,
I added your reference to my "source in protocols" ! You are the best !! And as a source! my very best.
Kupinski, AM. Ultrasound Evaluation and Mapping of the Superficial Venous System. In: The Vascular System, Philadelphia: Lippincott Williams & Wilkins, 2013. p 243-258
On Wed, Feb 3, 2021 at 7:57 PM Ann Marie Kupinski <[log in to unmask]> wrote:
Hi Denise,
I do almost all of my arm mappings with the patient sitting upright. I place the arm I am scanning on a pillow on their lap. This usually works well. Some patients might not be able to sit up and I have to do those supine. I rarely use a tourniquet but I do make sure the patient is warm. I uncover only one arm at a time.
Ann Marie
On Wed, Feb 3, 2021 at 10:08 PM Denise Levy <[log in to unmask]> wrote:
Hi, Typical me.. I find what I am looking for while waiting for a response. The answer is in the SVU guideline..
PATIENT POSITIONING • Positioning is supine, in sitting position or reverse Trendelenburg to promote vein dilatation, with the arm relaxed and extended out to the side. For patient comfort, it is helpful to support the arm on a bedside table/pillow. • The room should be warm and limbs covered until ready to be imaged to reduce vasoconstriction. link below.
Whatever position makes the vein the largest with that particular patient. I prefer the patient supine and warm. I also scan backwards for the left arm rotating the bed and the patients love the ride.
Still would love to hear from everyone who would like to chime in. Gotta keep those flownet people communicating.
Thank you in advance and my best, Denise
On Wed, Feb 3, 2021 at 6:34 PM Denise Levy <[log in to unmask]> wrote:
Hello all,
Please weigh in on patient positioning for upper extremity vein mapping for creation of fistula besides the use of a pressure cuff no higher than 60 mm/hg.
Two thoughts, I have done both and prefer supine, recumbent. Just to clarify in my protocols. Thank you all, Denise
Vole
1. supine with a pillow
2. sitting position.
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