Upper Extremity Venous Protocol
- Gray scale still images not needed unless positive for thrombus or presence of PICC line.
- Vein compressions are taken with cine clips (dual-screen stills not required). Scanning Duration: 30 minutes for unilateral arm.
Right IJV Prox/Mid/Distal with compression
- (Only the right neck/arm is demonstrated on this page as an example.)
- IJV fluctuates in size with normal respiration, and may appear collapsed unless the patient holds his breath or performs Valsalva maneuver. Cine: One compression clip each at the proximal, mid, and distal segments.
Right IJV Mid w/ Compression
Right IJV Mid
- Heel-toe the probe to show sagittal IJV at an angle.
- Obtain your sagittal images at only the mid segment IJV when it is normal. Color image: One image with wall-to-wall color filling when normal.
Doppler image: Sample the center of the vessel with adjustments to angle, baseline, speed, scale, and gain.
Right IJV Mid
Right Innominate V
- Follow proximal IJV inferiorly and angle into the clavicle towards the heart. Color image: One image that is optimized due to higher velocity flow.
Doppler image: Sample the center of the vessel with adjustments to angle, baseline, speed, scale, and gain.
Right Innominate V
Right Subclavian V Prox
- Turn the probe to be transverse to the IJV/innominate vein (notch facing you), and angle again into the clavicle. You should see the sagittal subclavian vein joining the IJV. Color image: One image that is optimized due to higher velocity flow.
Doppler image: Sample the center of the vessel with adjustments to angle, baseline, speed, scale, and gain.
Right Subclavian V Prox
Right Subclavian V Mid/Dist With Compression
- Find a good window by scanning over the mid clavicle in the short axis until you see the subclavian artery and vein posterior to the bone. Identify the vein by sampling both vessels with Doppler.
- It may be difficult to compress over this area. Ask the patient to inhale quickly through his nose, which will help to compress the vein.
- Your window for compression may be superior or inferior to the clavicle. Cine: One compression clip each at subclavian vein mid and distal. (A true proximal vein compression may be attempted, but is not required.)
Right Subclavian V Mid w/ Compression
(note the shadowing clavicle)
Right Subclavian V Mid/Dist
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Color image: One image each at the mid and distal segments.
Doppler image: Sample the mid and distal segments.
Right Subclavian V Mid
(note the shadowing clavicle)
Right Axillary V With Compression
- Scan over the anterior armpit (distal continuation of the subclavian vein).
- There should be one vein and artery, except when the axillary vein is duplicated. If there are small brachial or basilic vein branches, then the probe is angled too far laterally on the arm.
- If axillary vein is too deep and visualization is limited, use a color box to show venous (blue color) filling that disappears with compression. Cine: One compression clip.
Right Axillary V w/ Compression
Right Axillary V
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Color image: One optimized image.
Doppler image: Sample the center of the vessel with adjustments to angle, baseline, speed, scale, and gain.
Right Axillary V
Right Brachial V Prox/Mid/Dist With Compression
- Scan over the medial bicep to identify the brachial vessels (paired veins with single artery).
- The median nerve runs with the brachial vessels, and is normally noncompressible. This is not to be mistaken for a DVT! Cine: One compression clip each at the proximal, mid, and distal segments.
Right Brachial and Basilic V Mid w/ Compression
Right Brachial V Prox/Mid/Dist
- Show both of the paired veins with color filling (together in one image or separately) for each of the segmental proximal, mid, and distal portions.
- To promote color filling in the vein, have the patient make a fist, or lightly jolt your probe into the patient's arm. Color: Images with optimization.
Right Brachial V Mid
Right Basilic V Prox/Mid/Dist With Compression
- The unpaired basilic vein is found medial to the brachial vessels. Cine: One compression clip each for at least two segments of basilic vein.
Right Brachial and Basilic V Mid w/ Compression
Right Basilic V Prox/Mid/Dist
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Color image: One image each for at least two segments of basilic vein.
Right Basilic V Mid
Right Cephalic V Prox/Mid/Dist With Compression
- The unpaired cephalic vein is found from the anterior deltoid to lateral antecubital fossa.
- You should look very superficially for the cephalic vein, more so than any other vein. If needed, you can switch to a higher frequency linear transducer (use the "thyroid probe").
- Apply almost no pressure to the skin, otherwise the vein may already be completely compressed as you are scanning. Cine: One compression clip each for at least two segments of cephalic vein.
Right Cephalic V Mid w/ Compression
(note loss of skin contact due to very light pressure)
Right Cephalic V Prox/Mid/Dist
- To promote color filling in the vein, lightly jolt your probe into the patient's arm. Color image: One image each for at least two segments of cephalic vein.
Right Cephalic V Mid
Left Subclavian Vein Mid
- If the exam is for unilateral arm, obtain color and Doppler of the contralateral subclavian vein. Color image: One optimized image.
Doppler image: Sample the center of the vessel with adjustments to angle, baseline, speed, scale, and gain.