POCUS - Lower Extremity Deep Venous Thrombosis (DVT) - Updated
TLDRIn this educational video, Jared Marx, a point-of-care ultrasound expert, guides viewers through performing a lower extremity DVT ultrasound. He emphasizes the importance of compression to assess deep vein structures and the use of a high-frequency linear probe. Marx provides a step-by-step approach, from identifying the saphenous junction to visualizing the popliteal trifurcation, highlighting the need for proper patient positioning and probe orientation. The video aims to equip healthcare providers with the skills to diagnose or rule out DVT effectively at the bedside.
Takeaways
- 😀 The video is an educational resource on lower extremity deep vein thrombosis (DVT) ultrasound, aiming to guide providers on using point-of-care ultrasound at the bedside.
- 🔍 The primary goal of the ultrasound is to determine if deep vein structures are compressible, which is a key indicator of the presence or absence of a DVT.
- 📍 The ultrasound examination should cover areas from the common femoral vein down to the popliteal vein, including the popliteal trifurcation.
- 👨🏫 The speaker emphasizes the importance of a two-area ultrasound, including the area around the saphenous junction with the femoral vein and the popliteal vein.
- 🛏️ Patient positioning is crucial, with recommendations to lay the patient flat, bend the knee, and use a frog-leg position to facilitate the ultrasound examination.
- 🔬 A high-frequency linear probe is used for the examination, starting near the inguinal ligament and moving down the leg to the popliteal vein.
- 🧭 The saphenous vein is used as a landmark to help locate and orient the ultrasound probe along the venous system.
- 🚫 The presence of a clot is indicated by the inability to compress the vein walls, which should normally touch when pressure is applied.
- 🔄 The speaker advises using pulse wave Doppler to verify the type of vessel when anatomy is unclear or when distinguishing between artery and vein.
- 🏥 The video script is a revision of a previous video with improved graphics and videos to clarify the ultrasound procedure for DVT detection.
- 💻 The speaker encourages viewers to reach out with questions via email or comments, and to subscribe for more educational content.
Q & A
What is the main topic of the video lecture?
-The main topic of the video lecture is lower extremity deep vein thrombosis (DVT) ultrasound, focusing on how to perform this study for point-of-care use.
What is the purpose of the video revision mentioned in the script?
-The purpose of the video revision is to provide better graphics and videos to further clarify the steps and techniques for performing a lower extremity DVT ultrasound.
What are the binary questions that the ultrasound aims to answer?
-The binary questions the ultrasound aims to answer are whether the deep vein structures are compressible, meaning if the anterior wall and the posterior wall touch when pressure is applied.
Why is it important to evaluate the area around the saphenous vein junction during DVT ultrasound?
-Evaluating the area around the saphenous vein junction is important because the saphenous vein helps locate and orient oneself along the venous system, and clots in this superficial vein could potentially enter the deep system due to the presence of a valve.
What position should the patient be in for a lower extremity DVT ultrasound?
-The patient should be in a supine position with the head of the bed lowered, their back stretched out, and their legs in a frog-leg position to facilitate access to the necessary areas for ultrasound evaluation.
What type of probe is recommended for performing a lower extremity DVT ultrasound?
-A high-frequency linear probe is recommended for performing a lower extremity DVT ultrasound.
Why is it necessary to ensure the probe marker and screen indicator are directed the same way during the ultrasound?
-Ensuring the probe marker and screen indicator are directed the same way helps maintain correct orientation and prevents confusion when moving the probe, as it ensures that the movement on the screen corresponds accurately to the probe's physical movement.
What is the significance of the popliteal vein and artery orientation in the ultrasound?
-The orientation of the popliteal vein and artery is significant because it helps in identifying the correct vessels during the ultrasound. The vein is usually posterior and the artery anterior, but when scanning from the back of the leg, the vein appears on top of the screen compared to the artery.
Why is it important to visualize the popliteal trifurcation in the ultrasound?
-Visualizing the popliteal trifurcation is important to ensure that the ultrasound evaluation extends as distally as possible, checking the popliteal vein before it branches into the calf veins, which are not typically scanned in proximal leg ultrasound.
What is the role of pulse wave Doppler in the context of this ultrasound study?
-Pulse wave Doppler can be used to verify the type of vessel being evaluated, especially when there is difficulty in distinguishing between an artery and a vein during the ultrasound.
How often should compression be applied when scanning the femoral vein?
-Compression should be applied approximately every two centimeters along the femoral vein, from the groin area down to the adductor canal.
Outlines
📚 Introduction to Lower Extremity DVT Ultrasound
In this introductory paragraph, Jared Marx, the presenter, welcomes viewers to a lecture on point-of-care ultrasound focused on lower extremity deep vein thrombosis (DVT). He invites questions and comments, emphasizing the educational nature of the video. The lecture aims to teach how to perform an ultrasound study to evaluate for DVT, which is considered a fundamental skill for many healthcare providers. Marx clarifies that the video is a revision with improved graphics and visuals, and it discusses the indications for using leg ultrasound to diagnose or rule out DVT, incorporating clinical decision rules for safety and effectiveness. The binary question approach to ultrasound is introduced, focusing on the compressibility of deep vein structures as an indicator of DVT presence.
🔍 Anatomy and Technique for DVT Ultrasound
This paragraph delves into the anatomical considerations and technical aspects of performing a DVT ultrasound. The presenter discusses the importance of the saphenous vein as a landmark for orientation within the venous system. He advises on patient positioning, including a supine position with legs externally rotated to facilitate access to the veins. High-frequency linear probes are recommended for the procedure. The paragraph also covers the correct orientation of the ultrasound probe and the significance of the saphenous junction in identifying the femoral artery and vein. The presenter demonstrates the compression technique to assess vein compressibility, which is crucial for detecting potential clots.
📏 Systematic Approach to DVT Ultrasound Examination
The presenter outlines a systematic approach to examining for DVT, starting from the saphenous junction and moving distally along the common femoral vein. He emphasizes the need to compress and assess the compressibility of various branches, including the deep femoral vein and its branches. The paragraph highlights the importance of recognizing the correct anatomy to avoid misdiagnosis, such as mistaking an artery for a vein. The use of pulse wave Doppler is suggested for verifying vessel type if anatomy is unclear. The systematic compression every two centimeters along the femoral vein is recommended to ensure thorough examination.
🦵 Completing the DVT Ultrasound: Popliteal Vein and Trifurcation
The final paragraph discusses the examination of the popliteal vein and its trifurcation, which completes the proximal leg ultrasound for DVT detection. The presenter describes patient positioning for accessing the popliteal vein, including the use of a reverse Trendelenburg position to make veins more prominent. He cautions against mistaking the popliteal artery for the vein due to incorrect probe placement or failure to recognize anatomy. The importance of visualizing the popliteal trifurcation is emphasized to ensure a comprehensive examination. The paragraph concludes with a reminder that point-of-care ultrasound typically does not involve scanning the entire leg, and practices may vary by institution.
Mindmap
Keywords
💡Point-of-Care Ultrasound (POCUS)
💡Deep Vein Thrombosis (DVT)
💡Compression
💡Femoral Vein
💡Popliteal Vein
💡Saphenous Vein
💡Adductor Canal
💡Popliteal Trifurcation
💡Binary Questions
💡Clinical Decision Rules
💡Reverse Trendelenburg Position
Highlights
Introduction to lower extremity DVT ultrasound and its educational purpose for providers.
Explanation of the study's straightforward nature and its role in the provider's diagnostic toolkit.
Indications for using lower extremity ultrasound to diagnose or rule out DVT, as an alternative to CT scans.
Clarification of the binary questions used in DVT ultrasound: compressibility of deep vein structures.
Discussion on the necessity of a two-area ultrasound, including the saphenous junction with the femoral vein.
Importance of evaluating from the common femoral vein to the popliteal vein, including the popliteal trifurcation.
Anatomical orientation using the saphenous vein to locate and navigate the venous system.
Proper patient positioning for ultrasound, including supine position and leg placement for optimal access.
Use of high-frequency linear probe and its placement near the inguinal ligament for initial imaging.
Ensuring probe marker direction aligns with screen indicator for accurate imaging during movement.
Identification of the saphenous junction and its significance in DVT evaluation.
Demonstration of controlled compression technique to assess vein compressibility.
Differentiation between acute and chronic DVT findings in vein imaging.
Sequential evaluation of the common femoral vein and its compressibility.
Assessment of the deep femoral vein and its branches for potential clot presence.
Scanning technique along the femoral vein, emphasizing the importance of identifying arterial and venous structures.
Adductor canal evaluation for vein compressibility before transitioning to popliteal vein assessment.
Techniques for visualizing the popliteal vein and artery in the posterior leg position.
Importance of recognizing correct anatomy to avoid mistaking artery compression for vein status.
Final assessment of the popliteal trifurcation to ensure comprehensive evaluation of the popliteal vein.
Differentiation between proximal leg ultrasound guidelines and whole leg scanning practices.
Conclusion summarizing the educational value of the DVT ultrasound lecture and invitation for further questions.
Transcripts
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