Clinical Application Note - Venous Investigation of the Lower Limb Using Doppler 603351-2.pdf
ADVANCED POCKET DOPPLERS
CLINICAL APPLICATION NOTES
NOTE 2 Venous Investigation Of The Lower Limb Using Doppler
HOW TO USE THIS APPLICATION NOTE
PATIENT SYMPTOMS Verify that your patient’s symptoms
correspond to one or more of those listed in Figure 1.
LOCATING VEINS Figure 4 suggests probe position for
locating a vein.
DOPPLEX® EQUIPMENT REQUIRED Select the most
appropriate Dopplex® Pocket unit to perform the examination.
For suggestion of suitable Dopplex® equipment, refer to Figure 2.
EXAMINATION RESULTS Taking careful note of
yourDopplex® display and venous waveforms (if applicable),
refer to Figure 5 overleaf and compare your examination
results with those shown.
PROCEDURE If you have the Dopplex® Printa II Package or
Dopplex® Reporter Software Package (and a computer),
connect your Dopplex® bi-directional Doppler and
begin your examination, refer to Figure 3.
NOTES Refer to Figure 6 overleaf for general notes relating
to this form of examination for venous disease.
VENOUS OEDEMA ● POST-THROMBOTIC
DOPPLEX EQUIPMENT REQUIRED
Mult, Maxi or Rheo Dopplex® unit, 5MHz probe, (deep and
superficial veins) or 8MHz probe (superficial veins),
Dopplex® Printa II Package or Reporter Software Package.
With patient standing encourage relaxation by holding
frame or bar, and ensure pulse rate is stable.
Connect Printa II Package to your bi-directional Doppler.
Ensure ambient temperature is comfortable and apply gel.
Hold probe between forefinger and thumb at 45o angle,
Commence examination at superficial femoral vein in
the upper thigh and identify flow by applying distal calf
Check display for directional flow, and record waveform.
Proceed to the popliteal vein and follow the same
procedure as for the superficial femoral vein.
The long saphenous and short saphenous veins can
then be examined.
The sapheno-femoral and sapheno-popliteal junctions
are identified by placing the probe over the groin and
popliteal fossa respectively and augmenting flow by
tapping the appropriate vein distally.
Diagnostic Products Division
NORMAL SUPERFICIAL FEMORAL VEIN
Manual compression of the calf distal to the site of examination increases
or ‘augments’ venous blood flow.
With the Doppler probe pointing towards the heart, arrows on the
Dopplex® display will indicate antegrade flow (away from the probe). No
retrograde flow (towards the probe) will be present.
This response also confirms the substantial patency of the venous
system between the site of examination and the site of manual
compression (calf augmentation).
DEEP VENOUS INCOMPETENCE
Valvular reflux on distal calf compression will result in an augmented
signal in an antegrade direction, immediately followed by retrograde
Arrows on the Dopplex® display will indicate flow away from the probe,
closely followed by flow towards the probe.
Occlusion of the superficial femoral vein will result in a Doppler signal
being obtained either spontaneously or during calf compression.
The flow pattern of a complete proximal occlusion (i.e., external iliac or
common femoral vein) will depend on the residual compliance of the
veins between the probe and the obstruction. However, this will usually
result in a reduction in strength and duration of the signal. The flow
pattern of a distal obstruction during calf compression will depend on
the collateralisation. It should be noted that this will usually result in a
reduction and delay of the augmented signal.
Long and short saphenous and popliteal veins.
Results similar to those obtained with the superficial femoral vein will be
observed upon examination of the long saphenous, short saphenous
and popliteal veins.
Gross superficial incompetence may interfere with insonation of deep veins. This can be minimised by placing a superficial venous
tourniquet proximal to the probe.
A Trendelenburg can be performed to confirm long saphenous incompetence. A superficial venous tourniquet is placed on the thigh with
the leg elevated. The probe is then placed over a previously marked calf varicosity. On standing the patient and release of the tourniquet,
a retrograde flow signal will be present if the sapheno-femoral junction is incompetent.
This note is intended as a guide only. The above Dopplex® displays are an indication only. The number of arrows actually displayed will
vary according to the Dopplex® unit gain setting and probe position. If in doubt contact your local vascular studies unit. If you have any
questions regarding the products contact the address below.
References: 1: Bergan J.J. and Yao J.S.T. Surgery of the Veins. Grune and Stratton, Orlando, 1984. 2: Browse N.L., Brunard K.G.
and Lea Thomas M. Diseases of the Veins. Edward Arnold, London, 1988. 3: Folse R. and Alexander R.H. Directional Flow Detection in
Localising Venous Valvular Incompetence. Surgery 1970; 67:114.
Our thanks go to Mr Ian Lane, Medical Director, University Hospital of Wales, Cardiff, UK.
and Dr. Mo Aslam, Dept of Surgery. Hammersmith Hospital, London, UK
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NOTE 1 • Arterial Investigation Of The
NOTE 2 • Venous Investigation Of The
Lower Limb Using Doppler
NOTE 3 • Venous Investigation Of The
Lower Limb Using PPG
NOTE 4 • Screening For The Absence Of
An Acute DVT Using PPG
NOTE 5 • Using A Hand Held Doppler To
Assist With PICC Placement
Huntleigh Healthcare Limited
Diagnostic Products Division
35 Portmanmoor Road, Cardiff, CF24 5HN United Kingdom.
Tel: +44 (0)29 20485885 Fax: +44 (0)29 20492520
E-mail: email@example.com Web: www.huntleigh-diagnostics.com
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Vascular Assist with Doppler,
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