Mid Thigh

- So, it's actually quite easy to do
an ultrasound examination in the E.D.
to determine if a patient has deep vein thrombosis,
and this is a well established practice of ultrasound.
We're gonna do a modified version of that
for the E.D. exam though.
To set up for this examination you want to tilt
the gurney, so that you're in a reverse trandelenburg.
So this encourages venous extension in the leg,
so it's easier to visualize the veins with ultrasound.
We're going to use a linear transducer for this examination,
and the views that we do for this exam
will just be in a transverse orientation only.
So when you're setting up for this examination
make sure the orientation marker again is to the right.
For this examination technique we're gonna use
a compression technique where we just
slightly compress the vein with some downward motion.
When you set up the exam on the system,
just select the exam key,
then from your menu select the venous exam type,
and hit select.
When you do this you're optimizing the system,
so it's automatically configured
for your best resolution of the veins.
We're gonna use a little bit of ultrasound gel,
and we're gonna assess two areas.
The femoral area and the popliteal area.
I'm gonna start with the femoral area.
We're going to place the ultrasound transducer
at the inguinal crease...
in a transverse view.
When I do this, immediately below the transducer and the
ultrasound image I'm going to see two anechoic structures.
The one that's gonna be more
medial is the common femoral vein.
The one that's more lateral is the common femoral artery.
The way I can landmark this is by looking for
the junction with the saphenous vein,
or the long saphenous vein.
And we see this emptying into the
anterior aspect of the common femoral vein.
And in this image we actually see the
venous valves separating
the long saphenous and common femoral veins.
So at this point what I do, is I just
use my compression technique.
So I just push with the transducer down until I see
both walls of the vein coapt or touch and meet each other.
If I get a complete coapt like this
I know there's nothing between those two walls,
so there's no venous thrombosis in the vein.
So again, just compress down until
you see those two walls meet completely.
You'll see that the artery does not compress,
and is pulsatile beside the vein.
Now that you've identified your landmarks,
you wanna do a thorough evaluation of that area.
So again placing the transducer at the inguinal crease,
we're going to compress the area of the common femoral vein.
We wanna move a few centimeters proximal to this,
so superiorly on the body,
and we'll start a compression technique.
Making sure that those walls collapse completely,
and we just work through this area
compressing every centimeter.
We see our common femoral vein and saphen junction here,
and we can continue compressing
just a few centimeters below this.
On the ultrasound we've seen the division to
superficial femoral artery and profunda artery.
Just lateral to the vein,
and then we should see the vein divide to
femoral vein and profunda vein.
Again, compressing all the way down,
until you see this junction.
From here I'm going to move down to the popliteal region.
Just move the system down towards the knee,
and we're going to actually go behind the knee.
Putting the transducer into the popliteal fossa.
Once you've identified the popliteal artery and vein,
mid-popliteal fossa level,
you wanna evaluate above and below this area
to make sure you evaluate all those areas
for deep vein thrombosis.
So we're going to start mid-level,
and just work our way superiorly in the leg.
To the superior aspect of the popliteal fossa.
Compressing all the way.
We go up a few centimeters,
and then we start to move down the leg
compressing into the inferior aspect of the popliteal fossa.
Again making sure that those vein walls
actually touch and meet each other,
so we know that there's no deep vein thrombosis
that's fresh which would be h-ai-p-oe-c-u-g.
Could be difficult to see if we did not
do this compression technique.
Those are the two steps for assessing the leg
for deep vein thrombosis.
It's just these two evaluation points.
But just make sure that you evaluate each area thoroughly,
and you do your compression technique completely.

Brightcove ID

5508114175001

https://youtube.com/watch?v=FHerMNhCR54

How To Perform A Saphenous Nerve Block

Read more about How To Perform A Saphenous Nerve Block

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Dr. David Auyong reviews scanning techniques and sonographic landmarks for an ultrasound guided nerve block.

Clinical Specialties

Anesthesiology (Regional)

Media Library Type

How To Videos

Subtitles

- The saphenous nerve block is useful for
medial knee surgery, medial leg surgery,
and medial ankle and foot surgery.
The saphenous nerve is a continuation
of the femoral nerve below the knee.
This is a good block to do in conjunction
with a popliteal sciatic nerve block to give you
complete anesthesia below the knee.
To perform the saphenous nerve block,
we typically use a linear probe.
The linear probe allows us to get
good resolution and reasonable penetration.
Typical settings for the saphenous nerve block
start between four and six centimeters total depth,
expecting the nerve to be between two and four centimeters.
Now the saphenous nerve is a small nerve,
and we may not see it in everybody.
In fact, most people we don't see it in.
The reason we do a saphenous nerve block
is that we don't take away any quadriceps muscles,
and so the patient will have no quadriceps muscle weakness.
To get a saphenous nerve, you may also do a femoral block,
but by doing a femoral block, you may
or you will take out all your quadriceps.
So this technique I'm going over is a great technique
for outpatient surgery, because their
quadriceps muscle strength will be intact.
This technique I'm using is useful in elderly
and obese patients because we're using muscle landmarks
rather than nerve or other small landmarks.
So we usually start about 10 centimeters above the knee.
Put the probe on the medial side of the leg.
We can abduct the leg a little bit
to give us better visualization here.
Now when we put the probe on here,
we like to start more anterior.
This gives us a view of the femur,
the hyperechoic stripe here, as well as the vastus medialis.
The vastus medialis can pretty much be found in everybody.
We're going to slide the probe posterior next.
The next muscle we'll come across is the sartorius muscle.
Now we see the vastus medialis muscle ending
and see the sartorius muscle in view now.
There are many anatomical differences in patient to patient.
The saphenous nerve can run anterior
to the sartorius muscle, posterior to the
sartorius muscle, and I've even seen it
piercing the sartorius muscle.
So the whole key is, is that we will put
our local anesthetic below the sartorius muscle
in order to get a good saphenous nerve block.
Most of the time we're doing a field type block
where we deposit the local behind the sartorius muscle,
and expect that that local will get to the nerve,
because these nerves can be difficult
to see in obese or elderly patients.
So now, our needle approach is
gonna be using a 10 centimeter needle.
This needle will be inserted a few centimeters
away from the probe in this angle.
We like to see the needle in a shallow plane
and then advance it deeper below the sartorius muscle.
This block can also be performed if the patient is prone,
imagine my needle coming from the other side.
Typical volumes used here are between
five and 20 milliliters of local anesthetic; if a good
nerve is seen, usually represented by a hyperechoic
structure, then I'll just place five milliliters.
Most patients, we do not see the individual
nerve here, and we will place 10 milliliters
as a type of field block in this area.
Here, our needle is advancing through the vastus medialis.
We try to position the tip of the needle
underneath the sartorius muscle,
which is located to the right of the screen.
You can see the hyperechoic areas,
some of which may represent the nerve.
Our needle is now directly below the sartorius muscle,
and you can see the local anesthetic
spreading below the sartorius muscle
to track to the saphenous nerve.

Brightcove ID

5508114742001

https://youtube.com/watch?v=E1tmS9Lv1bU

Body

Dr. David Auyong reviews scanning techniques and sonographic landmarks for an ultrasound guided nerve block.

3D How To: Deep Vein Thrombosis Exam

Read more about 3D How To: Deep Vein Thrombosis Exam

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3D animation demonstrating a Deep Vein Thrombosis ultrasound exam

Media Library Type

How To Videos

Media Library Tag

Lower Extremity

Deep Venous Thrombosis

Three-Point Compression

Patency

Mid Thigh

Superficial Femoral Vein

Common Femoral Vein

Subtitles

- [Voiceover] A linear array transducer
with a venus exam type is used to perform
a lower extremity, deep vein thrombosis ultrasound exam.
At least three evaluation sites are necessary.
Common femoral vein, at the saphenofemoral junction,
confluence of the proximal deep femoral vein,
and the superficial femoral vein,
and the popliteal vein.
The patient is in a supine position
with the leg in slight external rotation and flexion.
Place the transducer in a transverse position
with the orientation marker to the patient's right side,
at the level of the inguinal ligament.
The three structures of the femoral triangle are visualized.
The common femoral artery, common femoral vein,
and greater saphenous vein.
The common femoral artery is round and pulsatile,
and the common femoral vein is thin-walled,
oval in shape and collapsible with compression.
The greater saphenous vein confluence
is observed at the anterior aspect
of the common femoral vein.
With the transducer perpendicular to the skin,
apply gentle downward compression
until the vein collapses
and the anterior and posterior walls completely touch.
Slide the transducer distally to the level
of the confluence of
the superficial femoral and proximal deep femoral veins.
Repeat the compression technique,
demonstrating complete collapse of the veins.
Move the transducer to the popliteal fossa.
From this approach, the popliteal vein
will appear anterior to the popliteal artery.
Repeat the compression technique.

Brightcove ID

5508123491001

https://youtube.com/watch?v=khD3dnxEt2o

3D How To: Saphenous Nerve Block

Read more about 3D How To: Saphenous Nerve Block

/sites/default/files/Saphenous_edu00504_thumbnail.jpg

3D animation demonstrating an ultrasound guided saphenous nerve block.

Clinical Specialties

Anesthesiology (Regional)

Media Library Type

How To Videos

Media Library Tag

Subtitles

- [Voiceover] A linear array transducer
with a nerve exam type is used to perform
an ultrasound-guided saphenous nerve block.
The target depth is approximately
one to three centimeters in an 80 kilogram adult.
The patient is positioned in a supine position
with the leg slightly abducted and externally rotated.
The transducer is placed in the middle of the thigh
in a transverse plane, with the orientation marker
directed to the patient's right.
The leg is scanned medially to laterally
to identify the superficial femoral artery,
which lies underneath the sartorius muscle.
The saphenous nerve can lie either
anterior or posterior to the artery.
The saphenous nerve may not be visible.
If it is, it will appear as a bright,
hyperechoic oval or triangular structure.
The needle is positioned one to two centimeters lateral
to the transducer, and advanced under the transducer.
Local anesthetic is injected incrementally,
superficial and deep to the artery
to complete the saphenous nerve block.

Brightcove ID

5508114714001

https://youtube.com/watch?v=54VG2GhJ3w4

Body

3D animation demonstrating an ultrasound guided saphenous nerve block.

Case: DVT Ultrasound Part 2

Read more about Case: DVT Ultrasound Part 2

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Deep-Vein Thrombosis and Ultrasound: Case Study

Media Library Type

Media Library Tag

Deep Venous Thrombosis

Superficial Femoral Vein

Three-Point Compression

Thrombosis

Thrombus

Vein

Subtitles

- Hello, my name is Phil Perera,
and I'm the Emergency Ultrasound Co-Director
at the L.A. County U.S.C. Medical Center
in Los Angeles, California.
And welcome to SoundBytes.
Welcome back to SoundBytes Ultrasound
and part two of the bedside DVT ultrasound evaluation.
Hopefully you've had a chance
to complete part one of the module prior,
looking at the normal anatomy of the leg veins
and normal compression examination looking for a DVT.
In this module part two,
we'll specifically examine positive DVT examinations
using the focused exam to look at the femoral
and popliteal veins.
A DVT will be identified by a failure
of venous compression using the high frequency probe.
We'll wrap up the module by looking at some DVT mimics
and alternative findings that you may encounter
on bedside ultrasound examination of the leg.
To reemphasize the positive findings
on lower extremity DVT ultrasound,
a thrombosed vein will not completely compress
with pressure down by the high frequency probe.
We may be able to observe echogenic material
within the vessel lumen consistent with a clot,
but that has to do with the age of a clot.
Fresh clot may be more echogenic or bright in nature,
whereas older clot may be more organized and darker
or hypoechoic on bedside ultrasound examination.
This video clip was taken from a patient
who presented to the emergency department
with a painful and swollen leg.
We're using doppler flow
to first identify the target femoral artery and vein.
We can see here the doppler pulsations
within the femoral artery noted lateral
or towards the left of the image.
We see here the femoral vein towards the right
or towards the medial aspect of the image
and note the lack of doppler flow.
Looking within the vessel, we can see swirls of thrombus
within the femoral vein consistent with clot.
And we note also the saphenous vein
on top of the femoral vein is also thrombosed.
We note here that there's no doppler pulsations
within the femoral vein as the result of blockage
due to the clot.
Now that we've identified the target femoral artery
and vein using doppler flow,
we can switch over to grayscale or B-mode sonography.
Here we're looking at the femoral artery
as it bifurcates into the profundus
and superficialis arteries.
And we note here towards the medial aspect of the artery,
or towards the right, the femoral vein.
Again, looking within the femoral vein,
we see swirls of echogenic clot consistent
with fresh thrombus.
And we note again that the saphenous vein
off the top of the femoral vein appears clotted as well.
So our next move would be to apply compression down
onto the vessels to look for compressibility of the vein.
Here we note we're compressing down
with a high frequency linear array type probe,
and we can see indentation of the femoral arteries
towards the left.
But note here the failure of compression of the femoral vein
due to the presence of thrombus within the lumen.
And we can see the thrombus moving around
as we press down with the probe.
Again, a positive DVT exam based on the fact
of failure of compression of the femoral vein.
Now let's look at another video clip showing a positive DVT
in a patient presenting to the emergency department
with a painful and swollen leg.
We're using doppler flow again
to target the femoral vessels,
and we see the pulsations of the femoral artery
lateral to the femoral vein.
We note here the absence of flow within the femoral vein,
suspicious for a DVT,
but our next move would be to apply compression
down with a probe.
Here we're compressing
with a high frequency linear type array probe
directly onto the femoral vein,
and we note the failure of compression of the vessel.
We can also see a rocking movement of the thrombus
within the lumen of the vessel.
Notice that it rocks back and forth
as we apply pressure down with the probe.
Again, a positive finding for a DVT of the femoral vein.
This video clip was taken from a post-surgical patient
with a painful, swollen leg.
We're applying compression down
to the common femoral vessels,
and we notice right away a positive finding
within the femoral vein.
We see here echogenic swirls of clot
and notice the failure of compression
of the vein with probe pressure.
Here we also see the saphenous vein
towards the anterior part of the image
above the femoral vein, also with clot formation.
And we notice that the saphenous vein fails
to compress down with probe pressure.
Now let's move down the leg and look specifically
at the popliteal vein.
Here are two video clips,
towards the left, the B-mode or grayscale sonography image,
and towards the right, a color-flow doppler.
We identified the popliteal vein
as seen towards the top of the image,
effectively posterior to the popliteal artery.
And we can identify the color-flow flashes,
the pulsations of the popliteal artery,
as seen deep to the image here.
Notice the echogenic swirls of clot
within the popliteal vein,
and to the left here we're compressing down
and we note the popliteal vein fails
to compress secondary to the DVT.
This video clip was taken from a patient
who presented with a painful, swollen calf.
We identified the popliteal vein
as seen to the top of the image,
or posterior in relation to the popliteal artery,
which is seen here anteriorly,
or towards the bottom of the image.
Now, we're pressing down with the probe,
applying pressure to the popliteal vein,
and we notice a positive finding.
The popliteal vein fails to compress
with direct probe pressure.
Now, what's interesting as in contrast to other clips
in this module, we don't really identify the swirls
of echogenic clot within this popliteal vein,
thus this was an older clot
that has been more organized with time,
thus giving a darker appearance more hypoechoic in nature.
Now let's turn to a discussion of some potential pitfalls
within DVT ultrasonography.
In the femoral region, lymph nodes may appear
as a thrombosed vein with a failure to compress
on bedside sonography.
Therefore, it's very important to adequately determine
the location of the femoral artery and vein
and compare that to the location of the lymph node.
The lymph node will be a single structure,
unlike the paired femoral vessels.
Also, the lymph node will usually be seen more superficial
to the vascular structures of the femoral artery and vein.
Here's an example of a femoral lymph node.
Notice that it has the appearance
of what could be construed as a DVT.
We see the node,
and it looks like it has echogenic material within it,
but this is the normal ultrasound finding of a lymph node.
Notice that it's a single structure
and not related to the common femoral artery
as a DVT would be within the common femoral vein.
Here we changed the magnification or the depth
of the ultrasound image to better investigate the lymph node
in its relation to the femoral vessels.
Note the single node, the femoral node seen superficial
to the femoral vessels as seen deep within the image.
Note that the node is single,
in contrast to the paired femoral vessels seen deeper.
As we progress down the leg,
we can encounter another potential pitfall
within the realm of DVT ultrasound,
and that is the alternative finding of a Baker's cyst.
A Baker's cyst can be encountered just behind the knee
within the popliteal region.
This cyst can result from an outpouching
of synovial fluid from the knee joint,
usually in patients with advanced arthritis.
Unfortunately, the Baker's cyst can rupture,
spreading inflammatory joint fluid down the leg,
and can present very similarly to a DVT.
This video clip demonstrates the typical appearance
of an unruptured Baker's cyst.
This Baker's cyst was found in the popliteal region
of a patient who was referred to the emergency department
for a swelling behind the knee.
Here we see the typical appearance of a cyst
that is that of a dark or anechoic fluid collection
on bedside sonography.
In this video clip we're going to change the depth
of the ultrasound image to better interrogate
the Baker's cyst in its relation
to the popliteal artery and vein.
Here we see the single superficial Baker's cyst
to the right in its relation to the popliteal artery
and vein seen deeper on the image and to the left.
And note that they have very different appearances,
that the Baker's cyst is a single structure
in contrast to the paired popliteal vessels.
In this video clip we see a large ruptured Baker's cyst
tracking down the calf
and closely approximating a DVT on clinical examination.
We see a short axis view to the left.
And I'm gonna start with the probe high
within the popliteal fossa right here.
I'm gonna move the probe down the calf,
and we can see that the fluid collection spreads
all the way down the calf.
In the long axis view to the right,
I'm gonna start by showing the superior axis to the left
and inferior to the right.
And we can see the fluid collection
of the ruptured Baker's cyst tracking from superior
all the way inferiorly down the calf.
So thanks for tuning in for this SoundBytes module
going over bedside DVT examination part two.
Now you've learned the focused bedside
DVT ultrasound examination
and can quickly evaluate both the femoral
and popliteal veins for clot.
This can be a very helpful examination
in working up those patients with a swollen and painful leg,
allowing for initiation of timely and appropriate therapy.
This bedside DVT examination can also be used
to look for DVT in cases of suspected pulmonary embolus.
So I hope to see you back in the future
as SoundBytes continues.

Brightcove ID

5508109927001

https://youtube.com/watch?v=Jg0TwINcZqE

Case: DVT Ultrasound Part 1

Read more about Case: DVT Ultrasound Part 1

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Case Study on Deep Vein Thrombosis.

Media Library Type

Case Study Videos

Media Library Tag

Lower Extremity

Deep Venous Thrombosis

Three-Point Compression

Patency

Mid Thigh

Superficial Femoral Vein

Common Femoral Vein

Soundbytes Cases

Subtitles

hello my name is Phil Pereira and an emergency ultrasound code
at the LAN
the USC Medical Center in Los Angeles California and welcome to sound bites
welcome back to sound bites ultrasound in this module will learn the focused
ultrasound evaluation of the like four deep venous thrombosis
now divided this module up in two parts one and two
in this module entitled dvt ultrasound part 1
well first of all learn the normal anatomy of the leg veins integral to
performance of the dbt ultrasound examination will then move on to learn
the normal compression exam of the leg veins and how to interpret normal
findings on the bedside dbt examination specifically in this module we're going
to concentrate on the focus dbt examination the focused or limited dbt
exam allows for increased speed in the performance of the examination will
concentrate on to specific areas of the leg
looking at the femoral region and the popliteal region
this limited examination also maintains excellent sensitivity in the detection
of proximal DB tease and in fact most radiology perform dvt examinations
screen only down to the popliteal vessels the cafe an exam is not
routinely performed as part of most radiology perform dvt examinations and
indeed in the focus dvt examinations will skip the examination of the cap
themes that leads us into the concept of the focus dbt exam as being an optimal
means for evaluation for dvt at the bedside and the focus dvt exam will
begin by examining the femoral vein starting high at the level of the
proximal common femoral artery and vein just below the inguinal ligament will
continue the exam of the femoral vein down about four to five sauna meters
through to bifurcation of the vein into the deep and superficial femoral veins
well then turn to examination of the popliteal vein placing the probe hi
within the popliteal fossa will examine the popliteal vein about for sauna
meters within the popliteal fossa continuing the exam of the popliteal
vein down to trifurcation of the vessel into the cap gains
let's now review the lower extremity Venus anatomy integral to performance of
the focus dvt examining
action we begin by identifying the common femoral vein seen here just below
the England ligament notice that the common femoral vein is seen just medial
to the common femoral artery
now the common femoral vein continues down the leg to bifurcate into the deep
and superficial femoral veins
we note here the deep femoral vein coursing to the back of the leg and we
know the adjacent deep femoral artery
we also see here the saphenous vein which joins into the common femoral vein
above the level of bifurcation
now it's important to realize that the superficial femoral vein is the thing
that actually continues down the leg to become the popliteal vein behind the
knee and we note the superficial femoral vein coursing down the leg and
accompanied by the parrot superficial femoral artery behind the knee that
superficial femoral vein will become the popliteal vein and we see the adjacent
popliteal artery
now at the level of traffic ation the popliteal vein will become three
different campaigns and we note here the anterior tibial vain
that's going to course anteriorly on to the CAF the posterior tibial vain seen
post dearly in the CAF and also the perineal vain seem to the lateral aspect
of the cab and it's because these campaigns are so small that it's
difficult to see them on bedside ultrasound ography let's now watch a
video and learn how to perform the ultrasound examination looking for dvt
within the femoral vein system
we begin by placing the high-frequency linear array type probe
it's the same probe that you'll be using for vascular access and a side-to-side
orientation over the common femoral vein and artery just below the inguinal
ligament notice that we're compressing down with the probe and essentially the
dbt exam is a compression exam as a normal vein will completely closed with
pressure down with the probe notice that were sequentially compressing at
different levels along the common femoral vein compressing from the
beginning at the top just below the in Qin ligament all the way down through
bifurcation into the superficial and deep femoral vessels
now a clot will not completely compress with pressure down with the probe and
thus will be identified on bedside examination notice here
its standard to have the marker on the probe going lateral so that we know
where we are with regard to the orientation of the probe versus the
screen
it's best to position our patients slightly up right to distend the femoral
vessels for the DVT exam and as shown in this video we actually had the patient
with a head of the bed up about 30 degrees
we also want to have the legs slightly externally rotated to best orient so
that we can place the probe directly over the common femoral artery and bein
here we see the ultrasound findings that will occur when placing the probe as
shown in the illustration towards the left a note here the probe is placed
with the marker . laterally just inferior to the England ligament over
the common femoral artery and vein as shown in the pictorial towards the right
notice here that the common femoral vein will be seen medial to the common
femoral artery and because we have the marker . oriented laterally or towards
the left of the image the common femoral vein will be seen to the right here
here's a video showing the actual ultrasound findings of the common
femoral artery and vein using color flow Doppler we are in two selves to the
image to the left here showing that the common femoral vein will be seen
medial to the common femoral artery and we know the ultrasound findings to the
right showing pulsatile flow within the common femoral artery
located just lateral to the common femoral vein and we see the basic hum of
the blood flow within the common femoral vein seen medial to the artery here
well it's very nice to have color flow Doppler to differentiate the common
femoral artery from the common femoral vein we can also discern the to using
grayscale or b-mode sonography as shown in the video clip here to the right here
we note the common femoral artery to the left or lateral to the common femoral
vein as shown medially notice that the common femoral artery has more
hypertrophic walls and also pulsatile flow within it
differentiating it from the common femoral vein as seen medially continuing
down the leg as shown in the prone position in the illustration to the left
here we see the following ultrasound findings in the illustration to the
right
we know that the femoral arteries bifurcate at level above the comment
from
vain and here we see these superficial and deep femoral arteries in a location
just lateral to the common femoral vein
we also see a very important landmark the saphenous vein joining in to the
common femoral vein at this level it's very important to visualize the south in
this vein as it's really the only superficial vein in the body that we
worry about clot formation within as it goes directly into the common femoral
vein and can propagate up into the IVC and into the heart
here we see a video clip using color flow Doppler demonstrating the
bifurcation of the femoral artery into the superficial and deep family arteries
and here we see that bifurcation point right there
notice that the femoral arteries are located laterally or towards the left of
the common femoral vein which we see located neatly or towards the right of
the image in this video clip will note the bifurcation of the common femoral
artery into superficial and Profundis femoral arteries using grayscale or
b-mode sonography we know the common femoral vein is shown towards the medial
aspect of the image or towards the right and here again we see that bifurcation
point of the common femoral artery into the superficial and profundus femoral
arteries is labeled there and we just remember that . that the artery
generally bifurcates at a level higher than the femoral vein in this video clip
we're able to get a good look at the saphenous vein joining in to the common
femoral vein and we see the common femoral vein located medial to the
common femoral artery
note that the saphenous vein has the look often of a little hat on top of the
common femoral vein and we note here also the turbulent flow of blood here
within the common femoral vein as this was taken in the hypotensive patient
now let's turn our attention to the anatomy of the popliteal fossa
we note here the popliteal vein and the popliteal artery
remember that the popliteal vein is going to be in an orientation
located more posterior to the popliteal artery which will be located more
anterior
here's how to perform the focus dvt ultrasound exam looking into the
popliteal fossa
it's best to have the patient sitting up to further to stand the popliteal vein
and I like to have the patient sitting up with the leg dangling over the bed
I can then pull up a chair and move anterior to the page
agent will place the high-frequency linear array probe
hi within the popliteal fossa sequentially compressing it levels down
all the way down to trifurcation notice that we're using our other hand to
stabilize the anterior knee as we press with the probe post dearly
so again we'll start high within that Papa teal fossa compressing sequentially
all the way through the levels of the popliteal artery and vein down inferior
they're all the way down to trifurcation here's the anatomy with that will see
with the probe placed as shown in the illustration to the left
notice that the probe is placed into the posterior aspect of the knee behind the
popliteal fossa
again with the marker . oriented laterally thus will see the following
images as shown in the illustration to the right note that the popliteal vein
will be located closer to the probe or posterior to the popliteal artery which
will be further away from the probe or more anteriorly located as shown in this
image in this image will use color flow Doppler to further differentiate the
popliteal artery from the popliteal vein and in the video clip here to the right
we can see the pulsatile flow of blood within the popliteal artery has seen and
ear or further away from the probe then the popliteal vein which has seen more
posterior than the artery here
notice that we see a little bit of phasic flow of blood within the
popliteal vein
this video clip employees be mode or grayscale sonography to show the
popliteal vein and popliteal artery
again we can see the popliteal artery located more anterior than the popliteal
vein and we can see the pulsatile movements of the popliteal artery
differentiating it from the vein and in fact we can see a little bit of
turbulent flow of blood within the popliteal vein here and located more
posterior Lee than the popliteal artery
when performing the focus lower extremity dvt ultrasound examination we
want to first identify the femoral and popliteal arteries and veins using be
mode or grayscale sonography now colorflow doppler ultrasound can be
helpful in differentiating the artery from the vessel and also making sure
that you're looking at vascular structures but is not essential most of
our information will actually come from b-mode sonography want to apply
compression to the vein pressing down with the probe
in the short axis or transverse orientation in a normal examination the
walls of the vein will completely touch together
conversely if a dbt is present the walls of the vein will not completely touch
together as a thrombus within the lumen of the vein will prevent the walls from
completely collapsing
here we see normal compression of the common femoral vein and we see here the
common femoral vein to the right of the common femoral artery which we see to
the left
no we're looking in the short axis or transverse orientation pressing down
with the probe and note with pressure down on the probe that the common
femoral vein completely collapses and that the walls the anterior wall and
posterior wall of the vessel meet
we also see compression of the saphenous main that little cap on the top of the
common femoral vein so a completely normal exam of the common femoral vein
at the level just below the England ligament here we're looking a little bit
more distally at the common femoral vein at the level of the bifurcation of the
common femoral artery into superficial and profundus femoral arteries and we
note here complete compression of the vein as we push down with the probe and
note again that the anterior and posterior wall is completely meet
together
now let's move down the leg to look at the normal compression exam of the
popliteal vein recall that the popliteal vein is going to be seen towards the
posterior aspect of the image or closer to the top of the image here then the
popliteal artery as we press down we know complete compression of the
popliteal vein and we see here that the artery still stays open
so again this would be a normal compression exam of the popliteal vein
with the anterior and posterior walls of the vessel completely touching down with
pro pressure
in conclusion thank you for joining me for the sound bites module going over
bedside dvt examination part 1
hopefully now you understand the focus dbt exam which allows for increased
speed with excellent accuracy in the exam performance in this module part 1
we focused on the basic anatomy and the normal examination for the DVT
evaluation for a normal examination we hope that the femoral and popliteal
veins will completely compress down with pro pressure
unfortunately a venous thrombosis will prevent
vane from closing and so we're turn in part to going over the positive
examination and those findings that you might encounter on the focus bedside dbt
examination
so I hope to see in the future as sound bites continues

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