Peripheral Venous Imaging (SPS130)

10 credits

Aim of this module

This module provides trainees with the knowledge that underpins this third year specialist module in Vascular Science. It will provide trainees with the knowledge, understanding and practical skills to safely contribute to the diagnosis of acute lower limb deep venous thrombosis and superficial thrombophlebitis.

1. Triage request for investigation of a patient with suspected DVT and prepare the room and equipment.
2. Prepare the patient and take a clinical history.
3. Perform scans on patients with suspected DVT.
4. Interpret, explain and report results.

Number Work-based learning outcome Title Knowledge
1 1

Triage request for investigation of a patient with suspected DVT.

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2 1

Set up equipment and room ready for a DVT investigation.

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3 2

Control infection risks associated with DVT investigations in accordance with departmental protocols.

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4 2

Minimise risks and hazards during the DVT investigation in compliance with health and safety policies.

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5 2

Explain the procedure to the patient, address any procedure related questions they may have and provide information on how the patient will be informed of the results.

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6 2

Obtain clinical history from the patient pertinent to a DVT investigation.

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7 3

Gain informed consent for the DVT investigation.

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8 3

Perform an ultrasound scan using B Mode to identify normal venous anatomy in the leg (above and below knee).

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9 3

Perform an ultrasound scan using colour Doppler and spectral Doppler to demonstrate the haemodynamics of normal leg veins (above and below knee).

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10 3

Perform an ultrasound scan to identify an above- knee DVT.

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11 3

Perform an ultrasound scan to identify a calf DVT.

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12 3

Perform an ultrasound scan to identify an incidental finding, e.g. Baker’s cyst, superficial thrombophlebitis.

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13 4

Produce an interpretive report of investigations.

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14 4

Recognise the pitfalls and limitations of the investigation.

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15 4

Ensure results are given in a timely manner with appropriate action for urgent findings.

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You must complete
2 Case-based discussion(s)
2 of the following DOPS / OCEs
Assessment Title Type
Perfom and analyse an above knee DVT scan groin to popliteal DOPS
Perform and analyse a below knee DVT scan calf vessels DOPS
Perform and analyse a proximal DVT scan Iliac veins vena cava DOPS
Perform and analyse a superficial venous scan to assess for thrombophlebitis DOPS
Perform and interpret a complete diagnostic scan on a new patient with suspected DVT. DOPS
Perform and interpret a complete diagnostic scan on a patient with previous history of DVT. DOPS
Perform and interpret a complete diagnostic scan on a follow up patient to assess for clot propagagtion of either superficial thromboplebitis or DVT. DOPS
Perform and interpret a complete diagnostic scan on a morbidly obese patient. DOPS
Perform and interpret a complete diagnostic scan on an immobile patient in a wheelchair DOPS
Perform and interpret a complete diagnostic scan on an immobile patient on a trolley bed DOPS
Introduce yourself to the patient and confirm their identity OCE
Explain the DVT scan procedure and purpose to the patient OCE
Obtain patient consent for the DVT scan OCE
Obtain the relavant clinic history and symptoms pertinent to the DVT scan. OCE
Prepare and position a mobile patient for the DVT scan OCE
Prepare and position a patient with mobility difficulties for the DVT scan OCE
Communicate with the patient during the scan to explain the practical aspects of the procedure e.g. compression OCE
Explain exhalation inhalation or valsalva technique to DVT patient. OCE
Explain the DVT scan findings to the patient OCE
Explain what happens with the DVT scan results OCE

Important information

The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.

Learning Outcomes

  1. Recognise and identify normal and atypical peripheral venous anatomy and pathology.
  2. Explain the normal haemodynamics and physiology of the peripheral venous system and evaluate the numerous effects of pathology on blood flow.
  3. Discuss and justify the clinical use of ultrasound in the diagnosis of acute peripheral venous disease, the linkages with other imaging techniques and the clinical importance in selecting the appropriate technique for the best management of the patient.
  4. Discuss and justify the diversity and urgency of presenting signs and symptoms, and critically evaluate expected underlying haemodynamics and pathology.
  5. Describe the expected co-morbidity associated with venous disease and evaluate the health and safety risks during the investigation and how they are managed.
  6. Explain the infection risks associated with venous ultrasound and patients with suspected deep venous thrombosis.
  7. Describe the principles of the deep venous thrombosis pathway and appraise the impact and consequences this has on diagnostic vascular services.
  8. Interpret acute peripheral venous ultrasound images, associated spectral data and measurements
  9. Critically evaluate the need to evaluate the age of thrombus and proximal extent.
  10. Critically evaluate the need to convey complex scientific information to inform multidisciplinary teams of the diagnostic results, conclusions and consequences, in clear reports, in a clinically appropriate time frame.

 

Indicative Content

Overview of peripheral venous disease

  • Anatomy of deep lower limb veins
    • Anterior tibial veins
    • Posterior tibial veins
    • Peroneal veins
    • Gastrocnemius veins
    • Soleal sinuses
    • Popliteal vein
    • Femoral vein
    • Common femoral vein
    • Profunda vein
    • External iliac vein
    • Internal iliac vein
    • Common iliac vein
    • Inferior vena cava
  • Anatomy of the superficial lower limb veins
    • Sapheno-femoral junction
    • Long saphenous vein (and branches)
    • Sapheno-popliteal junction
    • Short saphenous vein
    • Giacomini vein
  • Anatomy of the perforating and communicating veins
    • Cockett’s perforators
    • Boyd’s perforators
    • Dodd’s perforator
    • Gastrocnemius perforator
  • Presence and position of valves and valvular sinuses
  • Morphologic variations of the vein anatomy
  • Pathology
    • Acute deep vein thrombosis
    • Superficial thrombophlebitis
    • Chronic venous incompetence
    • Varicose veins, reticular veins
    • AV malformations
  • Haemodynamics and normal physiology
    • Function of valves
    • Function of the calf pump
    • Effects of respiration on venous flow
    • Effect of pathology on flow
  • Presenting signs and symptoms of peripheral venous disease
    • Acute DVT
    • Superficial thrombophlebitis
    • Varicose veins
    • Chronic venous insufficiency
  • Associated co-morbidity and risk factors
  • Imaging techniques
    • Ultrasound, venography, MRV
    • Correlation with histology
    • Natural history studies
    • Prospective studies
  • Treatment
    • Medical management
    • Surgical management
  • NICE guidelines

Ultrasound investigation of acute lower limb deep venous thrombosis and superficial thrombophlebitis

  • Historical perspectives and criteria developments
  • Peripheral venous examination technique
    • Risk assessment and infection control
    • Patient preparation
    • Explanation of test
    • History taking
    • Patient positioning
    • Scanning procedure and protocol
      • Infra-inguinal veins
      • Supra-inguinal veins
    • Interpretation and determination of disease severity
      • B-mode imaging interpretation of thrombosis
        • Luminal diameter and echogenicity
        • Compressibility
  • Doppler imaging and spectral interpretation
    • Spontaneity of flow
    • Phasicity of flow
    • Augmentation
    • Pulsatility
  • Accuracy of duplex scanning in the detection of acute venous disease
  • Limitations, equivocal data, artefacts, conflicts and pitfalls
    • Suboptimal visualisation
    • Diagnosis within the pelvis
    • Bifid femoral venous systems
    • Excessive transducer pressure
    • Acute-on-chronic deep vein thrombosis
  • Other findings
    • Baker’s cyst
    • False aneursym
    • Muscle tears
    • Haematoma
    • Abscess
    • Arteriovenous fistula
    • Popliteal aneurysm