Upper Extremity Venous Protocol

Structure Scan Plane Label-Identify RT & Images Stored
LT Appropriately
Transverse IJV Gray Scale- without compression
Internal Dual Screen W/COMP Gray Scale-with compression
Jugular Vein Sagittal IJV Color Doppler
IJV Color & Spectral Doppler
Innominate Sagittal INNOM V Gray Scale
with Internal INNOM V Color Doppler
Jugular and INNOM V Color & Spectral Doppler
Subclavian
Confluence
Sagittal SUBCL V CENTRAL Gray Scale
Subclavian
SUBCL V CENTRAL Color Doppler
Vein Central
SUBCL V CENTRAL Color & Spectral Doppler
Subclavian Sagittal SUBCL V MID Gray Scale
Vein SUBCL V MID Color Doppler
Mid SUBCL V MID Color & Spectral Doppler
Subclavian Sagittal SUBCL V PERIPH Gray Scale
Vein SUBCL V PERIPH Color Doppler
Peripheral SUBCL V PERIPH Color & Spectral Doppler
Transverse AXIL V Gray Scale- without compression
Dual Screen W/COMP Gray Scale-with compression
Axillary Vein Sagittal AXIL V Color Doppler
AXIL V Color & Spectral Doppler with
augmentation
Transverse BRACH V Gray Scale- without compression
Dual Screen W/COMP Gray Scale-with compression
Brachial
Sagittal BRACH V Color Doppler
Veins
BRACH V Color & Spectral Doppler with
augmentation
Transverse BASIL V Gray Scale- without compression
Dual Screen W/COMP Gray Scale-with compression
Basilic Vein Sagittal BASIL V Color Doppler
BASIL V Color & Spectral Doppler with
augmentation
Transverse CEPH V Gray Scale- without compression
Dual Screen W/COMP Gray Scale-with compression
Cephalic Vein Sagittal CEPH V Color Doppler
CEPH V Color & Spectral Doppler with
augmentation
Transverse RAD V Gray Scale- without compression
Dual Screen W/COMP Gray Scale-with compression
Radial Veins Sagittal RAD V Color Doppler
RAD V Color & Spectral Doppler with
augmentation
Transverse ULN V Gray Scale- without compression
Dual Screen W/COMP Gray Scale-with compression
Ulnar Veins Sagittal ULN V Color Doppler
ULN V Color & Spectral Doppler
w/augmentation
Scan through and verify patent venous system before augmenting

Anatomical/Image Correlation

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Upper Extremity Venous Protocol

Artery Vein Vein with
Artery Vein with Doppler
Compressi
Tips on
 Patient set-up - very important for ease of completing the examination (for the
sonographer and patient) – multiple positions used throughout exam
 Have the patient turn their neck slightly away from the side being evaluated
when evaluating the IJV.
 When scanning the right arm, allow enough room on the side of patient closest
to you for the patient to rest their arm on the bed.
 When scanning the left arm, position the patient as close to you as safely
possible.
 If patient is unable to raise arm for axillary images, ask for assistance.
 When referring to the venous system, the term central means closer to the heart,
and the term peripheral means farther from the heart
 Deep veins always accompany an artery
 Only compress veins in the transverse view (unable to compress innominate or
subclavian veins)
 Presence of a venous catheter should be noted on sagittal gray scale and color
images to evaluate for thrombus formation

Color and Spectral Doppler
 Veins should fill completely with color – angle or square box, or use power Doppler
if needed
 No angle correct is needed
 Gate should be placed in center of vessel
 Respiratory phasicity and cardiac pulsatility should be seen in the internal jugular,
innominate, and subclavian veins
 If proximal (more central) obstruction is suspected, evaluate the contralateral
subclavian vein for symmetry of spectral waveforms
 Spectral waveforms in the other UE veins should be phasic and augment with distal
compression

Thrombus Present
 Do not augment distal to the location of the thrombus
 Document thrombus with color & spectral Doppler
 Document exact location of thrombus
 Determine if thrombus is occlusive or non-occlusive

Duplicated Veins
 The brachial, radial, and ulnar veins are normally duplicated, or paired
 Always document both in transverse, and one or both with color Doppler
 If thrombus is evident in one or both veins complete documentation is required
 If no evidence of thrombus document only one with spectral Doppler

Labs
 D-dimer – if increased may indicate thrombus formation

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