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Introduction ⬇

Peripheral venous Doppler studies examine venous blood flow in the selected extremity (upper or lower). It is most commonly used to assess for deep venous thrombosis (DVT) and can also be used to map veins to be harvested and used for grafts. Peripheral venous ultrasound is also used to locate veins for venous access and to assess dialysis access grafts. This examination has replaced contrast venography in many institutions.

Procedure ⬆ ⬇

  1. Ask the patient to lie on the examining table with the leg or arm turned out slightly and the knee or elbow partially bent.

  2. Apply a couplant (ultrasound gel) to the leg from the groin down or to the arm from the shoulder area down to enhance imaging.

  3. Move a handheld transducer gently up and down the limb while images of appropriate blood vessels are made. At intervals, apply gentle compression to the vessel. Examine both sides.

  4. Tell the patient that the examination time is about 30 minutes.

  5. See Chapter 1 guidelines for intratest care.

Clinical Implications ⬆ ⬇

Abnormal images and Doppler signals may provide evidence of the following:

  1. Acute or chronic DVT

  2. Occlusive venous disease

  3. Valvular incompetence

  4. Clotted grafts

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain the test purpose, benefits, and procedure. Instruct the patient to refrain from smoking for at least 2 hours before the study. Assure the patient that no radiation is employed, typically no contrast medium is injected, and no pain is involved; however, slight discomfort may be experienced from lying with the extremity extended or when compression is applied.

  2. Advise the patient that a liberal coating of couplant (ultrasound gel) must be applied to the skin to promote sound transmission. A sensation of warmth or wetness may be felt during application.

  3. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Remind the patient to remove any residual gel from the skin.

  2. Review test results; report and record findings. Modify the nursing care plan as needed.

  3. Provide support and counsel appropriately should an abnormality be detected. Monitor and counsel for venous disease and need for possible further testing and treatment.

  4. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Interfering Factors ⬆ ⬇

  1. Severe obesity compromises examination quality.

  2. Cardiac arrhythmias and disease may cause changes in hemodynamic patterns.

Reference Values ⬆

Normal