Carotid Doppler: Doppler wave forms obtained from the common, external and internal carotid arteries. As well as the vertebral and subclavian

Transcription

1 Competency

2 Carotid Doppler: Doppler wave forms obtained from the common, external and internal carotid arteries. As well as the vertebral and subclavian arteries. Preferred angle is 60 degrees or less. Stenosis criteria used is the Consensus scale A common anatomic variant of the aortic arch is a common origin of the innominate and left common carotid arteries

3 Upper extremity arteries and deep veins: Radial artery, radial veins Ulnar artery, ulnar veins Brachial artery, brachial veins Axillary artery, axillary veins Subclavian artery, subclavian vein Superficial veins: Cephalic, thumb side Basilic, pinky side

4 Lower extremity arteries and deep veins: Common femoral artery, vein (S/F junction) Femoral artery, vein Deep femoral artery, vein Popliteal artery, vein (T/P trunk) Posterior tibial artery, vein Peroneal artery, vein Soleal vein (sinuses) Gastrocnemius artery, vein Superficial: Greater and lesser saphenous veins

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7 Common findings: Pulsatile venous flow while doing a venous ultrasound is likely indicative of congestive heart failure Loosely attached venous thrombosis should be noted when reporting findings Noncompressible arteries during an arterial study is most likely due to calcifications and diabetes Tortuous carotid arteries can and do elevate velocities even without plaque

8 Thoracic outlet syndrome: Caused by a narrowing of the artery most likely due to a congenital extra rib Symptoms are reproducible Complications include, aneurysm, clot formation and embolus Diagnosis is usually made by doing an arterial study with maneuvers and having the patient reproduce the symptoms by positioning their arms until they are symptomatic

9 Venous thrombosis: Acute versus chronic Acute, the vessel is dilated and has an anechoic or hypoechoic appearance and noncompressible Chronic, the vessel is usually not dilated and has bright hyperechoic appearance and can be partially compressible or compressible Recanalization of old DVT may be present, appearing as a brightly echogenic streak that moves with compression

10 Renal artery stenosis: Uncontrolled hypertension is the most common reason for doing a renal artery Doppler FMD, fibromuscular dysplasia is an incidental finding causing stenosis of the renal artery without evidence of atherosclerotic disease A string of pearls is the main characteristic of FMD FMD is most often found in young woman, it is a rare connective tissue disorder that affects the walls of the arteries

11 Aortic stenosis: Aortic stenosis can be due to multiple factors, sclerotic aging valves and bicuspid valve, which are the most common causes found here. Aortic stenosis Parameters: >1.5 Mild stenosis Moderate stenosis <1.0 Severe stenosis

12 Decreasing the compression sometimes adds definition to the walls Use a lower frequency in difficult to image patients Contrast is indicated for use when 2 continuous segments are not visualized as it provides greater accuracy in determining LV function Contrast can also be used in suspected thrombus or other conditions in which definition is needed

13 Four views are taken before and after stress; PLAX, PSAX, AP4 AND AP2 Following exercise, images must be obtained within 1:30 seconds Contrast may be performed with both exercise stress echo and Dobutamine During a Dobutamine stress echo, images are done at these times: pre-infusion, low-dose (within 3 minutes), peak dose and recovery after heart rate returns to resting or is under 100

14 During a TEE it is the sonographers job to assist the physician with image optimization and taking notes The temperature of the probe should be monitored at all times and should be less than degrees C There are two thermal limits, once the first limit reached, the temperature displayed will turn red if the second limit is reached, the system will freeze and ask if you want to continue If the system hits 42.7 C, the system will freeze and remain in freeze mode until the temperature decreases by 0.5 degrees

15 Green (Sani HB) top wipes are used for all the ultrasound probes, with the exception of the TEE probe which is disinfected in Central Sterile The contact time for these wipes is 10 minutes The purple (Super Sani cloth) top wipes can be used for cable and the machine surface, contact time for these is 3 minutes Probes and cables should be disinfected after each patient, the machine should be wiped down several times during the day and of the day and immediately after TEE procedures