Upper Extremity Venous Doppler

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Upper extremity venous Doppler is performed  two rule out thrombosis. A clot seen within the Internal Jugular, Subclavian, Axillary or Brachial veins would be considered a Deep Vein Thrombosis (dvt), a condition that can lead to Pulmonary Embolism is a piece of the clot is dislodged (emoboli) and travels to the pulmonary vasculature.

DVT’s are usually caused by stasis, immobility and hypercoagulable states. However in the case of upper extremity clots the main culprit is usually PICC lines.
Very few PICC lines are placed in the cephalic vein, they frequently occlude with thrombus. The Basilic vein is the typical location for insertion, but thrombose 70-80 percent according to some studies.

Echogenic Line within a clot free vessel

A typical scanning protocol includes transverse and sagital images with and without color doppler and spectral wave analysis of the IJV, Subclavian, Axillary, Brachial, Basilic, Cephalic, Radial and Ulnar veins. In my institution we include inonimate and Superior Vena Cava in the vessels we interrogate.

Normal Brachiocephalic confluence

Jugular Vein Thrombosis

Subclavian clot

 

In ten years I have had only a handful of thrombosed upper extremity veins in the absence of a line. A couple of those patients were pitchers and had paget schroetter syndrome aka Venous thoracic outlet syndrome.
Henry Suarez RDMS,RVT

Further reading:

Paget Schroetter Syndrome

Catheter Related UE Thrombosis

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4 thoughts on “Upper Extremity Venous Doppler

  1. Can you give any tips on how to image the innominate and the supraclavicular subclavian? I have a difficult time visualizing these.

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    1. I would try scanning above the clavicle and angling down towards the heart. Use a sector probe for the smaller footprint and depth. And also try having the patient propping their head slightly up and towards the side you interested so the muscle is more relaxed..

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