Left leg DVT ergonomics

[Linh]

Dear Steve,

I do my DVT supine and decub most of the time. However, there are times when the PTV/Pero veins are so small that I need to swing the patient’s leg hanging down from the edge of bed and raise the bed up. RT side is fine as I still use my dominant hand (RT hand) to scan and the left hand to squeeze the calf. But for the LT leg, I find it difficult to use the Lt hand to scan with the indicator still on the thumb side and RT hand to squeeze. What is your approach?

Best regards,
Linh

[Stephen Bird]

Hi Linh,

I have a scanning bed that the back can sit up.
I have them sitting up in the bed with their hip external rotated and I ask them to move right over to my side of the bed.
This creates enough gravitational pressure to fill the calf veins nicely.
I use a convex 10C3 transducer which is lovely for these examinations.
When I get to the popliteal vein I ask them to bend their knee a little and roll slightly towards me allowing access to the pop vein. I do my PTV with knee gently flexed using a medial approach and I do the peroneals with the knee slightly more flexed using a poster-lateral approach.

It works well for me,

I am not a fan of sitting the patient on the edge of the bed. It does work, but you get their feet in your lap and they are less well supported and I worry about them falling backwards.

Steve.

[Linh]

Thanks Steve. I do worry about them falling off as the bed would be quite high. I’ll try the sitting position next time.

[Linh]

Dear Steve,

For Left Arm DVT, do you scan with patient sitting up or lying supine? I found it awkward and painful to scan with patient sitting up especially for Left side. Or do you combine scanning lying down for upper arm and sitting up for forearm?

Do you drop the arm lower than the level of the bed so distal veins are better visualized?

Best regards,
Linh

[Stephen Bird]

Hi Linh,

For left arm DVT I lay the patient supine with their head at the other end of the bed so the left side is close to me.

This makes it ergonomic when you get used to it.

I find you don’t have to lower the arm to fill the veins.

This is essential for a lower limb but in the upper limb it is not so essential.

I still cross my fingers all upper limb DVT studies are the right arm!

Steve

[Linh]

Hi Steve,

I use this position for LT elbow US. Now I can use it for DVT arm also, that’s neat.

I had a patient with a pacemaker so it will be Left majority of the time unfortunately!

Linh

[Stephen Bird]

Yep,

I do the same trick for my medial left elbows and ulnar nerve studies.

It makes it really ergonomic for everyone.

Steve

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