Upper Extremely Venous Ultrasound Scan Protocol

Scanning Protocol

1. TRV Jugular Vein.
2. SAG Jugular Vein.
3. SAG Jugular Vein with Color.
4. SAG Jugular Vein with Color and Doppler.
5. TRV Subclavian Vein.
6. SAG Subclavian Vein.
7. SAG Subclavian Vein with Color.
8. SAG Subclavian Vein with Color and Doppler.
9. TRV Axillary Vein.  Split screen: with and without compression.
10. SAG Axillary Vein.
11. SAG Axillary Vein with Color.
12. TRV Brachial Proximal Vein. Split screen: with and without compression.
13. SAG  Brachial Proximal Vein with Color.
14. TRV Brachial Mid Vein. Split screen: with and without compression.
15. SAG Brachial Mid Vein with Color.
16. TRV Brachial Dist Vein . Split screen: with and without compression.
17. SAG Brachial Dist Vein with Color.
18. TRV  Radial Vein. Split screen: with and without compression.
19. SAG Radial Vein with Color.
20. SAG Radial Vein with Color and Doppler.
21. TRV Ulnar Vein. Split screen: with and without compression.
22. SAG Ulnar Vein with Color.
23. SAG Ulnar Vein with Color and Doppler.
24. TRV Basilic Vein. Split screen: with and without compression.
25. SAG Basilic Vein with Color.
26. TRV Cephalic Vein. Split screen: with and without compression.
27. SAG Cephalic Vein with Color.

Jugular Vein Transverse

Jugular Vein Transverse

Jugular Vein SAG

Subclavian Vein TRV

Subclavian Vein TRV

Subclavian Proximal SAG

Subclavian Vein Distal

Mid Brach vein TRV image. Can see Basilic v 2 cm lateral from Brach v.
Remember that there are 2 Brach veins accompany one Brach art.

Jugular v is Anterior and Lateral to Carotid

Lt Brach mid vein  without Compressian and compression view

Radial v just below the elbow. Remember that there are 2 rad v accompany 1 rad art.

TRV below elbow . You can see radial vessels anterior to Radius , You can see Ulnar vessels anterior to Ulna.

Scanning Tips

• Ask the patient about the indication for this exam: swelling or pain.
• Ask the patient the history: previous DVT; Central line or Chemotherapy/ Antibiotic etc Catheters;
•   recent IV; trauma; recent travelling; recent surgeries; Hx of clotting factors disorders etc.
• Place the patient in Supine or Trendelenburg position, so you can actually, see the upper extremity and neck veins. Remember, if you situate the patient with their head higher than the legs, than all the blood will flow down towards the legs , and upper body veins will collapse, which will make it hard to visualize the vein on ultrasound.
• Scan accordingly to your institution protocol. Some hospitals do not require to show compression on Jugular or Subclavian Veins. Compressing Jugular Vein might make your patient dizzy or nauseous.
• Compressing Subclavian Vein might make the patient feel discomfort or even pain, since you will be pushing relatively hard against the Clavicular Bone .
• Again, according to protocols of some institutions, it is not necessary to show Doppler at each level of scan. If you hospital or clinic requires so, than , please, Doppler at the end of each level of this scan.
• Remember that "veins are above the arteries" above the diaphragm, which means that you will see veins cephalic to corresponding arteries.
• Note that due to nature of venous wall, a vein will exibit dilation or collapse while you scan, in contrast to the elastic artery, that will keep relatively constant caliber during the scan.
• Remember that when in doubt, you can always drop a Doppler pulse into the vessel and it will distinctly show either arterial triphasic waveform, or venous flow, which at the level of Jugular or Subclavian will be strongly influenced by heartbeat as well as respiration, and look sporadic. 
• The skinnier the patient the more difficult it is to get the picture of Subclavian Vein in TRV plane. Sometimes it is better to slide down a couple of rib intervals from Clavicle and tilt the probe upwards. The Subclavian V. should be right above the Subclavian artery. You can also place the probe transverse on a Sternum about 2-3 cm down from the notch. You should see Subclavian Vein starting out from behind the sternum.
• The Subclavian Vein will almost always be seen 2-4 cm below the Clavicular bone. It is very rare to see the Subcl. V. from above the Clavicle approach, and there is a good chance to get a smaller Supraclavicular Vein at this level. The hint here will be that the Subclavian Vein is always accompanied by Subclavian artery, and if you do not see the artery next to the vein, then the vein you are scanning most likely is NOT Subclavian.
• Usually, it is pretty redundant to show Cephalic and Basilic Veins at each zone or level, but no matter of how many pictures you take, you still have to check those entire veins from the very proximal level to the very wrist.
• Same logic concerns the Radial and Ulnar Veins. You, as a sonographer, are required to make sure there is no clot at any given zone of the vein, and you need to cover the entire vein to state that it is negative for clots.
• When scanning Jugular Vein, make sure you are going from the very distal part of it at the skull/ mandibular bone, and all the way proximal to the heart, all the way down to Innominate Vein. It will require turning the transducer somewhat caudally in Transverse or slightly Coronal view, looking towards the heart as far as you can follow the vein.