Name: point-of-care ultrasound screening for proximal lower extremity deep venous thrombosis
Uploaded: 2023-02-10T13:13:00
Description: Watch this Scientific Journal Video about Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis at JoVE.com

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在涉及人类参与者的研究中执行的所有程序均符合杜克大学卫生系统机构研究委员会的道德标准和1964年赫尔辛基宣言及其后来的修正案或类似的道德标准。该协议是使用以下出版物3，10的输入执行的。对作者本人进行正常图像的图像，并作为常规教育超声扫描的一部分，用于教学目的的正面图像，并事先根据机构标准获得口头同意。根据以下标准选择?...

<ol>
	<li>Beckman, M. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Venous+thromboembolism:+A+public+health+concern.">Venous thromboembolism: A public health concern.</a> American Journal of Preventive Medicine. 38, 495-501 (2010).</li><li>Kearon, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Natural+history+of+venous+thromboembolism.">Natural history of venous thromboembolism.</a> Circulation. 107 (23), 22-30 (2003).</li><li>Schafer, J. M., Stickles, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sonoguide:+Ultrasound+guide+for+emergency+physicians.">Sonoguide: Ultrasound guide for emergency physicians.</a> American College of Emergency Physicians. , (2020).</li><li>Pomero, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Accuracy+of+emergency+physician-performed+ultrasonography+in+the+diagnosis+of+deep-vein+thrombosis:+A+systematic+review+and+meta-analysis.">Accuracy of emergency physician-performed ultrasonography in the diagnosis of deep-vein thrombosis: A systematic review and meta-analysis.</a> Thrombosis and Haemostasis. 109 (1), 137-145 (2013).</li><li>Theodoro, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Real-time+B-mode+ultrasound+in+the+ED+saves+time+in+the+diagnosis+of+deep+vein+thrombosis+(DVT).">Real-time B-mode ultrasound in the ED saves time in the diagnosis of deep vein thrombosis (DVT).</a> American Journal of Emergency Medicine. 22 (3), 197-200 (2004).</li><li>Burnside, P. R., Brown, M. D., Kline, J. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Systematic+review+of+emergency+physician-performed+ultrasonography+for+lower-extremity+deep+vein+thrombosis.">Systematic review of emergency physician-performed ultrasonography for lower-extremity deep vein thrombosis.</a> Academic Emergency Medicine. 15 (6), 493-498 (2008).</li><li>Adhikari, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Isolated+deep+venous+thrombosis:+Implications+for+2-point+compression+ultrasonography+of+the+lower+extremity.">Isolated deep venous thrombosis: Implications for 2-point compression ultrasonography of the lower extremity.</a> Annals of Emergency Medicine. 66 (3), 262-266 (2015).</li><li>Cogo, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Distribution+of+thrombosis+in+patients+with+symptomatic+deep+vein+thrombosis.+Implications+for+simplifying+the+diagnostic+process+with+compression+ultrasound.">Distribution of thrombosis in patients with symptomatic deep vein thrombosis. Implications for simplifying the diagnostic process with compression ultrasound.</a> Archives of Internal Medicine. 153 (24), 2777-2780 (1993).</li><li>Badgett, D. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Duplex+venous+imaging:+Role+for+a+comprehensive+lower+extremity+examination.">Duplex venous imaging: Role for a comprehensive lower extremity examination.</a> Annals of Vascular Surgery. 14 (1), 73-76 (2000).</li><li>Kory, P. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Accuracy+of+ultrasonography+performed+by+critical+care+physicians+for+the+diagnosis+of+DVT.">Accuracy of ultrasonography performed by critical care physicians for the diagnosis of DVT.</a> Chest. 139 (3), 538-542 (2011).</li><li>Bates, S. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnosis+of+DVT:+Antithrombotic+therapy+and+prevention+of+thrombosis,+9th+ed:+American+College+of+Chest+Physicians+Evidence-Based+Clinical+Practice+Guidelines.">Diagnosis of DVT: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.</a> Chest. 141 (2), 3512 (2012).</li><li>Wolf, S. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=American+College+of+Emergency+Physicians+Clinical+Policies+Subcommittee+(Writing+Committee)+on+Thromboembolic+Disease.+Clinical+policy:+Critical+issues+in+the+evaluation+and+management+of+adult+patients+presenting+to+the+emergency+department+with+suspected+acute+venous+thromboembolic+disease.">American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Thromboembolic Disease. Clinical policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with suspected acute venous thromboembolic disease.</a> Annals of Emergency Medicine. 71 (5), 59-109 (2018).</li><li>Elliott, C. G., Goldhaber, S. Z., Jensen, R. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Delays+in+diagnosis+of+deep+vein+thrombosis+and+pulmonary+embolism.">Delays in diagnosis of deep vein thrombosis and pulmonary embolism.</a> Chest. 128 (5), 3372-3376 (2005).</li><li>Musil, D., Kovacik, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Delay+between+clinical+presentation+and+treatment+of+deep+venous+thrombosis+in+the+lower+limbs+and+regression+of+thrombosis.">Delay between clinical presentation and treatment of deep venous thrombosis in the lower limbs and regression of thrombosis.</a> Phlebology. 37 (2), 120-124 (2022).</li><li>Laursen, C. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Focused+sonography+of+the+heart,+lungs,+and+deep+veins+identifies+missed+life-threatening+conditions+in+admitted+patients+with+acute+respiratory+symptoms.">Focused sonography of the heart, lungs, and deep veins identifies missed life-threatening conditions in admitted patients with acute respiratory symptoms.</a> Chest. 144 (6), 1868-1875 (2013).</li><li>Barosse-Antle, M. E., Patel, K. H., Kramer, J. A., Baston, C. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Point-of-care+ultrasound+for+bedside+diagnosis+of+lower+extremity+DVT.">Point-of-care ultrasound for bedside diagnosis of lower extremity DVT.</a> Chest. 160 (5), 1853-1863 (2021).</li><li>Frankel, H. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Guidelines+for+the+appropriate+use+of+bedside+general+and+cardiac+ultrasonography+in+the+evaluation+of+critically+ill+patients-Part+I:+General+ultrasonography.">Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients-Part I: General ultrasonography.</a> Critical Care Medicine. 43 (11), 2479-2502 (2015).</li><li>Bernardi, E., Camporese, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnosis+of+deep-vein+thrombosis.">Diagnosis of deep-vein thrombosis.</a> Thrombosis Research. 163, 201-206 (2018).</li><li>Caronia, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Resident+performed+two-point+compression+ultrasound+is+inadequate+for+diagnosis+of+deep+vein+thrombosis+in+the+critically+ill.">Resident performed two-point compression ultrasound is inadequate for diagnosis of deep vein thrombosis in the critically ill.</a> Journal of Thrombosis and Thrombolysis. 37 (3), 298-302 (2014).</li></ol>

静脉血栓栓塞是一种常见疾病，在美国每年影响约300，000-600，000人，并伴有包括肺栓塞在内的严重并发症。这些患者的死亡率在10%-30%之间2，3，4。研究一致发现 DVT 的诊断存在显著延迟，一项前瞻性研究对 70 个医疗中心的 1，152 名患者进行了研究，发现 21% 的急性 DVT13 患者延迟超过 1 周。在另一项针对 76 例...

深静脉血栓形成（DVT）是在四肢深部外周静脉中形成血栓。这是一个常见且重要的发现，每年影响美国约300，000-600，000人1。DVT向肺栓塞的传播可发生在10%-50%的患者中，并且可能是致命的，死亡率为10%-30%，高于心肌梗死的院内死亡率1，2，3。血栓形成的危险因素包括遗传因素（DVT 家族史、凝血因子 V Leiden、蛋白 C 或 S 缺乏）、获得性因素（高龄、恶性肿瘤、肥胖、抗磷脂抗体等）和情境因素（妊娠、口服避孕药、近期手术、旅行、创伤或长期制动，包括住院）导致的高凝状态1。
危重患者 DVT 的早期诊断可以加快患者护理，并可能预防危及生命的并发症，例如肺栓塞、肺梗死和心脏受累1，2，3。Pomero 等人的一项系统评价显示，危重患者中 DVT 的汇总患病率为 23.1%4。下肢 DVT 筛查传统上由放射学超声技术人员进行全面的全腿双腿检查，包括灰度压缩超声和彩色/光谱多普勒。然而，一些较小的或社区的临床站点在一天中的某些时间（例如晚上或周末）缺乏超声医师的直接可用性，从而造成患者护理的延迟5。最近，急症护理提供者设计了使用以床旁超声 （POCUS） 为中心的成像方案筛查下肢近端 DVT 的方法，这些方案在危重患者中表现出类似的高敏感性和特异性3，4，6。下肢近端 DVT 定义为发生在股静脉或腘静脉系统内腹股沟、大腿或膝关节任何部位的 DVT。以下位置的 DVT 不属于这一类别：小腿静脉（DVT 的临床意义不确定）和盆腔静脉（即髂总静脉、髂外静脉和髂内静脉），只能使用下肢会诊静脉超声检查的颜色和光谱多普勒部分间接检测到2，3。
了解 DVT 的典型解剖分布使得进行这些床旁检查变得快速而容易。首先，70%-99% 的下肢近端 DVT 累及股骨或腘窝区域7，8，9。其次，灰度压缩超声是评估DVT的一种简单而准确的方法;当施加足够的压力以压低邻近动脉时，正常静脉应完全塌陷，而患有DVT的静脉则不会。结合这些原则，两区或三区下肢 DVT POCUS 检查以腹股沟、大腿和腘窝区域静脉的压缩超声为中心。这些技术已在先前的重症监护和急诊医学研究中得到临床验证，显示出高敏感性（96.1%，95%置信区间（CI）为90.6%-98.5%）和特异性（96.8%，95%置信区间为94.6%-98.1%），总体诊断准确率高（95%）3，4，6。然而，根据作者的经验，DVT POCUS检查在危重病人的护理中仍然没有得到充分利用，可能是因为临床医生不熟悉图像采集序列。本叙述性综述及相关视觉辅助工具描述了一种图像采集方案，用于执行POCUS检查以筛查下肢近端DVT，以帮助提供者在临床护理期间适当地加快图像采集。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Edge 1 ultrasound machine</td>
			<td>SonoSite</td>
			<td>n/a</td>
			<td>Used to obtain normal images/clips</td>
		</tr>
		<tr>
			<td>SPARQ ultrasound machine</td>
			<td>Philips</td>
			<td>n/a</td>
			<td>Used to obtain abnormal images/clips</td>
		</tr>
	</tbody>
</table>

point-of-care ultrasound screening for proximal lower extremity deep venous thrombosis

急性下肢深静脉血栓形成（DVT）是一种严重的血管疾病，需要准确和早期诊断以防止危及生命的后遗症。虽然彩色和光谱多普勒全腿加压超声通常在放射科和血管实验室进行，但即时超声 （POCUS） 在急性护理环境中变得越来越普遍。经过针对性 POCUS 适当培训的提供者可以在危重患者中以高灵敏度和特异性进行快速床旁检查。本文通过描述用于下肢DVT POCUS图像采集的三区协议，描述了一种简化但经过验证的POCUS方法。该协议解释了在下肢六个压缩点获得血管图像的步骤。从大腿近端水平开始，向腘窝间隙远端移动，该协议引导用户逐步通过每个压缩点：从股总静脉到股骨和股深静脉分叉，最后到腘静脉。此外，还提供了视觉辅助，可以在实时图像采集期间帮助提供者。提出此协议的目的是帮助患者床边的POCUS用户更容易获得和有效地进行下肢近端DVT检查。

我们描述了初始疑似DVT患者对下肢近端DVT POCUS的解释。
附 图2 显示了左下肢和右下肢DVT的阴性POCUS超声图像，如图 1 所示，从近端到远端静脉的多点压迫。在一项阴性的 DVT 研究中，静脉完全可塌陷，在所有区域的压缩超声期间，前壁接触后壁。在血栓临床验前概率较低的患者中，本研究对排除近端 DVT 具有高敏感性 （>95%） 和高?...

Watch this Scientific Journal Video about Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis at JoVE.com

Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis

传统上，下肢深静脉血栓形成 （DVT） 是通过放射学进行的静脉多普勒超声诊断的。经过聚焦即时超声 （POCUS） 适当培训的提供者可以在危重患者中以高灵敏度和特异性进行快速床旁检查。我们描述了聚焦POCUS DVT下肢检查的扫描技术。

下肢近端深静脉血栓形成的即时超声筛查

Acute lower extremity deep venous thrombosis (DVT) is a serious vascular disorder that requires accurate and early diagnosis to prevent life-threatening ...

我们的协议通过描述用于下肢DVT图像采集的三区协议，描述了一种简化但经过验证的诊断床旁超声方法。在聚焦床旁超声方面接受过适当培训的提供者可以在危重患者中以高灵敏度和特异性进行快速床旁 DVT 检查。诊断性POCUS检查可以加快DVT的诊断，从而开始早期治疗，从而可能降低并发症发生率并改善患者的临床结果。适当的DVT图像采集的关键步骤包括正确的患者定位，足够的增益和深度，以及完全压迫静脉的血管壁以确保不存在血栓。选择用于深静脉血栓形成或DVT扫描的高频线性换能器，以确保静脉的高分辨率图像。接下来，设置深度、增益和焦点。设置深度，以便通过按下向上或向下深度按钮，目标血管出现在超声屏幕的中间三分之一处。然后通过按下右增益按钮或左增益按钮并转动拨盘来设置增益，使容器包含一些灰色斑点，否则为黑色。如果机器有能力，则通过单击屏幕上的框并在按住按钮的同时移动它，然后将聚焦光束对准目标容器的水平或略低于目标容器的水平，然后松开。设置机器模式。单击B模式，这是一种二维灰度超声检查，以获得非压缩和压缩图像。为了获得最佳的扫描人体工程学，请将装有超声波的机器放在超声探头的直接视线范围内。扫描前，将患者的整条腿从腹股沟暴露到膝盖。将患者仰卧位，对股总静脉和股骨静脉进行 DVT 检查。将患者置于青蛙腿位置，以便更好地观察和扫描远端静脉。对于腹股沟和大腿的B模式扫描，以线性路径将凝胶涂在患者的皮肤上，该路径可追踪超声换能器的预期路径，以提高运动效率。对于膝盖的B型扫描，将凝胶涂在换能器本身上，因为大量的凝胶应用将促进扫描效率。接下来，对于换能器方向，将换能器放置在横向位置，方向标记指向患者的右侧，以确保扫描期间捕获的图像与结构的解剖方向相对应。垂直于静脉路径放置探头，以在短轴视图中可视化静脉。将静脉结构居中显示在屏幕上。在模棱两可的病例中，通过将探头旋转 90 度，使标记物指向患者的头部，从而添加长轴成像。对于按压序列，立即开始扫描腹股沟折痕。以向下压缩的方式按远端顺序进行，然后在每个点释放。压迫，使整个静脉塌陷，前壁接触后壁，而动脉保持脉动。不要在每次按压之间施加静息表面压力，因为它会掩盖静脉的可视化。当换能器施加足够的压力以压入邻近动脉时，静脉应完全塌陷。单击保存剪辑并压缩。然后释放股骨总静脉或CFV和股动脉或腹股沟韧带正下方的FA。将探头向远端滑动约一厘米，并在大隐静脉或GSV入口处的CFV和FA处记录相同的压缩和释放技术。单击保存剪辑，然后在 FA 分叉处压缩并释放 CFV 处的探头，进入股浅动脉或 SFA 和股深动脉或 DFA。在SFA和DFA之间，将有一个外侧穿支静脉从外侧引流到内侧进入CFV。确保侧穿支静脉和 GSV 均可压缩。单击保存剪辑，然后在 CFV 分叉到股静脉或 FV 和股深静脉或 DFV 处压缩并释放探头。再次单击保存剪辑，压缩并释放膝盖后面腘静脉处的探头。一旦 1 到 5 点完全可压缩，沿大腿从近端到远端扫描 FV，直到静脉消失在内收肌管中。在此扫描过程中，尝试大约每一到两厘米压缩一次静脉。在这项研究中，左腿血管解剖结构在横向视图中具有阴性和阳性下肢DVT示例，如下所示。在一项阴性的 DVT 研究中，静脉完全可塌陷，在所有区域的压缩超声期间，内壁接触后壁。在 DVT 阳性研究中，近端静脉 POCUS 既可以直接看到血栓，也可以检测近端静脉的不可压迫性，从而诊断非闭塞性血栓。该协议解释了在下肢从大腿近端向远端移动到腘窝间隙的六个压缩点获取DVT图像的步骤。

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电解下腔静脉静脉血栓形成的模型（EIM）

Animal models serve a vital role in deep venous thrombosis (DVT) research in order to study thrombus formation, thrombus resolution and to test potential ...

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医学

Rapid Point-of-Care Assay of Enoxaparin Anticoagulant Efficacy in Whole Blood

快速点护理依诺肝素的抗凝血剂功效的测定全血中

There is the need for a clinical assay to determine the extent to which a patient's blood is effectively anticoagulated by the ...

A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis

深静脉血栓形成的评价和定量的多中心MRI协议

We evaluated a magnetic resonance venography (MRV) approach with gadofosveset to quantify total thrombus volume changes as the principal criterion for ...

Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus

基于国际专家共识的护理点肺超声诊断新生儿肺病的协议和指南

Ultrasound is a safe bedside imaging tool that obviates the use of ionizing radiation diagnostic procedures. Due to its convenience, the lung ultrasound ...

Evaluation of a Point-of-Care Testing Analyzer for Measuring Peripheral Blood Leukocytes

用于测量外周血白细胞的床旁测试分析仪的评估

White blood cell (WBC) is an important indicator of inflammation in the body, and it can help distinguish between bacterial and viral infections. At ...

Point-of-Care Lung Ultrasound in Adults: Image Acquisition

成人床旁肺部超声：图像采集

Consultative ultrasound performed by radiologists has traditionally not been used for imaging the lungs, as the lungs&#39; air-filled nature normally ...

Point-of-Care Ultrasound: A Review of Ultrasound Parameters for Predicting Difficult Airways

床旁超声：预测困难气道的超声参数综述

Airway management remains a crucial part of perioperative care. The conventional approach to assessing potentially difficult airways emphasizes the LEMON ...

Imaging the Abdominal Aorta with Point-of-Care Ultrasound

An Approach to Point-Of-Care Ultrasound Evaluation of the Abdominal Aorta

Author Spotlight: Using Point-of-Care Ultrasound for Comprehensive Evaluation of the Abdominal Aorta

腹主动脉床旁超声评估方法

Disorders of the abdominal aorta, including aneurysms and dissection, have potentially high rates of morbidity and mortality. While computed tomography ...

Gastric Ultrasound Technique for Mitigating Peri-Procedural Aspiration Risk

Gastric Point of Care Ultrasound in Adults: Image Acquisition and Interpretation

Point-of-Care Ultrasound for Gastric Content Assessment and Risk Stratification in Perioperative Care (Video) | JoVE

成人胃旁超声：图像采集和解释

Over the past two decades, diagnostic point-of-care ultrasound (POCUS) has emerged as a rapid and non-invasive bedside tool for addressing clinical ...

Ultrasound in Evaluating Diaphragm Dysfunction and Monitoring Treatment

Measuring Diaphragm Thickness and Function Using Point-of-Care Ultrasound

Unraveling the Impact of Mechanical Ventilation on Diaphragm Function and Patient Outcomes (Video) | JoVE

使用床旁超声测量隔膜厚度和功能

The diaphragm is the main component of the respiratory muscle pump. Diaphragm dysfunction can cause dyspnea and exercise intolerance, and predisposes ...