b31

Indications
- Suspected deep venous thrombosis with non-diagnostic Doppler examination
- Preparation for lower extremity DVT thrombolysis
- Suspected calf vein thrombosis if intent is anticoagulate for isolated calf thrombus
Contraindications
- Contrast allergy (premedicate)
Patient Evaluation
- Ability to cooperate during procedure
- Ability to bear weight on opposite leg during procedure
Preprocedure Orders
- Routine
Tools
- 22ga. angiocath
- Long connecting tubing
Entry site
- Peripheral vein on dorsum of foot
- Place needle as distal and medial as possible
- Dorsal vein of great toe is ideal
Technique
- After secure venous access is obtained, tourniquet is removed and the patient bears weight on opposite leg while table it tilted to 60·. Injection is started with close observation of access site for signs of extravasation. Use continuous fluoroscopy during injection with filming, in multiple projections, of the progressive opacification of veins.
- Once the superficial and common femoral vein are filmed, apply pressure to the groin, bring table to horizontal, elevate leg and film "dump shot" centering over pelvis and lower abdomen. Infuse heparinized saline through access with patient's leg elevated. Fluoro over entire leg to assure complete washout of contrast prior to removing IV.
Post-procedure Note
- Routine
Post-procedure Orders
- Resume previous orders and medications