|Title||Vascular Assessment of Venous Disease|
By the end of this module, the Clinical Scientist in HSST will be able to apply their expert knowledge, skills and experience in the clinical setting to master the skill of lower limb venous assessment, solving problems and adapting techniques accordingly. This will include:
- deep vein thrombosis;
- superficial thrombophlebitis;
- venous incompetence (varicose veins and, post thrombotic syndrome);
- pre-operative vein mapping and trauma.
They will also be able to recognise, deliver, report and interpret the appropriate physiological test/s to address the findings following the initial clinical assessment. They will be expected to apply their expert knowledge of management options available to discuss management plans with the patient and/or the supervising clinician based on the investigative findings. They will also be expected to critically evaluate their own response to both normal and complex situations using the professional attributes and insights required of a Consultant Clinical Vascular Scientist.
Knowledge and understanding
By the end of this module the Clinical Scientist in HSST will be able to analyse, synthesise, evaluate and critically apply their expert knowledge to lower limb venous assessment of a range of patients, including those with complex problems including:
Anatomy, Physiology and Pathology
- typical anatomy and common variants of the venous system in the leg and arm.
- the range and variety of pathology including:
- deep venous thrombosis.
- superficial thrombophlebitis.
- venous incompetence.
- arterio-venous and venous malformation.
- arteriovenous fistula e.g. following trauma.
- venous stenosis or compression (e.g. May-Thurner syndrome, post DVT).
- normal and pathophysiological haemodynamics including normal and pathological ambulatory venous pressures and the effect of posture on venous haemodynamics, respiratory effects on venous flow related to changes in thoracic and abdominal pressure.
- augmentation techniques e.g. calf compression and valsalva manoeuvre, including limitations and sources of error.
- the effect of chronic cardiac failure on venous flow and waveforms.
Clinical History, Examination and Management Options
- recognition of the presenting signs and symptoms and identify possible alternative diagnoses.
- medical, interventional and surgical management options (see medical and surgical management module for further details).
- how to recognise the clinical sequelae of the diagnosis.
- how to recognise how diagnosis affects management pathway.
- the diagnostic techniques used by clinical vascular scientists to assess the range of venous disorders.
- the required properties of veins that are to be used for bypass conduits in arterial bypass or for haemodialysis access.
- methods of marking vein path or junction or perforator position prior to surgery.
- selection of the appropriate technique for each patient.
- the complimentary use of venography, CT and MRI in the diagnosis and management.
- the potential impact of venous disease on the quality of life of the patient including long term complications.
Technical and clinical skills
By the end of this module, the Clinical Scientist in HSST will be able to demonstrate a critical understanding of current research and its application to the performance and mastery of the following technical skills:
- Lower and upper limb venous colour flow imaging and spectral Doppler assessment of venous patency and competency.
- Identification of the sources of venous incompetence
- Assess suitability for endovenous ablation surgery
- Vein diameter measurement and marking for specific surgical procedures.
By the end of this module, the Clinical Scientist in HSST will be expected to critically reflect and apply in practice, with respect to lower limb venous disease in a range of patients, clinical and communication skills to advise and communicate effectively with patients, relevant clinicians and other healthcare professionals and will:
- take a clinical history.
- provide expert opinion on the most appropriate diagnostic test and technique for the clinical presentation.
- perform the ultrasound imaging or physiological measurement diagnostic test, optimising the equipment to acquire images, physiological waveforms and measurements.
- analyse and interpret images, physiological waveforms and measurements.
- identify sources of error and artefacts and respond to them appropriately.
- formulate and organise data (clinical history, clinical assessment, scientific results) to accurately report results and conclusion, emphasising the key findings.Vein diameter measurement and marking for specific surgical procedures.
- communicate with the multi-disciplinary team and participate in multi-disciplinary teams.
Attitudes and behaviours
By the end of this module, the Clinical Scientist in HSST will be expected to evaluate their own response to both normal and complex situations. They will also be expected to consistently demonstrate the professional attributes and insights required of a Consultant Clinical Scientist working within the limits of professional competence referring as appropriate to senior staff and will:
- communicate appropriately with the patient and place the patient at the centre of care.
- prioritise the safety of the patient.
- consistently work to high standards of clinical practice applying knowledge and evidence, making decisions and evaluating the impact of those decisions.
- monitor, evaluate and maintain clinical practice standards.
- share data on clinical practice standards with service users and managers to encourage dialogue and debate.
- recognise the importance of the multidisciplinary clinical team and will takeresponsibility for ensuring appropriate and effective decision making processes are in place.
- support and contribute to the development of multidisciplinary clinical team working and work with the team to determine scientific service priorities.
- be committed to and support continuous improvement of vascular services, with particular reference to auditing practice, evidence based practice, innovation, new and improved technologies.