Applied Fundamentals of Vascular Science —
Training activity: 13

Details

Perform ultrasound scans following a set protocol to identify normal lower limb deep vein anatomy (incl. calf veins)

Type

Developmental training activity (DTA)

Evidence requirements

Evidence the activity has been undertaken by the trainee​.

Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.

An action plan to implement learning and/or to address skills or knowledge gaps identified.

Considerations

• Patient centred care and support
• Local SOPs
• National, international guidelines and standards
• Documentation and record keeping
• Use of machine controls e.g. optimisation and ultrasound principles
• Principles of Doppler ultrasound
• Selection of appropriate probes for patient/vessel
• Patient positioning and exam technique
• Anatomy and variations of the deep venous anatomy on ultrasound

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

• What are the key steps and considerations within the set protocol for scanning the deep veins of the lower limb (including calf veins) to identify normal anatomy?
• What anatomical landmarks do you need to be confident in identifying using ultrasound for these veins?
• What preparation will you undertake to ensure you are familiar with the normal ultrasound appearance of these veins, including B-mode and Doppler characteristics?
• What specific aspects of the scanning technique will you focus on to ensure accurate identification and assessment of these veins?
• How will you assess whether the veins are normal e.g. using compression or colour doppler? Is this defined in your local protocol?

In action

• Are you following the steps of the set protocol for scanning the deep veins of the lower limb (including calf veins)?
• How confident are you in locating and identifying the common femoral, femoral, popliteal, anterior tibial, posterior tibial, peroneal veins, gastrocnemius veins and soleal veins based on anatomical landmarks and ultrasound appearance?
• Are you assessing vein compressibility effectively? Are all deep veins fully compressible?
• If a vein doesn’t appear to be compressible, are there any other techniques you are using to further assess this and ensure an accurate result is gained?
• If required by your set protocol, are you noting the presence of normal Respiro phasic venous waveforms in the common femoral vein?  If assessed, are you noting normal venous waveforms in the other major deep veins?
• What adjustments to transducer position, angle, pressure, and Doppler settings are you making to visualise the deep venous system clearly, including the calf veins?

On action

• Describe the process you followed to perform the lower limb deep vein scan according to the protocol.
  • What specific veins were you able to visualise?
  • Were there any challenges and what were these?
• How well were you able to adhere to the set protocol for imaging the deep venous system, including the calf veins?
  • How confident were you in identifying the normal deep vein anatomy?
  • Were there any specific scanning techniques that proved effective?
• Are there any specific steps in the deep vein protocol that you need to practice further?
  • What techniques for visualising the calf veins will you focus on in future scans?
• What will you do going forward to increase your confidence with the aspects of the deep vein scan that you found challenging?

Beyond action

• Consider your initial experiences in visualising the deep veins of the lower limb, including the calf veins. How has your understanding of potential anatomical variations or challenges in image acquisition in these regions evolved?
• How have subsequent experiences, potentially including observing and performing scans for deep vein thrombosis (DVT) or learning about venous haemodynamics enhanced your appreciation of normal deep vein anatomy?
• Have you revisited your initial reflections on this DTA? How has your growing understanding influenced how you approach these scans now?
• In what ways has developing proficiency in this DTA contributed to your ability to perform and interpret more complex venous examinations, such as assessment for superficial venous incompetence?

Relevant learning outcomes

#	Outcome
# 1	Outcome Communicate effectively with a range of patients and other professionals.
# 2	Outcome Assess vascular anatomy using ultrasound.
# 3	Outcome Apply the principles of ultrasound safety and ergonomics whilst performing a scan.
# 5	Outcome Apply the principles of ultrasound physics to adjust and optimise an ultrasound machine to obtain quality images.
# 10	Outcome Evaluate protocols and national guidelines and their impact of vascular science practice.