Training activity information
Details
Perform optimised ultrasound scans to identify an above knee DVT
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Considerations
- Local SOPs
- National guidance
- Clinical presentation of acute and chronic DVT
- Image optimisation
- Appearance of acute and chronic thrombus on ultrasound
- Limitations of the scan
- Unusual pathology and differential diagnoses
- Acting on urgent findings
- Patient safety and communication
- Artifact causes and corrections
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 does success look like?
- Identify what is expected of you in relation to successfully performing an optimised ultrasound scan to identify an above knee DVT.
- Consider how the learning outcomes apply, specifically in relation to assessing venous thrombosis and applying ultrasound physics for correct optimisation.
- Discuss with your training officer to gain clarity of what is expected of you in relation to expected technical and diagnostic standards, including adequate compression and Colour Doppler assessment, for above knee DVT.
What is your prior experience of this activity?
- Think about what you already know about venous anatomy, DVT presentation, and scanning protocols for above knee DVT.
- Consider possible challenges you might face during the activity, such as patient positioning, dealing with obesity, achieving optimal compression in difficult anatomical regions, or identifying subtle non-occlusive thrombus.
- Recognise the scope of your own practice for this activity i.e. know when you will need to seek advice or help, and from whom. You will need to seek advice from your Training Officer when required, for example if compression is inconclusive for a major vein or if highly unusual findings suggest non-DVT pathology.
- Acknowledge how you feel about embarking on this ultrasound scanning activity.
What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop, such as transducer manipulation, image optimisation for deep vessels, and accurate DVT identification using B-mode and compression.
- Identify the specific insights you hope to gain into comprehensive DVT assessment and the criticality of safety protocols.
What additional considerations do you need to make?
- Consult actions identified following previous experiences of ultrasound scanning (e.g., improving image depth or ensuring consistent probe pressure).
- Identify important information you need to consider before embarking on the activity, such as patient history, relevant DVT symptoms, safety guidelines (e.g., acoustic output), and review of venous anatomy.
In action
Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate whilst performing optimised ultrasound scans to identify an above knee DVT?
- Are you encountering situations such as:
- Inconclusive compression for a major deep vein (e.g., common femoral) due to deep positioning, severe obesity, or patient guarding?
- Subtle, non-occlusive thrombus that is difficult to distinguish conclusively from slow flow or acoustic noise?
How are you reacting to the unexpected development?
- How is this impacting your actions? For example, are you responding to the situation appropriately? Are you adapting or changing your approach to optimise the scan or achieve full vein coaptation?
- Consider the steps you are taking in the moment, such as:
- Immediately adjusting depth and gain settings to improve deep vein visualisation for better B-mode assessment
- Performing alternative compression manoeuvres (e.g., repositioning the limb or applying pressure at different angles) to achieve full coaptation
- How are you feeling in that moment? For instance, are you finding it difficult to adapt your compression technique? Is it affecting your confidence in reaching a successful diagnostic conclusion?
What is the conclusion or outcome?
- Identify how you are working within your scope of practice. For example, are you successfully achieving complete vein compression after technical adjustments to rule out or confirm DVT? Or are you needing support because compression remains inconclusive for a major vein, requiring confirmation from a senior colleague?
- What are you learning as a result of the unexpected development? For example, are you mastering deep vein optimisation techniques? Or gaining insight into the specific technical challenges of DVT assessment in challenging body habitus?
On action
What happened?
- Begin by summarising the key steps you took when performing the ultrasound scan to identify an above knee DVT, including the steps taken to ensure optimal compression and visualisation.
- Consider specific events, actions, or interactions which felt important, such as patient cooperation, technical difficulties in achieving optimal compression in the groin, or unexpected findings, and your own feelings.
- Include any ‘reflect-in-action’ moments where you had to adapt to the situation as it unfolded, for instance, immediately adjusting depth and gain settings when encountering a deep segment to maintain optimal B-mode quality.
- How did you feel during this experience, e.g., did you feel focused on achieving optimal image quality or frustrated by persistent technical issues?
How has this experience contributed to your developing practice?
- Identify what learning you can take from performing this scan. What strengths did you demonstrate, e.g., technical precision in probe manipulation or the ability to accurately correlate B-mode appearance with expected pathology?
- What skills and/or knowledge gaps were evident, e.g., unfamiliarity with the specific compression angle required for a deep vein in a difficult patient?
- Compare this experience against previous engagement with similar activities – were any previously identified actions for development achieved? Has your practice improved in optimising the scan or identifying findings for above knee DVT?
- Identify any challenges you experienced, such as needing to seek advice or clarification on scope of practice regarding a subtle finding or escalating a finding to ensure you were working within your scope of practice, and how you reacted to this.
What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received, with regards to improving your consistent technique for optimising deep venous visualisation.
- What will you do differently next time you approach an ultrasound scan for an above knee DVT, for instance, by proactively establishing a standardized sequence for adjusting compression angle and pressure before scanning a major vessel?
- Do you need to practise any aspect of the activity further, such as refining your technique for deep vein compression or key learning outcomes related to ultrasound physics and image optimisation?
Beyond action
Have you revisited the experiences?
- How have your subsequent experiences of performing above knee DVT scans since completing this specific training activity led you to revisit your initial approach or decisions during that activity? For example, how an instance where a subsequent patient required highly aggressive probe manoeuvring to compress a deep femoral vein due to severe patient habitus forced you to re-evaluate the thoroughness of your initial optimisation settings and compression methodology you applied during your first attempt at this training activity.
- Considering what you understand about venous anatomy, compression criteria, and managing technical challenges now, were the actions or considerations you identified after your initial reflection on this training activity sufficient? How have you since implemented or adapted improvements in your above knee DVT scanning technique based on further learning and experiences? For example, how you proactively integrated a standardised checklist for assessing full vein coaptation in the groin to minimise false-negative scans, demonstrating you have adapted improvements based on further learning.
- Has discussing technically challenging DVT scans or the impact of inconclusive compression on patient diagnosis with peers or colleagues changed how you now view your initial experience in this training activity? For example, how professional storytelling with a senior colleague about a case where persistent inconclusive findings required repeat imaging refined your understanding of the critical nature of meticulous image optimisation and compression technique.
How have these experiences impacted upon current practice?
- How has the learning from this initial training activity, in combination with subsequent above knee DVT scanning experiences, contributed to your overall confidence and competence in performing optimised ultrasound scans to assess venous thrombosis, particularly in preparing for assessments like Direct Observations of Practical Skills (DOPS)? For example, how your accumulated ability in reliably achieving deep vein compression now enables you to confidently perform full ultrasound assessment of the deep leg veins during a DOPS assessment.
- How has reflecting back on this specific training activity, combined with everything you’ve learned since, shaped your current approach to performing above knee DVT scans? How does this evolved understanding help you identify when something is beyond your scope of practice or requires escalation? For example, how your evolved approach means you now readily recognise when compression is compromised by severe pain or unusual anatomical structure and routinely seek assistance to ensure reliable diagnosis.
- Looking holistically at your training journey, how has this initial above knee DVT scanning experience, revisited with your current perspective, contributed to your development in meeting the objectives related to assessing lower limb venous thrombosis? For example, how this foundational experience has supported your development in applying ultrasound physics to correctly optimise the scan.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Assess lower limb venous thrombosis using ultrasound. |
| # 4 |
Outcome
Apply ultrasound physics to correctly optimise an ultrasound scan of the lower limb veins. |
| # 9 |
Outcome
Appraise the impact of research evidence on national guidelines. |