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You got a POCUS Question? Put up your hand!

November 9, 2017 0 Comments

Since we went to the format with EDE 2 of putting all of the old PowerPoint presentations online in an interactive format, we have offered to answer the questions of participants as they work through the modules in getting ready for the live part of the course. This is intended to mimic a classroom where you can put up your hand. This is just the online equivalent 🙂

We recently received a question from a participant at an upcoming course and thought it was worthwhile posting the Q&A on the blog.

Question:
I have a question regarding positioning the patient for the popliteal portion of DVT EDE. What do you think of having them lie prone with a pillow under their anterior ankle to gently flex the knee? It seems to me that it would be more comfortable for the examiner and the patient and free up the hand that would otherwise have to support the patella.

Answer:
That’s a good question. When I was first learning to do the DVT scan years ago, I did try that position. I found that it ended up being too cumbersome. A lot of the patients we scan are a bit obese and have some trouble lying flat on their stomachs for any length of time. Another issue is that it simply takes longer for somebody to turn all the way onto the stomach as opposed to just turning on their side (see image below). If I can save 30 seconds in the ED, I will! I scan in the popliteal region with the patient on their side about 95% of the time. I just find it faster to do the scan if they are on their side as opposed to being fully turned on their stomach. For the 5% of patients who cannot turn at all, I scan them in the supine position, with their knee bent only enough to get the probe under that area. You can do the scan with a patient prone. The results are still reliable. But you definitely need to still bend the knee. If the leg is straight, the veins will flatten and be tougher to see. Don’t forget that you still need to place the patient in reverse Trendeleburg position if you are scanning in the prone position. It helps to distend veins.
Hope that helps!

Feel free to chime in with your own opinion!

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