Upper Extremity Venous Duplex (DVT)

1. 1

   Patient supine, head turned slightly away. Linear probe (5–12 MHz).

2. 2

   IJV: probe lateral to carotid at the neck. Compress in transverse — IJV collapses easily (artery does not).

3. 3

   Subclavian vein: probe in infraclavicular region. Cannot fully compress due to clavicle — rely on Doppler phasicity.

4. 4

   Axillary vein: arm slightly abducted. Compress transversely from axilla to upper arm.

5. 5

   Brachial, basilic, and cephalic veins: linear compression sweeps from axilla to antecubital fossa.

6. 6

   Add color Doppler at subclavian: confirm respiratory phasicity. Loss of variation = central (SVC) obstruction.

7. 7

   If PICC present: trace catheter track and assess for surrounding thrombus along its course.

• Internal jugular vein — compression + Doppler
• Subclavian vein — Doppler
• Axillary vein — compression + Doppler
• Brachial veins — compression
• Cephalic and basilic veins

• Vein compressibility
• Intraluminal thrombus
• Doppler phasicity
• Augmentation with arm compression
• PICC/catheter position

• Subclavian vein not compressible due to clavicle — rely on Doppler only
• IJV thrombosis may be incidental finding
• Respiratory phasicity loss indicates central (SVC) obstruction

Respiratory variation in the subclavian/axillary Doppler signal indicates patency to central veins. Loss of variation = central obstruction.