Point-of-care ultrasound (PoCUS) for lower extremity deep vein thrombosis (DVT) remains a skill with significant variability in local practice. While some physicians perform DVT scans regularly, others rarely incorporate PoCUS into their workflow. Regardless of your current practice pattern, it’s always helpful to refresh your knowledge with these key do’s and don’ts of DVT PoCUS.

PoCUS for proximal leg DVT boasts a sensitivity of approximately 96% and a specificity of 97% when performed by trained emergency physicians, highlighting its value as an accurate bedside diagnostic tool.¹

DOs and DON’Ts of DVT PoCUS

DO #1: Review Your Anatomy

Would you assemble IKEA furniture without reading the instructions?

Before scanning, take a moment to refamiliarize yourself with venous anatomy and common abbreviations, such as CFV (common femoral vein). A solid understanding of the anatomy will save you time and ensure accuracy during your scan.

DO #2: Position the Patient Properly

Optimal patient positioning can make or break your DVT scan. Here are some tips:

• Standard Position: Position the patient upright at a 30–45-degree angle with slight leg flexion and external rotation (frog-leg position).²
• For Limited Hip Abduction: Roll the patient onto their side if they can’t maintain abduction.
• For Discomfort or Cramping: Use a pillow under the knee for added support.
• Trouble Visualizing the Popliteal Vein? Reposition the patient to an upright sitting position with their leg hanging off the bed. This can maximize venous filling and improve visualization.

DON’T #1: Misinterpret the Superficial Femoral Vein (SFV)

• Beware of the misnomer! The term “superficial femoral vein” is misleading — clots here are true DVTs!¹
• While the SFV is anatomically more superficial than the deep femoral vein (DFV), it is part of the deep venous system. To avoid confusion, this vein is now referred to as the femoral vein (FV).

DON’T #2: Ignore Your Pre-Test Probability

• Clinical context matters!
• Low-Risk Patients: Did you know you can rule out a proximal DVT in a low-risk patient without ordering a D-dimer?³
• High-Risk Patients: A negative DVT PoCUS in a high-risk patient with a positive D-dimer requires a repeat ultrasound in one week to rule out proximal extension.
• Need a Clinical Algorithm? Check out Rosen’s Figure 74.6 for practical guidance

Looking Ahead

• Exciting news for PoCUS enthusiasts!
• In January, our PoCUS team will release a comprehensive handbook on performing a Two-Zone DVT PoCUS. This detailed guide will walk you through the steps for a high-quality scan.
• For hands-on learning with real patients, join us at the Ottawa PoCUS Symposium on February 14, 2025. Don’t miss this opportunity to refine your skills and learn from leading experts.