Calf vein imaging for the newer techs – you got this
- Don’t panic – they are only veins – you’ve been looking at them for years.
- To begin, place your probe in the transverse position at the base of the gastrocnemius muscle medially – this is usually the best view of the four vessels.The posterior tibial veins are nestled near the tibia bone and are more anterior than the peroneal veins.The peroneal veins lie posterior to the posterior tibial veins somewhere between the tibia and fibula.
- Once you’ve identified the vessels, perform compressions to the knee and again from the base of the gastrocnemius muscle to the ankle.Obtain the best compression image of all four vessels – this can be accomplished with one image usually.
- If the peroneal veins are difficult to image from the medial calf, have the patient rotate their leg in the opposite direction and place the probe on the distal lateral calf – the peroneal veins will now be more anterior than the posterior tibial veins and will be more easily imaged.If you use this approach be sure to annotate the vessels properly.Use the terms “lateral view” or “posterior view”.
- Once you’ve obtained compression images, place the probe medially at the base of the gastrocnemius muscle in the longitudinal position.Turn the color on and obtain color filling images.Ideally, you want one image of all four vessels.Rotate the probe around the calf while compressing distally until you see the four vessels and obtain the best image.Ideally doesn’t always happen however -if you see the vessels on different planes take more representative images, labeling “PTV #1” or “PTV#2” as needed.
- Some patients are just difficult to image in the calf secondary to body habitus, edema, cellulitis , etc. – in those instances just get what you can and write in your report “Limited calf vein visualization – vessels patent where seen” and move on.
- If the calf veins are positive, it will be very obvious to you, and with practice the calf veins will be very easy to image and will elongate your study only briefly.
- Also obtain a compression image of the gastrocnemius veins.I usually get that image after completing the views of the popliteal vein.Scan through the muscle and take the image that includes most of the vessels – only one compression image is required.And again, if positive it will be very obvious.