Upper Extremity Arterial Protocol
Protocol
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For the left side arterial system, begin the protocol at the subclavian artery central.
Scan the entire arm without lifting the transducer following the vessels in their entirety and taking the
appropriate images at the described locations.
Patient set-up
o Patient set-up is very important for ease of completing the examination for the sonographer and
patient
o This is exam requires you provide the patient a place to rest the arm being evaluated.
 If available, a hospital food tray covered up with a towel works great.
o Have the patient turn their neck slightly to the opposite side of the arm being evaluated and
have the arm abducted slightly from the body with the palm facing up.
Do not remove bandages unless you have asked permission from the nurse first.
o If the patient has a PICC line, DO NOT remove the bandage
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Color Doppler
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Will vary with the presence/absence of pathology & curvature of the vessel
Make sure your color images relay the same information as your Gray scale & Spectral images
Utilize preset Color PRF (scale) and adjust according to the type of blood flow (velocities) being image
o If flow is normal and the color is outside the vessel wall or blooming in center of vessel slowly
increase PRF until color is no longer outside the vessel wall or blooming.
o If flow is normal and the color in the vessel is not filled in slowly decrease PRF until the color fills
the vessel
o Color box should be steered (angled) with vessel direction
Spectral Doppler
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Must use angle correct
Angle correct must be less than 60 degrees
Gate (SV length) must be in center of vessel & small width
Adjust your PRF (scale) to display a large waveform that has a clear spectral window and measure the
highest peak systolic velocity
Set the PRF(scale) appropriately for the velocities imaged.
Plaque Present (surface irregularities)
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Document plaque in transverse & sagittal planes
Do not adjust your gray scale (TGC) to display a complete anechoic vessel
Demonstrate blood flow around plaque with Color Doppler
If there is a stenosis
o A mosaic of color will be displayed
o Evaluate stenosis with Spectral Doppler for highest velocity by placing cursor in the stenotic
area
o Record and measure highest peak systolic velocity
o Record velocities in normal area of vessel approximately 2cm prior (prestenotic) and after
(poststenotic) the area of stenosis
o Significant stenosis is considered if the flow in stenotic area is twice the velocity of an area just
previous (prestenotic flow) to it
Upper Extremity Arterial Protocol
Structure
Innominate with
Carotid and
subclavian
bifurcation
Scan Plane
Sagittal
Label
RT INN, CCA, SUB
RT INN, CCA, SUB
Subclavian Artery
Central
Sagittal
RT SUB A Central
Subclavian Artery
Mid
Sagittal
RT SUB A Mid
Subclavian Artery
Peripheral
Sagittal
RT SUB A Peripheral
Axillary Artery
Sagittal
RT AXILLARY A
Brachial Artery
Sagittal
RT BRACHIAL A
Radial Artery
Sagittal
RT RADIAL A
Ulnar Artery
Sagittal
RT Ulnar A
RT INN
Images Stored
Gray scale innominate, CCA and subclavian Bif
Color Doppler innominate, CCA and subclavian
Bif
Color and spectral Doppler measure peak
systolic & end diastolic velocity
Gray scale sub a central
Color Doppler sub a central
Color and spectral Doppler measure peak
systolic & end diastolic velocity
Gray scale sub a mid
Color Doppler sub a mid
Color and spectral Doppler measure peak
systolic & end diastolic velocity
Gray scale sub a mid
Color Doppler sub a mid
Color and spectral Doppler measure peak
systolic & end diastolic velocity
Gray scale axillary a
Color Doppler axillary a
Color and spectral Doppler measure peak
systolic & end diastolic velocity
Gray scale brachial a
Color Doppler brachial a
Color and spectral Doppler measure peak
systolic & end diastolic velocity
Gray scale radial a
Color Doppler radial a
Color and spectral Doppler measure peak
systolic & end diastolic velocity
Gray scale ulnar a
Color Doppler ulnar a
Color and spectral Doppler measure peak
systolic & end diastolic velocity
Upper Extremity Arterial Protocol
Structure
Subclavian Artery
Central
Scan Plane
Sagittal
Label
LT SUB A Central
Subclavian Artery
Mid
Sagittal
LT SUB A Mid
Subclavian Artery
Peripheral
Sagittal
LT SUB A Peripheral
Axillary Artery
Sagittal
LT AXILLARY A
Brachial Artery
Sagittal
LT BRACHIAL A
Radial Artery
Sagittal
LT RADIAL A
Ulnar Artery
Sagittal
LT Ulnar A
Images Stored
Gray scale sub a central
Color Doppler sub a central
Color and spectral Doppler measure peak
systolic & end diastolic velocity
Gray scale sub a mid
Color Doppler sub a mid
Color and spectral Doppler measure peak
systolic & end diastolic velocity
Gray scale sub a mid
Color Doppler sub a mid
Color and spectral Doppler measure peak
systolic & end diastolic velocity
Gray scale axillary a
Color Doppler axillary a
Color and spectral Doppler measure peak
systolic & end diastolic velocity
Gray scale brachial a
Color Doppler brachial a
Color and spectral Doppler measure peak
systolic & end diastolic velocity
Gray scale radial a
Color Doppler radial a
Color and spectral Doppler measure peak
systolic & end diastolic velocity
Gray scale ulnar a
Color Doppler ulnar a
Color and spectral Doppler measure peak
systolic & end diastolic velocity