In my department middle grades, consultants and senior nurses do the
venometry. It is available 24/7 but in real life very few DVTs
present in the early hours of the morning. Although v easy you need
to use the venometer regularly to keep a low false positive rate.
Katherine Henderson
A&E Consultant Homerton
Quoting Fred Cartwright <[log in to unmask]>:
> --- Steve <[log in to unmask]> wrote:
> > Doppler ultrasound is used by many trust as the
> > investigation of choice. The
> > problem with this is that below knee dvt cannot be
> > accurately diagnosed and
> > is operator dependant. DVT the cause of PE in 90% of
> > cases but only found in
> > 50% of cases by doppler!
> >
> I understand from the radiologists that Compression
> U/S will be taking over from Doppler and is much less
> operator dependant.
>
> > Venometry seems to be a useful screening tool it has
> > similiar positive
> > prediction to d-dimers and has the advantage of
> > testing the anatomical
> > location.
> >
> > Therefore it does seem that d-dimer plays fourth
> > fiddle and therefore can be
> > disregarded in dvt protocols although is an
> > important test when excluding
> > PE- but remember less than 10% of the elderly will
> > ever have a negative
> > d-dimer.
> >
> > So the question in dvt is why do we need to diagnose
> > dvt? If you want to
> > prevent post thrombotic symptoms in all concerned
> > then you are unlikely to
> > succeed, however if you are only worried about
> > pulmonary embolus than you
> > are concerned with diagnosing clinically significant
> > disease and not all
> > dvts.
> >
> > Therefore bin d-dimers.
> > Screen with venometry (strain gauge)
> > If positive doppler
> > If positive treat, if negative in venometry or
> > doppler re-evaluate in 5-7
> > days.
> >
> A few questions.
> Who does the venometry?
> Is it available 24/7 or at least 8/7?
> What do you do with patients in plaster?
>
> We had a young man die of PE who developed a DVT while
> in POP!
>
> Thanks,
> Fred.
>
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