Changes: The Latest Revisions To The ICAVL Standards
[continued]
from
the November 2007 issue |
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Peripheral
Arterial Testing
Related
to required documentation of examination, the gray scale specifications
for abdominal aortic duplex were strengthened:
Documentation
of aneurysms, if present, must include the widest size of
the aorta measured outer wall to outer wall. Additional images
proximal and distal to the aneurysm must be recorded.
Peripheral Venous Testing
For
the purpose of clarification, an introductory paragraph was
added to the beginning of this Standards document:
At
a minimum, accreditation in Peripheral Venous Testing requires
that the laboratory possess a protocol and the ability to
assess for deep venous thrombosis. Diagnostic venous examinations
may be modified for other indications such as venous reflux
and venous mapping.
The
required characteristics for venous plethysmography instrumentation
have been enhanced:
1.2.1.1
All strain gauges, pneumatic cuffs, electrodes, tourniquets,
and/or other devices must be applied, inflated, and/or tightened
appropriately.
1.2.1.2
Sensors must be properly connected to the instrument used.
1.2.1.3
The instrument must be capable of providing a permanent recording.
The
techniques for examination performance standard 3.1.1 now specify
that long axis spectral Doppler evaluation be performed.
The
most significant change to the Peripheral Venous Standards involves
separating duplex testing for venous reflux from obstruction
(DVT). The Standards now describe the different testing
techniques for both, whereas in the past only obstruction was
discussed.
Related
to techniques of examination performance:
3.1.1.3
Both gray scale imaging and Doppler information must be used
to assess venous anatomy and blood flow.
3.1.2.2
For assessing venous patency, the entire length of the vein
must be evaluated.
3.1.2.3.1
For reflux examinations, patients must be evaluated in a
standing or sitting position.
3.1.2.7
Appropriate indication-specific duplex techniques and measurements
3.1.2.7.1
Testing for obstruction using proper transverse compression
technique
3.1.2.7.2
Testing for reflux using proper reflux-producing techniques
3.1.3.1.1
The protocol must describe the techniques and maneuvers
used to assess obstruction, reflux, calf muscle pump function,
and/or any other specific venous pathology that may be evaluated
using plethysmography.
3.1.3.1.2
When assessing reflux, venous refilling time is measured
and recorded in response to passive emptying or calf muscle
exercise.
3.1.3.1.4
Occluding cuffs and/or tourniquets as well as any sensing
devices must be placed appropriately on the extremity.
The
standard for documentation of examination performance has been
expanded:
3.2
Peripheral venous duplex ultrasound examinations must be comprehensive
and include standard components that provide sufficient documentation
for interpretation. The components of an examination vary
depending upon the indication(s) for testing (e.g., evaluation
for deep vein thrombosis (DVT) or obstruction, vein mapping,
reflux, assessment of calf muscle pump or others). When testing
is tailored to specific indications, a written protocol for
evaluating each type of examination must be provided.
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