What is a DVT (Deep Vein Thrombosis) ultrasound in the home called?

Point-of-Care Ultrasound for DVT in the Home Setting

Point-of-care ultrasound (POCUS) is the term used for DVT ultrasound performed in the home setting. This refers to clinician-performed and clinician-interpreted bedside ultrasound examinations that can be conducted outside traditional imaging departments 1.

Types of DVT Ultrasound Protocols

The Society of Radiologists in Ultrasound (SRU) recognizes several protocols for DVT ultrasound examination 2:

1. Complete Duplex Ultrasound (CDUS) - The gold standard protocol that includes:

   • Compression ultrasound from common femoral vein to ankle
   • Color and spectral Doppler of common femoral veins on both sides
   • Color and spectral Doppler of popliteal vein on symptomatic side

2. Extended Compression Ultrasound (ECUS) - The recommended point-of-care protocol:

   • Compression ultrasound from common femoral vein through popliteal vein to calf veins confluence
   • Recommended when CDUS is not available
   • Preferred over 2-region ultrasound

3. 2-Region Ultrasound - A limited protocol examining femoral and popliteal regions

POCUS for DVT in Home Settings

When performing DVT ultrasound in the home setting (POCUS), the SRU consensus recommends the Extended Compression Ultrasound (ECUS) protocol 2. This approach is preferred because:

• It can detect isolated femoral vein thrombosis (present in 5-7% of DVT cases)
• It provides a reasonable balance between thoroughness and practicality
• It can be performed with portable ultrasound equipment

Important Considerations for Home DVT Ultrasound

1. Follow-up Requirements:

   • A negative ECUS requires follow-up with CDUS in 5-7 days 2
   • This is because the calf is not evaluated in the ECUS protocol

2. Diagnostic Accuracy:

   • POCUS has demonstrated high sensitivity (93%) and specificity (93%) for DVT detection 3
   • Positive predictive value of 83% and negative predictive value of 97% 3

3. Time Efficiency:

   • POCUS can significantly reduce disposition time compared to waiting for radiology-performed ultrasound 4
   • This allows for more rapid diagnosis and treatment initiation

4. Training Requirements:

   • Adequate training and experience with normal and abnormal studies are necessary 2
   • Standardized education protocols are needed 1

Limitations of Home DVT Ultrasound

• Cannot reliably detect iliocaval DVT (above the groin)
• Limited evaluation of calf veins
• Operator dependent
• May miss isolated calf DVT

Clinical Pathway for Home DVT Ultrasound

1. Assess pretest probability using Wells score
2. Consider D-dimer testing for patients with low pretest probability
3. Perform ECUS if ultrasound is indicated
4. If ECUS is negative but clinical suspicion remains high, arrange follow-up CDUS within 5-7 days
5. If ECUS is positive, initiate appropriate treatment and arrange follow-up CDUS to map the entire venous system

By following this approach, POCUS for DVT in the home setting can provide timely diagnostic information while ensuring patient safety through appropriate follow-up.