UPPER LIMB VENOGRAPHY

Upper limb venography is a radiographic examination of upper limb veins in which contrast is injected into the veins of wrist to visualize the abnormalities of the forearm and arm veins.

Indication 

• Obstruction in veins due to the blood clot
• Deep vein thrombosis
• Evaluate deep vein valves
• Venous malformation
• Swelling in upper limb

Contraindication 

• Hypersensitivity to contrast
• Blood clotting disorder
• Suspected pregnancy
• The patient have asthma and diabetes

Equipment

• Fluoroscopy unit with tilting table 
• Contrast
• Butterfly needle
• Antiseptic solution
• Syringes
• Tourniquet

Patient  preparation

• The patient should not eat or drink after midnight.
• Patient KFT reports must be reviewed prior to the examination.
• Ask the patient to stop taking anticoagulants before the exam.
• Describe the whole procedure to the patient.
• Ask the patient to remove clothing and wear a hospital gown. 

Procedure

• Place the patient in the supine position.
• Clean the area of the patient foot with an antiseptic solution.
• A tourniquet is applied above the ankle to stop blood flow.
• An intravenous line is inserted into the patient’s arm and sedative medication is given through the line to make the patient relax.
• A butterfly needle is inserted into the superficial vein of the wrist then 40 ml of contrast is injected by hands at the rate of 2-4 ml per second.
• The first series of spot films of the forearm is taken immediately after contrast media administration.
• Ask the patient to perform the Valsalva maneuver to delay the transit of the contrast media.
• The second film of the arm is taken after a few seconds in a relaxing Valsalva maneuver.
• In this position, the veins of the arm the basilic, and the cephalic are filled with contrast media.
• Several films of the arm and the shoulder region are taken in anterior-posterior and lateral projection.
• At the end of the procedure, the needle should be flushed with saline to avoid phlebitis.
• After completion of the examination, the butterfly needle is removed, and the dressing is applied to the puncture site of the foot.

Aftercare

• Keep the patient under observation BP, heart rate injected site swelling and other vital signs should be monitored.

Interpretation

• If the venogram shows blood clots or blockage in the veins, special medicine may be given to dissolve the clot or a balloon angioplasty may be performed.
• To widen the vessels and improve blood flow during the angioplasty a metal stent may be placed by the surgeons.