Clinical Ultrasound in Covid-19
Ultrasound can be used in the assessment of lung, but also for determining if the patient has a deep vein thrombosis (DVT).
This section will provide resources to support your learning in these two areas.
2. Leg ultrasound for DVT
As Covid-19 can cause hyper-coagulation in some severe and critical cases (Klok et al, 2020; Levi et al, 2020) you might be asked to scan a patient for suspected deep vein thrombosis (DVT). Before undertaking such an examination you need to make sure you have the appropriate skills and competency to do this. The research is still unclear and there are theories that potentially the pulmonary clots develop within the lungs rather than being embolitic in nature. Patients often have high D-dimer levels and other markers (Zhou et al 2020).
Depending on the circumstances you may be able to complete a full examination of the limb including compression, colour Doppler +/- spectral Doppler. If resources are limited or the patient is in intensive care and difficult to scan a more focused assessment may be required. This will have limitations and it should be recognised in the report.
This section contains basic resources about ultrasound assessment for DVT.
Equipment needed:
- Real-time ultrasound machine
- Pulse wave Doppler
- Colour Doppler
- B-mode ultrasound of the deep veins of the limb
- Compression, to determine whether the vessel collapses completely (used with care/excluded if thrombus is seen within the vessel)
- Pulse wave Doppler and Valsalva technique
- Colour Doppler to assess filling of the vessel.
- Appropriate PPE
- Sterile gel sachets
- Possible probe cover
- Preparation of the machine
- Decontamination following the examination using manufacturer approved processes.
| Ultrasound examinations should only be carried out by a competent and trained health care professional, with appropriate audit to ensure safe, competent on-going practice. |
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References:
Klok, F. A., Kruip, M., van der Meer, N., Arbous, M. S., Gommers, D., Kant, K. M., Kaptein, F., van Paassen, J., Stals, M., Huisman, M. V., & Endeman, H. (2020). Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thrombosis research, S0049-3848(20)30120-1. Advance online publication. https://doi.org/10.1016/j.thromres.2020.04.013
Levi, M., Thachil, J., Iba, T., Levy, J. (2020) Coagulation abnormalities and thrombosis in patients with COVID-19. The Lancet Haematology, 0 (0) doi:10.1016/S2352-3026(20)30145-9. Available at: https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(20)30145-9/fulltext
Zhou, F., Yu, T., Du, R., et al. (2020) Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. S0140-6736 (20)30566-3. Available at: https://www.sciencedirect.com/science/article/pii/S0140673620305663