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Discussion

Dopplering Pulses--

Had a patient who had a revascularization and we were Doppling the pulses.

Long story short, the patient was perfusing. The surgeon came in the next morning and said that one of the pulses we were getting was "arterial" and one (the pedal) was "venous".

I thought he was putting me on.

I always thought that any pulse that's Doppled via the little handheld machine on the floor, is an arterial one. I was taught that veins don't have pulses, therefore the sound had to be arterial.

I tried to get him to tell me more, but he didn't, so now I'm coming to you experts.

First, is there such a thing as a "venous" or an "arterial" pulse, and if so, what's the significance of each?

I need to stress that I am not talking about the ultrasounds of the veins or arteries; I'm talking about the little handheld machine like this:

Doppler_Sono_klein.JPG

http://www.dr-hammer.de/Untersuchungen/Doppler/Doppler_Sono_klein.JPG

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  • Admin

Angie, I've heard the venous "pulse," although it's more of a constant flow rather than a "whoosh" with each beat. I don't hear the beats, just a constant "whoooooooooooooooooooooooooooooooosh."

I'll usually find the DP about an inch prox to where the toes begin, just lateral of center. If I have trouble locating the PT, I will usually go beneath the bone, find the vein's sound and then angle a little more away from the bone, posterior. Or, I'll try more distal to the bone, toward the heel (as the artery kind of curves around following the shape of the heel).

I'm surprised he thought you heard the vein, as they sound different, and I'm sure you know what the artery sounds like . . . strange.

Never heard of a venous pulse. Whooshing yes. I guess we need more experts to answer. I have heard blood flow with doppler but pulses I believed were arterial.

The only way the vein could pulse is if the surgeon created an arteriovenous fistula. These are (usually) done in the arm for dialysis patients.

Angie,

I can tell you that the venous doppler is different than the arterial doppler. When you hear a venous doppler it's a constant whooshing sound, although you may hear what our practice refers to background 'artifact' that can be mistaken for an arterial sound.

Arterial dopplers have three classifications monophasic, biphasic, and triphasic. Each one sounds just like its description, depending on how many 'whooshes' you hear. Most individuals have a biphasic tone 'whoo-whoosh'. Triphasic 'whoo-sho-sh' is the best of the three, which depicts optimal blood flow, and monophasic 'whoosh' being simply adequate blood flow.

When you hear a venous doppler, you won't hear the actual 'whoosh', its more of a constant 'whhoooo'.

Sorry for my elementary explanations and descriptions, but it's the best I can do via the internet.

Hope this helps!!

:idea:

We call it the "venous Hum!"

  • Admin

All accurate descriptions of that continuous sound heard by dopplering the vein! It's not a pulse, but a continuous noise.

  • Author

Well, we now have a raging debate going on at work over this.

The surgeon made it sound like the venous noise was actually pulsation, and I definitely heard pulsating whooshes, just not quite as snappy as in other areas of the foot.

I think we nurses are hung up on the premise that veins don't pulse, and how could even a venous flow be a bad thing (not that this was said outright, but it was implied by the doc that the "venous" sound at the dorsalis pedis was not optimal). My premise was that you could not have "venous" movement without an arterial pulse somewhere. After all, what propels the blood if there is no arterial movement?

Your thoughts?

Angie,

I know that when you doppler a vein, you are within proximity of the artery, and sometimes you can/will hear the pump of the artery, but venous doppler don't have that quote-unqoute pumping 'whoo-whoosh' sound.

There is a distinct demarkation b/t arterial and venous, and unless we have a doppler in front of us to demonstrate it's really hard to explain. Sorry:o

  • Admin

Venous flow is a good thing, but it is not an indicator that the artery the surgeon is interested in is working. Venous flow can be present, yet the muscle can be supplied (albeit at very reduced levels) by collaterals (the body is wonderful at developing creative re-supply to the muscle).

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