3 Point Compression Ultrasound (3PCUS) For Lower Extremity DVT

As an intensivist, I’m always looking for ways to utilize ultrasonography to rule out/in pathologies on my differential. Rather than ordering lower extremity Doppler ultrasounds for every patient (a study that is costly from a time, financial, and human resource standpoint), I perform a three-point compression ultrasound (3PCUS) to rule out most proximal lower extremity deep vein thromboses (DVTs). The premise is that since veins are low-pressure conduits, they should be easily compressed with pressure applied by the ultrasound transducer. Lack of compression may suggest that the venous pressure is high or there is a mechanical blockade within the vessel itself.

I’ll start with the lower extremity in a “frog-leg” position and scan, from proximal to distal, the common femoral vein (CFV), sapheno-femoral junction (SFJ), and popliteal vein (PV). At each point, I’m compressing and releasing the vein to rule out an occlusive DVT at that point.

In situations with difficult anatomy or questionable findings, I’ll absolutely ask my ultrasound technician colleagues for assistance by ordering a formal exam.

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