The whole test is one move: put a vein in the middle of the screen and press until the walls touch. If they touch, no clot at that spot. If they don't, that's a DVT until proven otherwise.
The skill isn't the compression — it's compressing every 1–2 cm through both regions without skipping the spots where clot actually lives.
Curated from the POCUS 101 DVT Ultrasound Made Easy: Step-By-Step Guide. Their labeled vessel-anatomy images and compression clips are the fastest way to lock in the landmarks.
Vascular/venous preset. Vein in transverse (short axis) — compression is only interpretable in short axis.
Supine, hip externally rotated, knee slightly bent. Reverse Trendelenburg or head of bed up 30°–45° distends the veins and makes everything easier to find.
Press until the vein walls completely touch. The artery should just start to deform — that's proof you pushed hard enough.
Transverse at the inguinal crease · vein medial to artery
Start at the inguinal ligament. The common femoral vein (CFV) sits medial to the pulsatile common femoral artery. Begin compressing 1–2 cm above the saphenofemoral junction.
Compress every 1–2 cm · saphenofemoral junction → bifurcation
March distally through the saphenofemoral junction (where the great saphenous dives into the CFV) and on through the CFV's split into the femoral and deep femoral veins, continuing 1–2 cm below the bifurcation.
Knee bent · probe in the crease · vein superficial to artery
In the popliteal fossa the vein sits on top of (superficial to) the artery — "pop on top." Start at the proximal popliteal vein.
Every 1–2 cm · popliteal vein → calf vein confluence
Continue compressions distally until the popliteal vein splits into the calf veins (anterior tibial, posterior tibial, peroneal). That confluence is the end of the exam.
| What you see | Read | Notes |
|---|---|---|
| Full coaptation | normal | Walls touch completely at every station in both regions |
| No coaptation | DVT | Even with an anechoic lumen — fresh thrombus is often invisible |
| Soft, deformable filling | acute clot | Acute thrombus squishes but won't let walls meet; vein often distended |
| Rigid, echogenic material | likely chronic | Non-deformable, brightly echogenic, small contracted vein — post-thrombotic change; compare with priors |
| GSV clot at the junction | treat seriously | Superficial vein, but proximity to the CFV changes its behavior |
Color Doppler and augmentation are adjuncts, not the test. If compression is equivocal, get the formal study — don't Doppler yourself into confidence.
An inguinal node in cross-section looks exactly like a vein with clot. Turn the probe: a node is a discrete oval that disappears in long axis; a vessel is a tube that keeps going.
The most common false positive is timid compression. Your internal check: the artery should visibly start to deform. No arterial deformation, no valid negative.
Two regions leaves the mid-thigh unscanned, and isolated femoral vein DVTs do occur. When pretest probability is high, extend the compressions down the thigh or arrange the formal study.
The vessel formerly called the "superficial femoral vein" is a deep vein. A report of clot there is a DVT that needs treatment — the old name has caused real misses.
Angled pressure slides the vein sideways instead of closing it and fakes non-compressibility. Stack the probe straight over the vessel, push straight down.
Posterior knee pain with a negative compression exam? Look for the crescent of fluid tracking from the joint — a ruptured Baker's cyst mimics DVT clinically and sits right in your popliteal window.
A starting template for the POCUS note. Text in brackets [ ] and pick-lists in { } are fields to complete. Save it as a SmartPhrase, then edit every field to match the actual study.
POINT-OF-CARE ULTRASOUND: LOWER EXTREMITY DVT
Indication: {leg swelling / pain : suspected PE} [side ***]
Exam type: Focused / limited, 2-region compression
Operator: @ME@ Interpretation: independent, real-time
Probe: linear
FINDINGS ([right : left] leg)
- Common femoral vein: {fully compressible : non-compressible}
- Saphenofemoral junction / bifurcation: {compressible : non-compressible}
- Popliteal vein to trifurcation: {compressible : non-compressible}
- Echogenic intraluminal thrombus: {none : present [***]}
IMAGE QUALITY: adequate / limited by [***]
Images saved and archived to [PACS / Qpath / ***].
IMPRESSION: {no evidence of proximal DVT in the regions examined :
proximal DVT identified [location ***]}. Limited 2-region study; does
not assess calf or mid-femoral vein segments.
I personally performed and interpreted this study.
Electronically signed: @ME@ @TD@ @NOW@
Sample template only — not a validated institutional SmartPhrase. Verify wording, image-archival, and attestation requirements against your department's POCUS credentialing, coding, and compliance policies before clinical use. Documentation supports, but does not replace, the medical record and QA workflow.