1. NECK/ARM VENOUS ULTRASOUND – SONOGRAPHER WORKSHEET
Patient Name: __________________
Patient MRN: __________________
(Your Hospital Logo)
NECK/ARM VENOUS ULTRASOUND – SONOGRAPHER WORKSHEET
Current Date: __________ Comparison Date: __________ Age: ________ Sex: F M
VEIN
RIGHT
LEFT
Patent
DVT non-occl
DVT
occl.
Internal jugular (IJ)
Brachiocephalic (Bc)
Subclavian (Sc)
Axillary (Ax)
Brachial (Br)
Basilic (Bsl)
Cephalic (Ce)
RIGHT
LEFT IJ IJ Sc Sc Ce Ce Bc Bc Ax Ax
SVC
Catheter:
☐No ☐Yes, Location(s):
COMMENTS:
Bsl
Bsl Br Br