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Veritas De Vena Truth Concerning Veins

Dr. Ronald Bush, MD FACS

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Chapter 3 Using Tumescent Successfully Ron Bush, MD, FACS

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Chapter 3 Using Tumescent Successfully Tumescent Concentration 440 ml 0.9 Normal Saline 16 ml Sodium Bicarbonate 60 ml 1% xylocaine with epinephrine Safe dose is up to 35 mg/kg, which equates to 3,500 ml. The average total tumescent used for a thermal ablation is 350 ml -500 ml. The only anesthetic needed for every procedure done in ambulatory venous surgery. Uses: Thermal Ablation Ambulatory Phlebectomy Tips: • • • • • • • •

Never use undiluted xylocaine for any vein procedure. Do sequential skin wheals with tumescent before you start ablation. To administer tumescent into the saphenous sheath, go through the previously placed skin wheals. This is much more comfortable for the patient. Use a 3-ml syringe with a 30-gauge needle to make your skin wheals 2 syringes usually makes 6-7 skin wheals Skin wheals should be 3-5 inches apart Total dose used for an ablation should be under 500ml Safe dose is up to 3L in a normal person. However, if you are over 1L, you should consider another line of work.

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Chapter 3 Using Tumescent Successfully

Copyright ©  2012  by  www.veinexperts.org        

Use a 30-gauge needle to make a skin wheal

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Chapter 3 Using Tumescent Successfully

Copyright © 2012 by www.veinexperts.org     The size of the skin wheal is no larger than a dime. If it is placed too deep you will not have a nice raised wheal and you will not have sufficient analgesia for the skin. Place the wheal exactly in the center of the probe, which has the saphenous in a transverse midline

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Chapter 3 Using Tumescent Successfully

Copyright © 2012 by www.veinexperts.org

  Note completed wheals

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Chapter 3 Using Tumescent Successfully

Copyright © 2012 by www.veinexperts.org

Tumesecent  being  administered  deeply  in  the  saphenous  sheath.  Note  the  access  point  is  through  the   previously  placed  wheal.          

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Chapter 3 Using Tumescent Successfully

Copyright © 2012 by www.veinexperts.org

  US  showing  tumescent           Ambulatory  Phlebectomy         • Mark  your  phlebectomy  with  a  skin  marker  over  each  bulge.   • Make  a  small  skin  wheal  with  tumescent.   • Using  a  20-­‐gauge  needle  and  a  30-­‐ml  syringe  then  pierce  the  skin  wheal   • Needle  should  be  less  than  1  inch  below  the  skin  surface   • Administer  fluid  under  mild  pressure  2-­‐3  inches  on  each  side  of  your  marks   • Connect  all  skin  wheals  with  tumescent  

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Chapter 3 Using Tumescent Successfully

Copyright ©  2012  by  www.veinexperts.org    

 

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Chapter 3 Using Tumescent Successfully

Copyright ©  2012  by  www.veinexperts.org    

     

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Chapter 3 Using Tumescent Successfully

Copyright ©  2012  by  www.veinexperts.org     This  is  as  deep  as  you  need  to  go.    Mild  pressure  will  diffuse  the  solution  adequately    

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Chapter 3 Using Tumescent Successfully

Copyright © 2012 by www.veinexperts.org

Needle  needs  go  no  further  than  shown  by  hemostat  on  the  needle.  This  gives  good  perivenous   anesthesia.          

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Chapter 3 Using Tumescent Successfully

Copyright ©  2012  by  www.veinexperts.org     Phlebectomy  being  done  and  notice  the  blanching  around  the  marked  veins.  This  is  vasoconstriction  from   tumescent.            

You should have a painless and bloodless phlebectomy if you follow these suggestions.

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Ch 3: Using Tumescent Successfully  

Everything you need to know about using tumescent for venous procedures

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