Ch 3: Using Tumescent Successfully

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Everything you need to know about using tumescent for venous procedures

Text of Ch 3: Using Tumescent Successfully

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    Veritas De Vena

    Dr. Ronald Bush, MD FACS

    Truth Concerning Veins

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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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