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Everything you need to know about using tumescent for venous procedures
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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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