ch 3: using tumescent successfully
DESCRIPTION
Everything you need to know about using tumescent for venous proceduresTRANSCRIPT
![Page 1: Ch 3: Using Tumescent Successfully](https://reader030.vdocument.in/reader030/viewer/2022020418/568bd74e1a28ab20349f3a1a/html5/thumbnails/1.jpg)
1
Veritas De Vena
Dr. Ronald Bush, MD FACS
Truth Concerning Veins
![Page 2: Ch 3: Using Tumescent Successfully](https://reader030.vdocument.in/reader030/viewer/2022020418/568bd74e1a28ab20349f3a1a/html5/thumbnails/2.jpg)
2
Chapter 3
Using Tumescent Successfully
Ron Bush, MD, FACS
![Page 3: Ch 3: Using Tumescent Successfully](https://reader030.vdocument.in/reader030/viewer/2022020418/568bd74e1a28ab20349f3a1a/html5/thumbnails/3.jpg)
3
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.
![Page 4: Ch 3: Using Tumescent Successfully](https://reader030.vdocument.in/reader030/viewer/2022020418/568bd74e1a28ab20349f3a1a/html5/thumbnails/4.jpg)
4
Chapter 3 Using Tumescent Successfully
Copyright © 2012 by www.veinexperts.org Use a 30-gauge needle to make a skin wheal
![Page 5: Ch 3: Using Tumescent Successfully](https://reader030.vdocument.in/reader030/viewer/2022020418/568bd74e1a28ab20349f3a1a/html5/thumbnails/5.jpg)
5
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
![Page 6: Ch 3: Using Tumescent Successfully](https://reader030.vdocument.in/reader030/viewer/2022020418/568bd74e1a28ab20349f3a1a/html5/thumbnails/6.jpg)
6
Chapter 3 Using Tumescent Successfully
Copyright © 2012 by www.veinexperts.org Note completed wheals
![Page 7: Ch 3: Using Tumescent Successfully](https://reader030.vdocument.in/reader030/viewer/2022020418/568bd74e1a28ab20349f3a1a/html5/thumbnails/7.jpg)
7
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.
![Page 8: Ch 3: Using Tumescent Successfully](https://reader030.vdocument.in/reader030/viewer/2022020418/568bd74e1a28ab20349f3a1a/html5/thumbnails/8.jpg)
8
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
![Page 9: Ch 3: Using Tumescent Successfully](https://reader030.vdocument.in/reader030/viewer/2022020418/568bd74e1a28ab20349f3a1a/html5/thumbnails/9.jpg)
9
Chapter 3 Using Tumescent Successfully
Copyright © 2012 by www.veinexperts.org
![Page 10: Ch 3: Using Tumescent Successfully](https://reader030.vdocument.in/reader030/viewer/2022020418/568bd74e1a28ab20349f3a1a/html5/thumbnails/10.jpg)
10
Chapter 3 Using Tumescent Successfully
Copyright © 2012 by www.veinexperts.org
![Page 11: Ch 3: Using Tumescent Successfully](https://reader030.vdocument.in/reader030/viewer/2022020418/568bd74e1a28ab20349f3a1a/html5/thumbnails/11.jpg)
11
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
![Page 12: Ch 3: Using Tumescent Successfully](https://reader030.vdocument.in/reader030/viewer/2022020418/568bd74e1a28ab20349f3a1a/html5/thumbnails/12.jpg)
12
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.
![Page 13: Ch 3: Using Tumescent Successfully](https://reader030.vdocument.in/reader030/viewer/2022020418/568bd74e1a28ab20349f3a1a/html5/thumbnails/13.jpg)
13
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.
![Page 14: Ch 3: Using Tumescent Successfully](https://reader030.vdocument.in/reader030/viewer/2022020418/568bd74e1a28ab20349f3a1a/html5/thumbnails/14.jpg)
14