Ch 3: Using Tumescent Successfully

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

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Use a 30-gauge needle to make a skin wheal

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Chapter 3 Using Tumescent Successfully

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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

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Note completed wheals

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Chapter 3 Using Tumescent Successfully

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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

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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

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Chapter 3 Using Tumescent Successfully

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Chapter 3 Using Tumescent Successfully

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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

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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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