What do you consider a very steep trendelenberg? How many degrees?
----- Original Message ----- 
From: "Willis, Chris" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, January 31, 2008 9:03 AM
Subject: Re: Venous insufficiency


Historically, in our lab we had several patients over the years faint on us 
during this procedure.  Standing for long periods of time performing 
forceful valsalva's close to an hour can cause this.  We have since changed 
to the patient supine in a very steep reverse trendelenburg.  This position 
is also better ergonomically with the sonographer.
Just my 2 cents worth............

Thanks

Chris Willis RVT
Coordinator
Vascular Laboratory
Eastern Maine Medical Center
Bangor, Maine 04401
Phone:  (207) 973-7471
Fax:  (207) 973-7450

________________________________

From: UVM Flownet on behalf of Benge, Claudia
Sent: Thu 1/31/2008 11:21 AM
To: [log in to unmask]
Subject: Re: Venous insufficiency



Ruth,

The ICAVL standards state: standing or sitting.  I doubt that we will 
change, at least not at this point.  We were scanning everyone standing up 
all the time.  I am going to make a controversial statement.  For those 
unfamiliar with a thorough venous insufficiency examination and for those 
labs who do not have beds/carts that at least meet the 45 degree reverse 
trendelenberg, standing the patient is the best way.  But also standing the 
patient causes the sonographer a lot of discomfort unless they have a "tall 
venous stand" and you may encounter sonographers that take some shortcuts 
when their arms and shoulders start cramping.



Society for Vascular Ultrasound has a venous insufficiency guideline on 
their website and they make the recommendations of a reverse trendelenberg 
of 15-20 degrees or standing.

The American College of Phlebology recommends unofficially standing the 
patient during the exam.  So there is variation.  I still support how we 
perform the venous insufficiency exam because as of this date, continued QA 
has proven we rarely miss reflux or any sign of phlebitis. (98.5% agreement 
on subsequent follow-up exams)



Claudia A. Benge, RDCS, RDMS, RVT, RVS

Technical Services Director

Decatur Vein Clinic

317 218 2823



-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Myers, Ruth
Sent: Thursday, January 31, 2008 11:02 AM
To: [log in to unmask]
Subject: Re: Venous insufficiency



Claudia- with the new ICAVl standards that state that the patient must be 
done standing for reflux studies, will you change your protocol ( or did I 
mis-read the standards?)

-----Original Message-----
From: Benge, Claudia [mailto:[log in to unmask]]
Sent: Thursday, January 31, 2008 9:27 AM
To: [log in to unmask]
Subject: Re: Venous insufficiency

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