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I do agree that if a patient has reflux in reverse Tberg, they will have it erect but the reverse is not true. And I would add that even standing, I have been unable to initially elicit reflux in vessels that indeed have reflux after a person has been standing for a while! Several studies have shown reflux is worse at the end of the day! People do not have venous reflux lying down! There is a lot we do not know about venous hemodynamics. Bill Schroedter
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-----Original Message-----
From:         Doug Marcum <[log in to unmask]>

Date:         Mon, 4 May 2009 19:38:44 
To: <[log in to unmask]>
Subject: Re: Step for venous insufficiency testing


Bobby,

Maybe I was vague in asking matt about his protocol.  Humbly,  I  
wasn't asking for pointers,  I was just surprised that it is not  
standard protocol to stand a patient if negative in reverse t-berg.  I  
would now have to ask ... How steep are you talking.   On a daily  
basis I scan patients starting in 30-40 degrees reverse tberg and they  
may elicit positive truncal vein(s) but negative perforator(s) that  
are found positive while standing.   I feel if any vessel is negative  
in supine/rev t-berg they should be stood up.

Doug Marcum RDMS,RDCS,RVT(APS)
Advanced Ultrasound Consultants
Elite Solutions for Vein Therapy/ Insufficiency Scanning and On-Site  
Education
P: 321.231.2191
F: 407-971-4775
www.advancedusconsultants.com
[log in to unmask]
Sent from my iPhone

On May 4, 2009, at 5:50 PM, Bobby Chacko <[log in to unmask]> wrote:

> If a patient is negative for reflux in the reverse trendelenberg  
> position, and then you repeat the test subsequently with the patient  
> standing up to maximize hydrostatic pressure, has the patient ever  
> been positive?
>
> I have never had a patient that was negative for reflux in reverse  
> trendelenberg, but be positive when I stand them up. What I have had  
> are two patients that passed out on me while I reluctantly asked  
> them to stand during the test - one of whom hit their head on the  
> adjacent wall before she hit the floor. For me, the risk ain't worth  
> the reward...
>
> bobby~
>
> Date: Mon, 4 May 2009 16:48:02 -0400
> From: [log in to unmask]
> Subject: Re: Step for venous insufficiency testing
> To: [log in to unmask]
>
> Matt,
>
> Out curiosity,  if a patient is normal in reverse trendelenberg you  
> don't attempt to ellicit reflux while standing?
>
> D
>
> Doug Marcum RDMS,RDCS,RVT(APS)
> Advanced Ultrasound Consultants
> Elite Solutions for Vein Therapy/ Insufficiency Scanning and On-Site  
> Education
> P: 321.231.2191
> F: 407-971-4775
> www.advancedusconsultants.com
> [log in to unmask]
> Sent from my iPhone
>
> On May 4, 2009, at 3:11 PM, "Smith, Matthew G." <[log in to unmask] 
> > wrote:
>
> We simply scan patients in a reverse trendelenburg.  Standing is a  
> last resort.  Rarely any issues in demonstrating reflux, I’m not sur 
> e why there’s such a push to stand patients for this exam, when  
> it’s rarely necessary.
>
> Matt
>
>
>
>
>
>
>
> -----Original Message-----
> From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of  
> Kathy Munson
> Sent: Monday, May 04, 2009 11:47
> To: [log in to unmask]
> Subject: Re: Step for venous insufficiency testing
>
>
>
> I agree.  It is also helpful if you have enough staff, to have one  
> person augment while the other person catches the image and handles  
> the knobs.
>
> K
>
>
> -----Original Message-----
> From: Denise Levy <[log in to unmask]>
> To: [log in to unmask]
> Sent: Sun, 3 May 2009 6:07 pm
> Subject: Re: [UVMFLOWNET] Step for venous insufficiency testing
>
> Have them wear a helmet for protection when the patient get vaso- 
> vagal...passes out.
>
> Prior to my current place of employment,  a patient was sent to the  
> ER with a head injury, because they stood a patient for over an hour  
> for a venous insufficiency and they passed out cold without  
> warning. ... I had several male patients pass out 3 years ago, vaso- 
> vagal sitting in a chair!!! We were one of 5 centers in the country  
> doing a study/research with VNUS for 3 years and I followed all the  
> cases. Several of my male patients get a cold cloth on the face to  
> ease their faintness and I had to talk them through their anxiety of  
> repeating their history of vaso-vagal with past visits to the lab.
>
>
>
> We have a bed with a foot board and chest strap to hold them  
> upright. See Joan Baker's site.
>
> Or happy landing for some of your patients.
>
> Oh and get plenty of ice for your sore neck, back and shoulder...The  
> position is a killer of vascular technologist..
>
>
>
> I've been there and the bed is the best way to go. Stand them up  
> with support.
>
> Denise Levy
>
> RVT, RDMS, RCDS
>
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