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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From: Doug Marcum <[log in to unmask]>
Date: Mon, 4 May 2009 19:38:44 -0400
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]
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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]
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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 sure 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 OfKathy 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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