Hi Susan,
Yes, you are right.  04/10 ICAVL standards ( indicate that the evaluation for venous reflux must be in a standing or sitting position.  It does not indicate a reverse Trendelenberg position is acceptable.
We have a patient exam bed that converts to a sitting position.  When it's necessary to stand the patient, we elevate the bed so that the patient can use it for support on one side, have them step onto a footstool having an arm (to support the patients other side) and have them place all their weight on the leg not being examined.  We have them face the sonographer for this part of the exam. 
I find that the patients in our facility that tend to black out are younger, and more normal weight.  You have to prepare them ahead of time, so that if they start to feeling funny, they instantly tell you.  When it happens (vasovagal symptoms), it happens fast.  We instantly have them sit down (or if they are already sitting down), and then tilt them with their feet elevated above their heart.  Then we call for the nurse.
Patients are of all sizes, having veins of all sizes.  Sometimes reflux is in small veins (markedly less than 5 mm).  Even that is treatable.  It answers a question for the patient and the referring physician.  Do they have reflux and where is it?  Even if the only treatment were compression stockings, it is important information.
For markedly obese patients, we have them hold up their abdomen.  Our MD has suggested, taping it up (to the pt bed), but we've not have had to resort to that.  I understand that is sometimes necessary to do that in the venous proceedure.  We also use the curved deep probe, normally used for abdomen penetration, for the obese pt (popliteal through CFV) evaluation.
We do not have the rapid cuff inflation/deflation system.  We do not phace ourselves in a contortionist position to squeeze the patient's calf.  Instead we as the patient to flex his foot, not moving his leg.  It does the periphral augmentation very nicely.  Occasionally, we have patients with their ankle immovable, then we ask for help.  Someone else needs to quickly and firmly squeeze the calf, while we hold the probe over the vein with the patient standing.
Mary Samocha, BS, RVT
VeinCare Centers of TN

-----Original Message-----
From: Case, Susan <[log in to unmask]>
To: UVMFLOWNET <[log in to unmask]>
Sent: Mon, Feb 7, 2011 11:46 am
Subject: Venous Reflux and ICAVL requirements

I am trying to find our how people are doing venous reflux exams these days. The ICAVL mandates that patients must be sitting or standing to perform the studies. Does anyone have any suggestions that do not necessitate purchasing new equipment?
Susan Case RDMS/RVT
Noninvasive Vascular Lab
Summa Health System
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