Wholeheartedly agree with Nicole! After 16 years of scanning VI studies, a job where standing the pt is required would be out of the question. I have a bed that puts the pt in a steep RT position, saving my back from another ruptured disc. I’ve never had to stand a pt and I’ve been able to elicit reflux in those that I “know” are there. Valsalva is your friend. 

Regards, 
Kim 


On Feb 6, 2021, at 11:37 PM, Duane Williams <[log in to unmask]> wrote:

So many times I think poor ergonomics come from poor training and no support from the powers that be.  O have been scanning along time and standing people for the last 10 years.  I had great ergonomic training and the people I worked for would get me what I needed within reason.  No special chairs or beds but the right kind of exam stools wirh backs.  Then exam stools with handles so it was as easy to move around as I needed,  I never believed you needed a fancy stair thingamajig.  I think that makes ergonomics worse.  Sitting the patient up on the edge of the bed and put the examined leg up on the Stool. Put your foot up on the Stool as well then rest your elbow on your leg.  Take the strain off make it easy on yourself.   The patient is more at ease since they don't have to stand for so long.  I am 60 and haven't had a career ending injury yet. 


On Sat, Feb 6, 2021 at 10:11 PM, MICHAEL CROWLEY
Hello, 

I completely understand Nicole's comment regarding the ergonomic disaster of scanning a patient in the standing position. The IAC has slightly adjusted their stance--see what I did there--likely due to the litany of complaints. I personally know of many people that provided feedback to the IAC regarding patient positioning with venous insufficiency studies.

Anecdotally, sonographers discuss ergonomics associated with venous insufficiency studies far more often than patient safety associated with standing. Nevertheless, below is the IAC's current statement regarding this topic:

Statement Regarding Proposed Changes to Patient Position: The IAC Vascular Testing Board of Directors appreciates the input put forward by the vascular ultrasound and vein center communities during the 60-day comment period for the IAC Standards & Guidelines for Vascular Testing Accreditation. Based on the comments received, the IAC has decided not to implement the proposed changes to the Standards requiring that peripheral venous examinations for reflux assessment be performed with the patient in the standing position, at the present time. However, this important topic will be reviewed again and possibly put forth again for public comment in the future. A multi-modality IAC task force comprised of vascular testing and venous treatment experts has been formed to further explore this Standard for future implementation. At the present time, standing remains the preferred position if not constrained by the patient’s physical condition. Patient position must be noted in the final report.

Best,
--Mike  

On Fri, Feb 5, 2021 at 9:09 AM Nicole Ball <[log in to unmask]> wrote:
Thank you for answering the question. 

I do understand the" Whys of Reflux", just thought the person applying might need to understand that.  I could never work at a vein center as my ailing neck/shoulder/back could never do that ergonomic disaster area all day long LOL.

Sincerely,

Nicole Ball, BS, RVT
Technical Director, Vascular Lab
Concord Hospital
250 Pleasant Street
Concord, NH  03301

>>> Bill Schroedter <[log in to unmask]> 2/5/2021 8:59 AM >>>


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The short answer Nicole is STANDING!
Why?
The established definition of “Pathologic Reflux is retrograde flow upon release of distal compression in a STANDING patient (Valsalva acceptable for proximal segments)”
Superficial System - Retrograde flow > 0.5 seconds
Deep System – Retrograde flow > 1.0 seconds”
If performed other than standing, the position must be noted in the report and considered in the interpretation
In contrast to what is commonly argued, we maintain that scanning the patient in a standing position is far more ergonomically friendly than reaching across the patient.
But – we also do not hesitate to NOT stand the patient if they cannot safely do so. Sometimes we will have them sit and dangle their legs, or only have them stand to quickly evaluate highly suspect segments. I mean we are trying to establish venous dysfunction, not diagnose a imminent life threatening condition.  So we simply state that the patient was unable to stand for the exam. That must then be considered in the diagnosis and formulation of the venous treatment plan.
Make it a great weekend!
Regards,
Bill
 
William B Schroedter, BS, RVT, RPhS, FSVU
4120 Woodmere Park Blvd
Suite 8B
Venice, Florida  34293
 
 
From: UVM Flownet <[log in to unmask]> On Behalf Of Nicole Ball
Sent: Friday, February 5, 2021 7:08 AM
To: [log in to unmask]
Subject: Re: Full Time Position
 
Hello.
 
Is all venous insufficiency testing done standing or RV?
 
Sincerely,


Nicole Ball, BS, RVT
Technical Director, Vascular Lab
Concord Hospital
250 Pleasant Street
Concord, NH  03301
 
>>> Linda Antonucci <[log in to unmask]> 2/4/2021 3:31 PM >>>
 

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Registered Vascular Technologist - Full-Time

Employer: Weill Cornell Vein Center

Location: New York, NY


We have an immediate opening for an RVT for our outpatient vein practice. Monday-Friday with no on-call. The practice is part of Weill Cornell Medicine and is on the Upper West Side of Manhattan.

Ideal RVT credentialed technologists will be experienced in the evaluation of lower extremity superficial and deep venous disease and pelvic venous disease as well as having experience in assisting physicians performing US-guided procedures including saphenous ablation. The practice includes 2.4 full-time faculty in the Division of Interventional Radiology who care for acute and chronic superficial, deep and pelvic venous disorders. The position includes typical university benefits, including tuition assistance for education for the employee after a specific length of employment.


Position Summary


Under general guidance, performs a full range of non-invasive vascular testing procedures


Job Responsibilities
·     Accompanies the provider into the exam room, updates or collects patient history, and inputs patient data into the practice management system. Explains procedure to be performed to the patient prior to procedure and answers any questions throughout.
·     Performs non-invasive testing procedures to evaluate arterial and venous circulation using a handheld Doppler, pulse volume recorder, photoplethysmography, and duplex ultrasound imaging techniques.
·     Performs more complex studies such as post-op graft evaluation, renal artery Duplex study, AVF/AVG evaluation, and Endovascular Duplex study.
·     Compiles test results for interpretation by physician. May also provide preliminary interpretation of test results. Notifies consulting physician of any unusual or abnormal reports.
·     Ensures that complete, accurate, and timely reports and billing is submitted and follow-up is completed.
·     Provides educational resources to physicians, house staff, medical students, patients, and visitors regarding nature of, and applications for, non-invasive diagnostic testing.
·     Assists with the accreditation/reaccreditation process and assists in maintaining the accreditation status as required by IAC (Intersocietal Accreditation Commission for Vascular Testing).
·     Maintains inventory of supplies, equipment, and/or reagents. May order supplies/equipment/reagents as authorized or ensure that needs are escalated appropriately. Receives supply orders and confirms accuracy of delivery. May assist with cost control.
·     Ensures that facilities and equipment are in optimal and proper working condition. Coordinates preventative maintenance and repairs as needed. May perform minor repairs if qualified and as needed. May advise on upgrades for performance enhancements.
·     Attends workshops, seminars, and/or conferences to keep abreast of standards and best practices within the field. Disseminates information to colleagues and/or staff as appropriate.
·     Greets registered patients at the time of visit and triages patients through the patient flow process. Checks schedules and accompanies patients to exam/procedure room. Assists patients as needed with walking, transfers, dressing, and preparing for exams.
·     Reviews and verifies patient identity, history, and requisition for the exam to be performed.
·     Ensures patient safety is maintained at all times.
·     Responsible for maintaining a sterile environment. Ensures standard infection control precautions are observed.
·     Assists with the review of cases and literature regarding patient care and research protocols, as well as the collection of data for publications.

Education

High School Diploma


Experience

Approximately 3 years of experience as a Vascular Technologist or Technician


Knowledge, Skills, and Abilities

Graduation from an accredited diagnostic ultrasound vascular program


Licenses and Certifications
·     Registered Vascular Technologist (RVT) or Registered Vascular Specialist (RVS) certification
·     BLS Certification (issued by the American Heart Association)

Working Conditions/Physical Demands

This position requires the occasional lifting of equipment and patients


Competencies
·     Appreciates and understands the connection between individual goals, departmental goals, and the organizational mission.
·     Maintains a team-oriented approach, and possesses the ability to cultivate positive and collegial workplace relationships.
·     Maintains a flexible and forward-thinking approach to the way work is done.
·     Approaches our job knowing that there are internal and external customers whose expectations we strive to exceed.
·     Possesses the ability to facilitate the flow of information through effective written and oral communication.
·     Demonstrates integrity and ethics at all times.
·     Possesses excellent work-related skills and the ability to apply them, while continually seeking ways to improve.
·     Understands the need to be responsible for our own outcomes, and takes pride in delivering the best possible work product.

About Weill Cornell Vein Center:

Since its founding in 1999, Weill Cornell Vein Center has been at the forefront of minimally invasive vein care. We consult on the full gamut of deep and superficial venous conditions and perform venous ablation, phlebotomy, and sclerotherapy in our beautiful outpatient office. Deep and pelvic venous procedures are performed at New York Presbyterian Hospital-Weill Cornell Medical Center.


About Weill Cornell and New York-Presbyterian Hospital:

Weill Cornell Medicine is a leading academic medical institution with a strong mission to care, discover and teach and is ranked as the #11 best US medical school by the U.S. News & World Report. Founded nearly 250 years ago, New York-Presbyterian is one of the nation's most comprehensive, integrated academic healthcare systems. Recognized nationally for quality and excellence, New York-Presbyterian is ranked as the #4 hospital in the nation by U.S. News & World Report. As New York's top-ranked hospital for 20 years, it has more "Top Doctors" than any other hospital in the country.


Interested candidates should contact Karina Rekhels, the WCVC Practice Supervisor (details below).


Contact: Karina Rekhels

Email: [log in to unmask]

Phone (Office): 646-962-6762

Phone (Vein Center): 646-962-9179

Mailing Address: 2315 Broadway, 4th Floor, New York, NY 10024
Linda Antonucci, RPhS, RVT, RDCS
Board of Directors American Vein and Lymphatic Society
President/CEO
Linda Antonucci Veins, LLC
Mobile: 201 410-3054
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