Venoscope II - Clinical Studies

Transillumination Mapping Prior to Ambulatory Phlebectomy
 
Robert A. Weiss, MD
Mitchel P. Goldman, MD
 
BACKGROUND.
Ambulatory phlebectomy (AP) for removal of varicose and reticular veins has become a very popular and widely used in-office outpatient technique over the past decade. One of the major obstacles of this or any other surgical vein removal technique is the technical difficulty presented to the surgeon by the disappearance of the veins to be removed when the patient is positioned horizontally on an operative table. Preoperative marking is therefore essential.
 
OBJECTIVE.
To investigate whether use of transillumination would facilitate and enhance marking of varicose veins prior to AP, we performed a study in which both traditional marking with the patient standing and transillumination marking with the patient horizontal were performed sequentially.
 
METHODS.
One hundred patients were sequentially examined prior to AP. The veins to be removed were mapped by the traditional way utilizing visual inspection and palpation in a standing position. They were then mapped in the supine or prone position utilizing a transillumination device specifically designed to enhance visualization of veins prior to venipuncture.
 
RESULTS.
In 100 out of 100 patients the markings performed using transillumination mapping most closely correlated with actual vein position during surgery. In addition, transillumination allowed for gauging of vein depth.
 
CONCLUSIONS.
Transillumination mapping significantly enhances the technique of ambulatory phlebectomy by more accurately visualizing the course of a varicose vein prior to extraction. Furthermore, sites for incisions or punctures are more accurately guided. As a result of this experience, it is now our routine practice to perform preoperative mapping for AP by transillumination in the horizontal position.
 
1998 by the American Society for Dermatologic Surgery, Inc. Dermatol Surg 1998:24-447-450.
 
 
Los Angeles, CA

Detecting IV Infiltrations Using a Venoscope®
 
Carolyn Baratta Yucha, RN, PhD, Paul Russ, MD, Sharon Baker, RN, MS
 
This research evaluates the Venoscope® for its ability to detect infiltrations when present (sensitivity) and to detect the absence of infiltrations when not present (specificity), and compares these findings with those obtained via ultrasonography. Healthy adult volunteers were randomly assigned to receive or not receive an intentionally made 5-ml normal-saline infiltration. The Venoscope® had a sensitivity of .92-.93 and a specificity of .89-1.0. Ultrasound had a sensitivity of .92-.93 and a specificity of .22-.25. The Venoscope®, which is simple and easy to use, is a valid indicator of the presence and absence of IV infiltrations.
 
DISCUSSION
Under the conditions studied, the Venoscope® was able to accurately detect the presence of an infiltration 92% of the time and to accurately detect the absence of an infiltration 80-100% of the time. These findings suggest that a valid use of the Venoscope® is the detection of IV infiltrations. In this study, the Venoscope® was able to detect infiltrations made with 5 ml of normal saline, 20 minutes postinfiltration. It is expected that the Venoscope® would perform better when using it to examine an IV site in the process of infiltrating or immediately after infiltration has occurred. Venoscope® examination is simple, it requires approximately 10 seconds to complete, and it can be performed readily at the bedside.
 
Although the ultrasound performed similarly with regard to detection of IV infiltrations (sensitivity), it was not able to detect lack of infiltration (specificity) as well as the Venoscope®. Because of logistics involved in data collection, ultrasound examination occurred approximately 40 minutes after infiltration/injection. Although it may have performed better had the examinations occurred earlier, this time change may have made no difference because diagnosis of infiltration was based on position of the cannula in relation to the vein, and this position was not expected to change over the time period studied. More importantly perhaps, ultrasound examination requires expensive equipment and extensive training; therefore, it is not cost-effective as a tool to examine IV sites on a routine basis.
 
Although IV infiltrations occur frequently, most do not cause any serious tissue damage. At the minimum, IV infiltrations cause patient discomfort and require re-insertion of an IV cannula elsewhere, which consumes nursing time and increases the cost of supplies. Alternatively, solutions containing calcium, potassium, antibiotics, vasoconstrictors, or chemotherapeutic agents are known to cause marked tissue damage. Early detection of infiltrations of these solutions may prevent nerve damage and/or tissue sloughing, which necessitates skin grafting and potential litigation. Use of the Venoscope® in routine hourly IV checks could allow the nurse to detect infiltrations earlier, thereby minimizing the amount of solution extravasated and subsequent tissue damage.
 
The RA using the Venoscope® to evaluate the IV sites had been examining IV sites in hospitalized patients intermittently during a 1-year period. It is unknown how much experience a nurse should have with the Venoscope® to detect infiltrations with the sensitivity and specificity reported here. In addition, this study evaluated the performance of the Venoscope® in young adults. Although its reliability and validity in infants, children, or older adults is unknown, it is likely that it would be easier to detect infiltrations in these subjects because they generally have less subcutaneous tissue than young adults. Lastly, this study does not evaluate the performance of the Venoscope® in ill patients who have IVs. However, there is no reason to believe that its performance would be altered in ill patients.
 
Carolyn B. Yucha, RN, PhD, is an Associate Professor at the University of Colorado Health Science Center School of Nursing in Denver, Colorado, where she teaches Anatomy, Physiology, and Pathophysiology. Sharon Baker is a Clinical Nurse Educator at University Hospital in Denver, Colorado. Paul Russ is an Associate Professor in the Department of Radiology at the University of Colorado Health Science Center in Denver, Colorado.
 
JOURNAL OF INTRAVENOUS NURSING
 
Vol. 20, No. 1 January/February 1997

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