Treating varicose veins with transilluminated powered phlebectomy

AORN Journal,  Dec, 2002  by Lisa M. Zotto

• E-mail
• Print
• Link

The article "Treating varicose veins with transilluminated powered phlebectomy" is the basis for this AORN Journal independent study. The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, education program professional, Center for Perioperative Education.

A minimum score of 70% on the multiple-choice examination is necessary to earn 3 contact hours for this independent study. Participants receive feedback on incorrect answers. Each applicant who successfully completes this study will receive a certificate of completion. The deadline for submitting this study is Dec 31, 2005.

Complete the multiple-choice examination and learner evaluation found on pages 991-994 and mail with appropriate fee to

AORN Customer Service
c/o Home Study Program
2170 S Parker Rd, Suite 300
Denver, CO 80231-5711

or fax the information with a credit card number to (303) 750-3212. You also may access this Home Study via AORN Online at http://www.aorn.org/journal/homestudy/default.htm.

BEHAVIORAL OBJECTIVES

After reading and studying the article on using transilluminated powered phlebectomy to treat varicose veins, the nurse will be able to

(1) identify the elements of clinical diagnosis pertinent to patients with varicose veins,

(2) discuss the components of preoperative patient preparation,

(3) describe the steps of the transilluminated powered phlebectomy procedure to surgically treat varicose veins, and

(4) explain the advantages of using transilluminated powered phlebectomy versus traditional surgical approaches.

This program meets criteria for CNOR and CRNFA recertification, as well as other continuing education requirements.

Varicose veins are superficial veins that have expanded in response to increased pressure and turbulence. (1) This leads to venous valvular incompetence. The valves in the veins are unable to close properly. As the valves become defective, the venous walls become weak, which allows for distension and reflux. Varicose veins are most common in the lower extremities but also occur in other areas, such as the spermatic cord (ie, varicoceles), esophagus (ie, esophageal varices), and rectum (ie, hemorrhoids). (2) Many theories exist regarding risk factors that relate to the incidence of varicose veins, including

* genetic predisposition for weak venous smooth muscle tissue;

* gender;

* hormonal influences during pregnancy;

* prolonged standing;

* obesity; and

* age.

Gender is considered a risk factor because traditionally the female:male ratio for venous disease is four to one in the United States; however, new studies suggest this ratio may be changing. It is believed that 25% of the worldwide adult population has some form of venous disease in the legs. (3)

Patients usually present with various signs and symptoms. Signs may include unsightliness, hyperpigmentation, and lipodermatosclerosis. Symptoms may include episodes of aching, burning pain, nocturnal cramps, ankle edema, dermatitis with or without itching, superficial thrombophlebitis, external hemorrhage, and, ultimately, ulceration.

CLINICAL DIAGNOSIS

The physician takes an initial history and performs a physical examination when a patient presents with complaints of varicose veins. It is vitally important that a complete physical examination of the lower extremities be conducted with the patient in two separate positions, standing and either supine or prone. The varicose veins should be at their greatest dilation and easily observed when the patient is standing. The veins disappear when viewed in the supine or prone position because of the reduction of hydrostatic pressure (ie, the decrease in the equilibrium of fluids such as blood). This reduction in the hydrostatic pressure is caused by the decrease in gravitational pull when the patient is in the prone or supine position.

Duplex ultrasound has become the standard diagnostic test and is required by many insurance companies for precertification before surgical treatment can be authorized. It is performed to determine whether the greater and lesser saphenous veins are incompetent. This can be a primary source of the formation of the varicose cluster. Lower extremity venous duplex ultrasound can provide flow information while at the same time providing high resolution views of both deep and superficial venous systems, including delicate valves, small perforating veins, and even reticular veins as small as 1 mm in diameter. (4)

Another diagnostic test that can be performed preoperatively is a continuous-wave Doppler ultrasound. A probe is used to distinguish between flow and stasis in a major vein, such as the saphenous vein, and to determine whether the veins are patent or obstructed. (5)

TREATMENT OPTIONS

Historically, only two treatment options have been available for varicose veins, including conservative measures, such as compression stockings, or corrective measures, such as surgery, sclerotherapy, or laser treatment. Sclerotherapy and laser treatment generally are performed on the smaller surface veins, which often are referred to as spider veins. Surgical treatment is necessary to treat larger varicose vein clusters. In many situations, a combination of treatment methods is best.