Treating varicose veins with transilluminated powered phlebectomy

AORN Journal,  Dec, 2002  by Lisa M. Zotto

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* a control unit,

* a light source, and

* an irrigation pump for tumescent solution.

The scrub person connects the resector, suction tubing, and irrigation tubing to the hand piece. He or she then connects the illuminator to the light cable and disposable illuminator tubing through which tumescent solution will flow. The scrub person passes the ends of the light cable, hand piece, suction, irrigation, and tumescent solution off the sterile field so the circulating nurse can connect each to its specific source.

The circulating nurse prepares the tumescent solution by adding 80 mL of 1% or 40 mL of 2% lidocaine to 1,000 mL of 0.9% normal saline. He or she then adds 1 mL to 2 mL of 1:1,000 epinephrine. The circulating nurse connects the tumescent solution to the illuminated irrigation tubing passed off by the scrub person. The circulating nurse places the solution in an irrigation pump and sets it at 500 mm Hg to 900 mm Hg. He or she attaches the illuminator to the light source, sets it at 1,000 lumens, and places the light source on standby to reduce the chance of burns.

Another 1,000 mL bag of 0.9% normal saline is used for resector irrigation. This bag of solution does not need to be pressurized, so it can be hung from a standard IV pole and used to irrigate the resector via gravity. The circulating nurse connects the end of the hand piece to the control unit, sets the revolutions per minute (RPM) at 1,000 (range 700 RPM to 1,200 RPM), and the suction on high. Table 3 is a sample surgical preference card for use in setting up the OR.

INTRAOPERATIVE CARE

The circulating nurse arrives in the ASU to greet the patient, introduce surgical team members, and explain the procedures that will take place in the OR. The circulating nurse has the patient confirm the surgical procedure to be performed, laterality if applicable, NPO status, and presence of allergies. The circulating nurse reviews the chart and diagnostic test results. Based on his or her assessment, the circulating nurse then develops a care plan (Table 4). After the anesthesia care provider interviews the patient, he or she and the circulating nurse help the patient onto the OR bed in the supine position. The circulating nurse secures the safety strap, places the padded arm boards on the OR bed, and secures the patient's arms on the arm boards.

Depending on surgeon, patient, and anesthesia care provider preference, transilluminated powered phlebectomy can be performed under general, spinal, or local anesthesia. A light general anesthetic is preferred with the use of a laryngeal mask airway. The anesthesia care provider induces the preferred anesthetic and secures the patient's airway.

The anesthesia care provider places the OR bed in Trendelenburg's position. If possible, the circulating nurse elevates the patient's legs 30 degrees using a picket-fence leg holder. The circulating nurse preps the patient's leg circumferentially from toes to the groin. The surgeon and scrub person drape the patient in sterile fashion, allowing for repositioning during surgery. The circulating nurse and scrub person place the instrumentation and equipment around the sterile field and connect each piece to its own power sources.