Anyone do VNUS closures?

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Specializes in Telehealth, Hospice and Palliative Care.

If you do VNUS closures under local anesthetic (no anesthetist, no general, no versed), do you use any sort of continuous vitals monitoring? My facility's current practice is to only do vitals before and after. But, considering that the cocktail in the local contains Bicarb and Lido with Epi, isn't there a risk of systemic effects?

I'm the only RN in the room, brand new nurse, and new to the facility. There is also an MD and an LPN/Surg Tech in the room. The facility has been doing the procedure for over a year in this manner.

I'm trying to decide if I should press for continuous vitals (there is an auto bp/spo2 in the room).

Thanks,

cokeforbreakfast

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Specializes in CVICU, ED.

Unless the patient has an allergy or sensitivity to any part of the cocktail given, I would not fret about it. The cocktail is given locally; the actual closing of the vien is from the radiofrequency delivered to the vein.

If large amounts of the medication are given, even locally, then yes, there is a chance of systemic effects. Just make sure you know what those signs and symptoms are, and if you see them, alert the physician and monitor more frequently.

Otherwise, this is a very common cocktail administration. I used to give this to patients in the ED to numb lacerations prior to suturing. Only one time did a patient ever have a problem with the medication and it was due to having numerous lacerations (trauma) and thus multiple administrations of lidocaine.

Good luck.

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Specializes in OR, Nursing Professional Development.

Haven't seen VNUS done under local, but our OR policy for local cases is to hook up at least BP and SpO2, plus EKG if there is any cardiac history. Which in my area pretty much means everyone gets hooked up for EKG.

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Specializes in Telehealth, Hospice and Palliative Care.
Unless the patient has an allergy or sensitivity to any part of the cocktail given, I would not fret about it. The cocktail is given locally; the actual closing of the vien is from the radiofrequency delivered to the vein.

If large amounts of the medication are given, even locally, then yes, there is a chance of systemic effects. Just make sure you know what those signs and symptoms are, and if you see them, alert the physician and monitor more frequently.

Otherwise, this is a very common cocktail administration. I used to give this to patients in the ED to numb lacerations prior to suturing. Only one time did a patient ever have a problem with the medication and it was due to having numerous lacerations (trauma) and thus multiple administrations of lidocaine.

Good luck.

So far, your answer makes me feel MUCH better. Thanks for taking the time to reply!

The cocktail is mixed in a 500 ml bag of NS. An average of half to 3/4 of the bag is given in the area near the vein before the ablation takes place (under guided ultrasound). The length is ballpark 18 inches. Time from the last injection until the vein ablation is completed is maybe 4 minutes. Does this make a difference in your answer?

I was just worried because the solution is injected around the vein before it is closed, and osmotic gradients would dictate that the cocktail would move into the venous circulation prior to the ablation.

Likely just a new nurse worrying about all the what if's....

Thanks again!

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Specializes in CVICU, ED.

I was thinking local anesthetic applied to the access site, which I think is more common. Is it possible that to not have to administer versed, the doctors are attempting to provide numbness to the whole length of the vein?

Hmm. That sounds like quite a bit of fluid to the leg (250+; also considering the patient can swell afterward as well). I would double check the concentration of the Lido and epi. The bicarb is most likely added to offset the "sting" of the lidocaine when administered and is probably miniscule.

Who mixes the bag of fluid? Is it based on weight?

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Specializes in CVICU, ED.

On a side note, if it is an ambulatory phlebectomy that is being done, typically the area is flooded with anesthetic fluid. VNUS closure can be done in conjunction with this.

Again, I would just double check the concentration of the anesthetic, be aware of the signs and symptoms of too much medication and monitor as needed. Sounds like you are doing a good job and being an advocate for patient safety. Overall, I think the patient would be fine with before and after vitals; more frequent if any changes take place that indicate trouble.

Hope this helps.

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