The Societies for Vascular Surgery and Ultrasound Meetings from May 30 – June 1, 2013

The primary goal of a rapid cuff inflator is to take the unnecessary stress out of venous insufficiency studies. While the machine is fairly straightforward to use, we at ACI Medical are always looking for ways to perfect the experience for vascular sonographers.

The VenaPulse® Hands-Free Augmentation Device will give sonographers standardized augmentations. However, it is up to the sonographer to know what works best for each patient’s unique physiology and medical condition.

With this simple guide, it is our hope that sonographers will be able to increase efficiency in the exam room. We will start at the beginning, when a patient is seen and studied for the first time.

1. Matching Cuffs to Patients

The first and most important step for cutting down on exam time is to decide which cuff is best for the patient walking through the door. Is the patient’s frame small, medium or large? Which valves do you need to study? How will the patient be positioned throughout the exam? Here are short profiles on the two types of inflation cuff provided in your VenaPulse® unit:

The Blue Cuff

Technologists have the option of placing a rapid inflation cuff anywhere along the patient’s leg.

• Widely used for any patient regardless of size
• Wraps anywhere from above the ankle to the upper thigh
• For use in any patient position
• Allows sonographer to visualize valves up to and including the sapheno-femoral junction

Also included with each VenaPulse® device is a black foot inflation cuff. This cuff does what the blue inflation cuff can’t:  it allows you to study vessels just above the ankle.

The Black Foot Cuff

Using the foot inflation cuff allows you to see perforators in the lower leg.

• Best used to view perforators and valves in patients with normal- to large-sized feet
• Ideal when patient is in relaxed reverse Trendelenburg position or standing with all weight on the non-studied leg
• *Augmenting smaller feet may not produce adequate results due to lack of blood volume

2. Consider the Refill Time

Consider this:  the average rate for arterial blood to flow back into the legs and feet is about 1.8 mL/second in a normal person and there are about 20 cc’s of blood in the foot. When the augmented area is full of blood, you will get a nice visual in the veins. However, if you do not wait long enough for the leg/foot to refill, you may get an unsatisfactory result.

We recommend waiting at least 15 to 20 seconds between augmentations to allow the patient’s blood to fill the area once again.

3. The VenaPulse® Device is Key to Charting

Your vascular lab can help minimize the variation between studies by using a rapid cuff inflator instead of hands. Even if the same patient sees two different sonographers, you can all be confident that each augmentation performed during other exams was the same as every other.

Just take note of the pressure used and you’re all set!

4. Take Care of Yourself During Every Exam

Using a foot-operated rapid cuff inflator helps you avoid hand cramps.

All people have their physical limits, and sonographers are no exception. During a long exam, does your hand begin to cramp? How does your back feel after an hour and a half of repetitive bending and twisting?

Having a foot-operated rapid cuff inflator will certainly help you be more comfortable so you can focus on the task at hand.

Mint Medical Education also has a great article about how sonographers can survive venous insufficiency exams and make the lab more ergonomically friendly.

This month marks the first ever issue of Aesthetics News Today. In this inaugural issue, the Product Roundup section features

The VenaPulse® device provides hands-free, standardized augmentations

the VenaPulse® Hands-Free Augmentation Device. Glenbrook Hospital Radiology Department in Evanston, Ill. and Hoag Memorial Hospital Vascular Laboratory in Newport Beach, Calif. report their experiences with the device and comment on the role it plays in their facilities.

Varicose veins due to lower limb venous reflux can be a cosmetic issue as well as the cause of discomfort in the legs. Fortunately for patients, there are many treatments available for varicose veins and they do not often require a long recovery.

However, the process for diagnosing varicose veins in the legs is often physically strenuous for vascular technologists. Testing the veins requires technologists to bend and twist into uncomfortable positions in order to squeeze the vein with one hand. This task is made more difficult while trying to maintain a good image on the ultrasound. Technologists can request a colleague to help them with the diagnosis procedure, but this arrangement can reduce productivity. Furthermore, the disadvantage to manual squeezes is the potential

By National Heart Lung and Blood Institute. (Varicous veins.) [Public domain], via Wikimedia Commons

According to a recent survey, 84% of diagnostic medical sonographers suffer from some sort of work-related injury.*

The VenaPulse® device provides consistent squeezes with the added benefit of improved ergonomics for technologists. By using a foot switch to operate a compression pump that inflates a wrap around the foot or ankle, the technologist can maintain a comfortable position while scanning. Use of the VenaPulse® device in the exam room reduces error and chances of injury.

*”Sonographer occupational musculoskeletal disorders:  What are they and how can they be prevented,” Sound Ergonomics, LLC and Biodex Medical Systems, Inc.

To read through Aesthetics News Today article, you can download the reprint: VenaPulse® Users Share Insights:  Considering Hands-Free vs. Manual Venous Reflux Exams?

“I want a VenaPulse® device for my facility!“

Assisted by the VenaPulse® Hands-Free Augmentation Device

The April/May 2014 issue of Vein Therapy News Magazine includes an ad for the VenaPulse® Hands-Free Augmentation Device.

Please check it out and give ACI Medical a call if you are interested in trialing a unit in your facility!

Many vascular technologists today use manual augmentations to perform venous reflux exams. Augmentations to the study

Assisted by the VenaPulse® Hands-Free Augmentation Device

patient’s leg are essential to the documentation of valves, but unfortunately, technologists only have two hands to operate the ultrasound machine, hold the wand to the desired location, and perform augmentations. Squeezing the patient’s leg manually can result in difficulties:

• A technologist’s hand may become tired or sore;
• The awkward positioning might strain a technologist’s body;
• Divided attention and discomfort widens the possibility for error

To reduce inconsistencies and provide a more comfortable experience for vascular technologists during venous reflux exams, ACI Medical has developed a foot-operated device that performs rapid and consistent augmentations:  the VenaPulse® Hands-Free Augmentation Device. The picture on the right features Professor Nicos Labropoulos using the inflation cuff system during a demo at the Venous Symposium earlier this year. His left hand is free to operate the ultrasound. A published prospective study from 2009 compares the VenaPulse® device’s performance with traditional manual augmentations. Conclusion:  The VenaPulse® device is just as effective as doing manual augmentations during venous reflux exams.

Prospective comparison of the pneumatic cuff and manual compression methods in diagnosing lower extremity venous reflux

Stavros K. Kakkos, MD, PhD, Judith C. Lin, MD, FACS, Jennifer Sparks, RVT, Melissa Telly, RVT, Michalene McPharlin, RN, RVT, and Daniel J. Reddy, MD, FACS. Vascular and Endovascular Surgery, Vol. 43 No. 5: pp. 480-484. http://ves.sagepub.com

Aim

To compare pneumatic cuff with manual compression in diagnosing reflux in patients with chronic venous insufficiency (CVI).

Patients and Methods

Eighteen patients (Clinical Etiologic Anatomic Pathophysiologic [CEAP 2-5], median Venous Clinical Severity Score [VCSS 6.5]) were studied. The VenaPulse device (ACI Medical, San Marcos, California) was used for cuff inflation. The hemodynamic performance of the 2 methods was tested in the first 9 patients, while their diagnostic value was tested in the last 9 patients.

Results

Both methods induced equal compression with median peak velocity of the antegrade flow (PVA) being 86 cm/s (P=.65). Coefficient of variation (CV) for PVA in the superficial veins was significantly higher with the manual method (16.8%) compared to the VenaPulse method (9.5%, P<.001), while sensitivity and specificity were 85% and 100%, and 78% (κ .68, P<.001) and 100%, respectively.

Conclusions

Pneumatic cuff and manual compression were shown to be equally effective in diagnosing venous reflux. Cost-effectiveness and ease-of-use studies comparing these methods are justified. Keywords: vascular lab; varicose veins; pneumatic compression

Here are some great photos of Professor Nicos Labropoulos of SUNY, one of the meeting’s Course Directors, demonstrating live imaging for attendees with the help of ACI Medical’s VenaPulse® device.

Professor Labropoulos regularly uses the hands-free augmentation device to make teaching less strenuous.

At the 2013 Venous Symposium, the blue inflation cuff is being used for demonstrations. Recently, work at the Oregon Institute of Technology has shown that use of a foot inflation cuff can be effective for viewing valves up to the sapheno-femoral junction. Read more on the VenaPulse® device home page.

Special thanks to Barb Gentilli for taking all the wonderful photos and to Professor Labropoulos!

Recent work at the Oregon Institute of Technology has shown that rapidly compressing the foot during venous evaluations (using the VenaPulse ®device) will give vascular technologists the ability to identify valvular reflux up through the sapheno-femoral junction.

Until recently, the VenaPulse ® Hands-Free Augmentation Device for venous evaluations has only employed an inflation cuff that wraps around the leg and must be moved each time a technologist wishes to document a different valve. While this method was already as efficient and reliable as manual augmentations*, there was still room for improvement.

Initially, the foot inflation cuff was designed to allow vascular technologists to view distal valves that could not otherwise be seen with the blue calf wrap. This changed when work at OIT discovered that the foot cuff alone was capable of giving technologists an unobstructed view of venous valves throughout the entire limb.

In short, using the VenaPulse ® device for venous evaluations is now an even more efficient and ergonomic tool for augmentations, now that adjusting the cuff is unnecessary. 

The foot cuff itself is patented and was specifically designed to rapidly empty the foot veins proximally. The foot augmentation method was shown to be effective in all but a few patients. For this reason, the calf wrap is still available.

Give us a call or send us an email today to learn how you can obtain the VenaPulse ® device for your vascular lab:

Toll free 888-453-4356 or lenniea@acimedical.com