Chapters Transcript Video Complete Venous Practice Setup Back to Symposium So how do you build a practice? I'll give you the key steps. So if you want to start a vein practice, you gotta screen patients. If you screen them, they will come. I mean seriously, if 175 million people are estimated to have venous disease, I mean that's half of the people in the country. I mean seriously, when you're at the airport just look around you're gonna see plenty of venous insufficiency if you want to take care of veins I promise you can find the patients. Just more stats. Like anything, it starts with the clinical assessment, OK? You need it for your note. So you see the patient, you gotta put this on there. If somebody's seeing you, I guarantee they have some swelling, so they're at least C3. OK. Most people have discoloration, so they're C4, A, B, or C. The main thing is when you write a note just write a thorough note so that you don't have to do the note again whenever they, you know, reject it or your nurse has to modify your note they'll be happy so try to make everybody's life easy. Venous ulcers, right? Or sorry, venous problems or if you have a venous ulcer versus an arterial, if you're really starting this out and you're seeing patients and they're coming to you with vein problems, or especially wounds. I always do an arterial duplex and a venous insufficiency study. It's rare, but some people will have arteriovenous malformations and things, and you'll have maybe a palpable pedal pulse, but you might have increased venous pressure from an abnormal connection between the artery and the vein. You rarely see that, but if you get an arterial duplex, you'll see monophasic flow, and it'll alert you that something weird is going on. Again, we have I've already gone over this arterial wounds. White Dead skin. Venus, red, angry, weeping. Very hard to get rid of truthfully, whenever you start dealing with venous patients, your, your main goal is gonna be to prevent them from ever getting a venous ulcer. If they have a venous ulcer, you need to get it healed as quick as you can, but once somebody gets it, the problem is they tend to come back because someone has swelling forever. It messes up their sweat glands so they don't have. They don't really make the oils to keep their skin healthy, so once you get it healed, they got moisturize like crazy. Remember creams are better than lotions. Creams have more oils in them, OK? So what makes up your team? Ultrasound tech, ultrasound machine. Your vein staff, so medical assistants. And you need a physician or a proceduralist. For the ultrasound tech, either you can have somebody in your practice. Or there are people that will come to your practice, which I alluded to earlier, they will come to your practice, they'll do the studies, and honestly what I found is these people are excellent, OK? In Houston I know 3 or 4 of them, so I guarantee any major city has excellent techs and truthfully reaching out to the BD team, they'll know them, um, and they'll be able to help you set it up. I think in-house is best, but again, you have to have the volume. So I'm a vascular surgeon. There's 5 of us, there's like 35 cardiologists. We have a very large vascular lab. But even within that very large vascular lab, there's some technicians that are much better than others that do in venous insufficiency studies. So you don't wanna just hire anybody. Truthfully, while you're building, ideally just get someone to come in and do the studies for you that's experienced. Ultrasound machine You don't need a $200,000 machine. You just need something that turns on and off. You need a higher frequency probe, right? You don't wanna be trying to do this with an abdominal probe, but you could use a sonocyte. Now you get some really edematous leg woody edema. You might want the better ultrasound machine, and if somebody in your practice is doing scans all the time, I promise whatever machine they have is gonna be fine. The vein staff is the key ingredient. That's what makes this fun, OK. Treat them right They'll treat you right If everyone's happy, you'll get so many cases done, you'll have such a good time. Truthfully, I do veins every other Friday, do like 30 veins, um. Do 20.5 day so we could do 40, but they might quit. So the thing is it's my favorite, it's my favorite part of the week, so I enjoy it. You set it up right, you'll love it too. Something that's important to note, especially if you're building a practice, is where are you gonna do the procedures? Your office. The OBL if you have one, the ASC, the hospital, I hope not. Don't do it in the hospital, right? It's, it's like doing it for free, OK? Figure out how to do it in your office. It is extremely well tolerated. There I can count on, you know, one hand how many people really can't tolerate temes and anesthesia, and I've done thousands of these procedures. I did have one patient that was had like an anaphylactic, uh, allergy to lidocaine supposedly, so we just did it with general anesthesia and, uh, no lidocaine. She did fine. Um, but again, these are exceedingly rare things. Specifically, if you're gonna do it in the office, the OBL, or the ASC, say that you have all three available. OK. Some of it actually depends on. Insurance. Uh, you could do the same procedure in the ASC as in your office in the same building and get paid twice as much to do the same thing. It's very much insurance dependent. It's gonna depend where you live and what the contracts you have are, but it is something. To be aware of because it can make a significant difference. Again Valium, make sure they're not driving themselves home though, OK? So make sure they got a ride. Um, I'd say about half the people take the Valium, we usually give them 10 if they're older, we give them 5, but again, half the people don't take it and they do fine to mess and anesthesia, the way I'll do it. I get the tech, you know, they drape everything. I'm doing another procedure. I come in while I'm doing that, they'll just kind of mark where the vein is, put a few dots, we'll time out. I'll take like a 30 gauge needle, do some local lidocaine where I'm gonna do the temescent, and really that's the only part that bothers them. They feel a little pressure whenever you do the temesin itself, but again, it's, it's very well tolerated. So don't let people use the excuse that temescent anesthesia, the patients hate it. I, I think it's more people have a hard time with ultrasound. And I, I don't know, it's, it's literally the whole case takes between like 5 and 10 minutes. You know, and that's not rushing. So you can do all the temescent and everything. They make it where it's either a valve syringe or an actual tumescent anesthesia machine. The machine definitely makes it easier, but you can do it either way. Um, ideal setup, OK? 2 or 3 rooms, 2 ultrasound machines. They're gonna prep patients and you're just gonna run between the rooms. Um, ultrasound technician, you don't have to have them, but it's, it's like the, it's pretty sweet, you know, you have somebody that's really large, hard to see their junction, you know, they do this all the time, but just like, it's like doing it on, you could do it with your eyes closed, they're so good. Um, With this setup, you can easily do 15 or 20 veins in a half day, so 8 to noon, you can do 15 or 20. Um, you'll get faster with time, but I don't even think that's an unreasonable thing. Our protocol again, look at everything. If you don't look at it, you can't treat it. Again, if they've had prior treatments, doesn't mean somebody did it right. So for patients, if you look, you'll find them. OK. Main takeaways because I know we're ready to get to the next thing. If you screen them, you'll find them. I promise you they're out there. If there's one person that you wanna reach out to, it's gonna be PCPs. They are overflowing with venous patients. You know, and truthfully, any of these patients. If you have the ability, you should, you should do an arterial and a venous workup on them. You can look, you can do a physical exam and guess what it is, but truthfully, for a thorough evaluation, always do an arterial in a venous. And if you ever wanna learn how to do these procedures, and you wanna start doing them either deep or venous, come see us in Houston. We'll show you how to do it. All right, thank y'all. Published Created by
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