VEIN STRIPPING Alternative Names: Vein Stripping with Ligation, Avulsion, or Ablation; Vein Ligation and Stripping; Vein

Surgery DEFINITION: Vein Stripping is a surgery to remove varicose veins in the legs. Vein Stripping is a Minor Surgery. It is use to remove a damaged vein and prevent complications of vein damage. If several valves in a vein and the vein itself is heavily damaged, the vein (or the diseased part of the vein) is removed (stripped). An incision is made below the vein, a flexible instrument is threaded up the vein to the first incision, and the vein is grasped and removed. PURPOSE/ INDICATION: The Doctor may recommend Vein Stripping for: Varicose veins that cause problem with blood flow Leg pain and heaviness Skin changes or sores that are caused by too much pressure in the veins To make your leg look better Blood clots or swelling in the veins Varicose veins that cant be treated with newer procedures

BACKGROUND/ OVERVIEW: Normally, valves in your veins keep your blood flowing up toward the heart, so the blood does not collect in one place. The valves in varicose veins are either damaged or missing. The cause of the veins to become filled with blood, especially when you are standing. Vein stripping is used to remove or tie off a large vein in the leg called the superficial saphenous vein. This helps treat varicose veins. Vein stripping usually takes about 1 to 1 hours. Patient may receive either: o General Anesthesia ( Patient will be asleep and unable to feel any pain) o Spinal Anesthesia ( Makes the Lower Half of the patients body feel numb) During the Surgery, The surgeon will make two or three small cuts in the Leg. The cuts are near the top, middle, and bottom of your damaged vein. One is in the groin of the patient. The other will be farther down the patient leg, either in the calf or in ankle. The surgeon will then thread a thin, flexible plastic wire into the vein through the groin and guide the wire through the vein toward the other cut farther down the patients leg. The wire is then tied to the vein, and pulled

out through the lower cut, which pulls the vein out with it. If the patient has other damaged vein near the surface of the skin, the surgeon may also make small cuts over them to remove them or tie them off. This is called ambulatory phlebectomy. The doctor will close the cuts with stitches. The patient will have bandages and compression stockings on the leg after the procedure. Today, Doctors are doing fewer vein-stripping surgeries because there are newer, non-surgical ways to treat varicose veins. These treatments are less painful and have a much faster recovery time. However, these methods cant treat veins below the knee.

RISK/ COMPLICATION: Vein stripping is usually safe. However, there are complications for Clients that are pregnant or could be pregnant. People taking drugs, Supplements, or herbs without doctors prescription. Clients who have been drinking more than 1 or 2 alcoholic drinks a day. Older adults for whom surgery poses a high risk due to other medical conditions. People who have poor circulation in the arteries of the legs. People who have swelling and fluid build-up due to blockage in the lymph vessels (Lymphedema), skin infection, or blood clotting defects. People who have abnormal passageway between an artery and vein (Arteriovenous fistula) in the leg. Risk from any anesthesia include, allergic reactions to medicines and breathing problems. Risk from vein stripping include, bruising or scarring, nerve injury and return of varicose veins over time. Risk from any surgery include, Bleeding, Bruising and Infection. Other effects are Development of a clot in the vein in the leg, Irritation of a nerve that runs along with the veins that are typically stripped, Pain at the site of incision, Fever, Cuts are swollen, red, or have pus coming from them, stitches loosen or come apart.

NURSING RESPONSIBILITY: Before Surgery: Pre-Operative interview. Ask patient to stop taking Aspirin, Ibuprofen (Advil, Motrin), Warfarin (Coumadin), and any other drugs that make it hard for your blood to clot. Tell the patient which medication he/ she still can take on the day of the surgery. If patient smoke, tell him/her to stop. Smoking will slow clients healing and recovery. Instruct the patient not to drink or eat anything for at least 6 to 8 hours before surgery. Instruct the patient to take prescribed medications with a small sip of water.

Check Vital signs. Remove jewelries, dentures and other patients accessories. Remove nail polish. Ask patient to Empty Bladder. Offer urinal or bedpan. Ask for signing of Consent form or legal documents that allows caregivers permission to do the procedure. Position the Client. After Surgery: Monitor Vital Signs, Intake and Output and IVF. Assess for signs of bleeding on site. Assess for signs of infection. Patient leg is wrapped with bandage to control swelling and bleeding. Limit patients activity on post-operative site. Elevate leg whenever possible. Provide wound care. Put compression hose on patient leg. This tight elastic stocking help decrease swelling and improve blood flow. Encourage change of position but avoid sudden exertion Instruct patient for intake of medication such as pain reliever. Consider using less dose of medication for elderly client. Promote good wound healing for diabetic client. Instruct client to seek immediately help if client experience trouble moving leg or foot. Instruct client to seek immediate care if bandage begins to soak with blood. Instruct client to seek immediate care if leg feels warm, tender and painful. Instruct client to seek immediate care if leg may look swollen and red. Instruct client to seek immediate care if client have chest pain or trouble breathing that gets worse over time. Instruct client to seek immediate care if client suddenly feels lightheaded and have trouble breathing. Instruct client to seek immediate care if client have new and sudden chest pain. Instruct client to seek immediate care if client cough up blood. Tell the Client that He/ She will be able to return to work within a few days. After several weeks, He/ She can resume normal leisure and recreational activities.