During surgery, saphenous vein is ligated and divided, then an incision is made in the ankle and a metal or plastic wire is passed the full length of the vein to the point of ligation. The wire is then withdrawn, pulling the vein as it is removed (“stripping”). Pressure and elevation keep bleeding at a minimum
Postoperatively, observe for skin changes, monitor venous and arterial function carefully, and assess for hemorrhage, infection, nerve damage and DVT.
For sclerotherapy, a chemical is injected into the vein, irritating the venous endothelium and producing localized phlebitis and fibrosis, obliterating the lumen of the vein. After injection of sclerosing agent, elastic compression bandages are applied to the leg and are worn for approximately 5 days. These bandages will be removed and be replaced by elastic compression stockings which will be worn for an additional 5 weeks. After sclerotherapy, patients are encouraged to walk to maintain blood flow in the leg.
Instruct to maintain on bed rest for 24 hours, after which the patient begins walking every 2 hours for 5 to 10 minutes.
Assist patient to perform exercises and to move the legs
Elevate the foot of the bed
Administer analgesics as prescribed
Inspect dressings for bleeding
Be alert for reported sensations of “pins and needles”
Instruct patient to dry the incisions well with a clean towel by patting rather than rubbing
Instruct to avoid application of skin lotion until incisions are completely healed to decrease chances of infection
Instruct the client to avoid anything that can increase pressure above the knees (e.g. crossing the legs, sitting in chairs that are too high, wearing garters, and knee-high stockings)
Apply compression stockings. Instruct the client on the use of antiembolism stockings, support hose, or elastic stockings. Instruct the client to put on stockings while lying down with legs in the air to promote venous return. Apply stockings to clean, dry legs. The stockings may be removed once or twice daily and should be washed and air dried regularly.
Discuss the importance of losing weight if the client is obese.