IV's with fluoro case?

[specepic]

Do you have your patients get an IV for ALL fluoro cases? (select all that apply)

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[Taus]

Sedation and sympathetic blocks only.

 

[MitchLevi]

Stimulators, stellates and MILD.

No ESI, RFA, lumbar symp, SIJ, etc.

 

[Ducttape]

stims, stellates, LSB, celiacs, MILD, and the rare request for sedation for RFA, averaging 1 every 3 or 4 months. typically these are patients who have had previous procedures done under sedation by competitors.

stim trials because they get IV abx, and ill give them sedation.
symp block in case of LA toxicity.
MILD for a little fentanyl. contemplating not using it at all.

 

[DOctorJay]

stim trials (abx) and sympathetic blocks only for me

 

[specepic]

For those saying No for RFA, are you not using IV sedation for RFA?

 

[DOctorJay]

correct, local only for RFA for me - I don't use any IV sedation in my practice

 

[stsa84]

For those saying No for RFA, are you not using IV sedation for RFA?

No. I do 95% of my RFA's in the office with just local. I have some patients I've inherited that are used to getting their RFA with sedation. I've talked a number of them into just doing it in the office with local, but reserve a half day a month at the hospital to do a few random cases with IV sedation for those few. (Will also do my RFA's with ICD's during that half-day, and SCS trials)

 

[paindoc503]

I’ve seen quite a few docs in my area insist on IVs for all cervical cases (without sedation). What is the rationale for this?

 

[MitchLevi]

I’ve seen quite a few docs in my area insist on IVs for all cervical cases (without sedation). What is the rationale for this?

They lack confidence and suck at their job.

 

[lobelsteve]

For those saying No for RFA, are you not using IV sedation for RFA?

Routine use of sedation for this procedure is not recommended.

 

[BobBarker]

No. I do 95% of my RFA's in the office with just local. I have some patients I've inherited that are used to getting their RFA with sedation. I've talked a number of them into just doing it in the office with local, but reserve a half day a month at the hospital to do a few random cases with IV sedation for those few. (Will also do my RFA's with ICD's during that half-day, and SCS trials)

Huge tactical error doing your scs trials at a hospital.

 

[stsa84]

I'm HOPD

 

[BobBarker]

When I was HOPD, I did everything at the hospital. They had 20 people that would have been home or standing around if I wasn’t working. If you are doing them in your office but billing as HOPD please tell me you aren’t helping position, clean, enter the name in the C-arm, etc. They are really robbing the system if you are doing HOPD billed injections in a typical office.

 

[Laryngospasm]

For those saying No for RFA, are you not using IV sedation for RFA?

Local not needed for RFA.. unless you have one of those patients.. you know the one

 

[oneforfighting]

Local not needed for RFA.. unless you have one of those patients.. you know the one

I’m assuming you meant IV sedation not needed

 

[specepic]

I’ve seen quite a few docs in my area insist on IVs for all cervical cases (without sedation). What is the rationale for this?

all my cervical cases get an IV due to higher incidence of vasovagal vs lumbar injections (not IV sedation, IV access)

 

[MitchLevi]

CESI is the least painful injection in our field.

 

[RoloTomassi]

all my cervical cases get an IV due to higher incidence of vasovagal vs lumbar injections (not IV sedation, IV access)

You find it necessary to use it for IVF? My VV self resolve in a few min

 

[MitchLevi]

 

[callmeanesthesia]

all my cervical cases get an IV due to higher incidence of vasovagal vs lumbar injections (not IV sedation, IV access)

Hasn’t been my experience. If they vasovagal I have them roll over and give them an PLR. All the hemodynamic effects, without the IV. Do you do cervical with patients seated or something?

 

[RoloTomassi]

Hasn’t been my experience. If they vasovagal I have them roll over and give them an PLR. All the hemodynamic effects, without the IV. Do you do cervical with patients seated or something?

Plr?

 

[callmeanesthesia]

Plr?

Passive leg raise.

 

[bedrock]

It was dogma in fellowship to place an IV on all CESI, ILESI OR TFESI. Now I can understand CTESI but not regular CESI.

I agree it is less painful than many procedures but some patients are still sensitive to it and many people are more prone to vagal after CESI than LESI, all other things equal.

Now, I certainly don’t give an IV to all CESI, but I do strongly suggest a Xanax for most CESI in patients under 60.

Much quicker for me to just write po Xanax on the orders than to deal with the vagals, and frankly it makes a better CESI experience for many patients and also for me too!

 

[SSdoc33]

no xanax. no IVs. no nothing.

i put IVs in for cervical procedures for about 6-7 years. after realizing that I never used one once -- in 7 years -- I stopped.

you shouldnt need an IV for a CESI or for an RF. if you do, then you need better technique. if patients bitch and moan about the guy down the street using sedation, they can go see the guy down the street. less headache for me.

 

[SC Tian]

community standard plays a big role imo, changed a lot since i moved to new practice

 

[Laryngospasm]

I’m assuming you meant IV sedation not needed

You are correct haha..

 

[specepic]

good discussion, ty!

 

[powermd]

Kypho only. I've started giving my SCS patients oral antibiotics starting 24 hours prior to the trial, so no need for the IV.

 

[BobBarker]

No IV’s for office cases currently. I do think it would be “better” to have them for kyphos and trials but no one to start them for me.

 

[gazzer]

What medications and doses do you guys prescribe for oral sedation?

Also, for the in office IV sed cases..what are you all using?

For RFAs without iv sed do you guys use lidocaine 1% or 2% for needle tracts? What volume of bupi 0.5% prior to ablating?

 

[RoloTomassi]

What medications and doses do you guys prescribe for oral sedation?

Standing order is 1-2 T3 + 1-2 Xanax .5 or 1-2 Valium 5. Up to Perc 10 + Valium 10. MKO also an option.

Also, for the in office IV sed cases..what are you all using?

Fent/versed

For RFAs without iv sed do you guys use lidocaine 1% or 2% for needle tracts? What volume of bupi 0.5% prior to ablating?

1% lido tract, 1.5 mL 2% lido MB. Bupi takes too long.

Can combine any of the above with nitrous.

 

[gazzer]

Standing order is 1-2 T3 + 1-2 Xanax .5 or 1-2 Valium 5. Up to Perc 10 + Valium 10. MKO also an option.

Fent/versed

1% lido tract, 1.5 mL 2% lido MB. Bupi takes too long.

Can combine any of the above with nitrous.

Nice.
How are you handling versed/fent? Do you push the medications yourself, then perform procedure? MA watches patient while you perform next procedure?

 

[RoloTomassi]

Nice.
How are you handling versed/fent? Do you push the medications yourself, then perform procedure? MA watches patient while you perform next procedure?

RN places IV, pushes, monitors vitals during and after.

 

[Ducttape]

i do not believe an MA is considered qualified enough to assist with conscious sedation. they need to be "certified".

have to have an RN. cant be LPN.