Ok, so, the patient has had a consultation in advance of the procedure. I have summarised
the procedure that we are going to do, I have answered any questions that the patient may
have and I have gained written consent for the procedure. I have also confirmed which
leg we are going to treat by putting a little mark – an indelible surgical pen mark on
the leg – to confirm that that is the leg we are going to treat. And we have now prepared
the leg and got the patient on the procedure table to do the procedure for him now. The
set up of the room is such that I am going to stand on the patient’s right – I am
right handed – and I will be conducting the procedure from the patient’s right.
And from an ergonomic point of view, from the design of the treatment room and the placing
of the all the various people within the treatment room, we have got the ultrasound machine on
the patient’s left, so that when I am performing the procedure, I am by the patient’s side,
using my right hand to do the procedure, and I am also looking straight ahead at the ultrasound
machine so that I am not having my neck turned to one side and from an ergonomic point of
view it is the most efficient way of doing the procedure. We have Jane who is going to
monitor the patient – make sure that the patient is comfortable and safe. She has already
attached monitor leads to the patient. And she is going to look at the monitor which
will display the pulse – the heart rate – it will look at oxygen saturation levels
in the blood and it will also measure the blood pressure and Jane will talk to the patient
throughout the procedure to make sure that the patient is comfortable and that the vital
signs are all satisfactory. Should there be any concerns about the patient’s well-being,
Jane will communicate that to other members of the team. So Jane is next to the patient
on the left and the monitoring equipment is at the head of the treatment table and Jane
is in charge of that. Pam who has prepared the table with all the various instruments
and items that we need will be at the foot of the table to my right. I am right handed
and Pam will pass me the next instrument that I require and she will also take away instruments
that I have used and that I no longer require during the procedure. So Pam will orchestrate
the various instruments and equipment that we need. We also have on the patient’s left
towards the foot, the laser equipment. Again it has a display which I need to see, Pam
needs to see and Jane is the laser operator. She will make sure that the settings are correct,
that I have access to the foot switch that starts the laser. She is in charge of the
key and she will turn the laser off if there are any safety issues. She will also supply
members of the team with safety goggles. So that’s how we organise the room to be the
most efficient – that’s for a right handed person, whether I treat the left leg or the
right leg, I always stand on the patient’s right. We always have the ultrasound equipment
directly opposite on the patient’s left. We don’t have a vascular technician to operate
the ultrasound equipment. We have a sterile cover so that I can alter the dials and settings
on the ultrasound machine without compromising sterility and the ultrasound probe has already
been covered with a sterile probe cover so we can we can look at the patient’s leg
and in a moment when we start the procedure I will show you how I cannulate the vein that
we are going to treat with laser – that is an essential skill and I will demonstrate
that in a moment.