UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE
TITLE: Vein Injection
Sclerotherapy: Varicose Veins and Spider Veins
Effective Date: February, 2005 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education
Reviewed March 2008 May 2009 November 2011
PURPOSE: To provide guidelines for setting up and assisting with vein injection at UWMF Clinics.
DEFINITION: Sclerotherapy is the use of sclerosing chemicals to treat varicosities. The agent produces
inflammation; and later fibrosis and obliteration of the lumen of the blood vessel.
POLICY: The clinical staff will utilize the following guidelines to set up and assist with vein injections at any
SUPPLIES: Provider’s order, Patient’s record, Permit for Operation
Small surgical tray (non-sterile), Small disposable surgical white towel, 1cc Tuberculin syringes,
30 G ½ needle, 4 x 4 gauze sponges, Isopropyl Alcohol, ½ in. and 1 inch width Transpore or
Micropore Tape, Coban Dressing, Alcohol wipes, Chux pad, Cloth Drape (if needed),
5ml Sotradecol 1%, 2 sets of non-sterile gloves
1. Check provider’s order and clarify any inconsistencies.
2. Wash hands and gather equipment.
3. Draw up 10 syringes with 0.5ml of Sotradecol solution in each using Tuberculin syringes.
* Strength may need to be diluted with sterile saline depending on provider preference.
4. Place a 30 G needle on each syringe and put on tray.
5. Open remaining supplies and place on surgical tray.
6. Introduce yourself and identify the patient. Include date of birth. Verify allergies.
7. Provide good light and provide privacy by closing curtains and door.
8. Room patient – Refer to Provider Preference List for Rooming Patients.
9. Verify insurance has been authorized or if patient is self-pay.
10. Explain procedure to the patient.
11. Following the provider’s discussion with patient, have patient sign Consent form for sclerotherapy.
12. Have patient change out of pants and cover with cloth drape.
13. Assist patient into comfortable position on the table.
14. Wash hands and put on gloves and assist provider (as needed).
15. Remove gloves and wash hands.
16. Assist patient to a comfortable position and assist with dressing (if needed)
Give patient “Post-sclerotherapy instruction” handout.
Review handout with patient.
Assist patient to waiting room and with follow-up appointments (if needed).
NOTE: If patient is self-pay, have them stop at registration desk on 4th floor to pay for services.
17. Apply gloves and clean all surfaces with Dispatch
Bring surgical tray and instruments to dirty utility room
Place needles in sharps containers
Discard waste and disposable equipment in proper receptacles
Wash instruments and tray in dirty utility room
Remove gloves and wash hands
Bring instruments to clean utility room
18. Documentation (in Progress Notes section of HealthLink) in the patient’s record:
the procedure performed, date & time completed
name and amount of any medications given (using SmartPhrase: .medinclinic)
how the patient tolerate the procedure
follow-up appointment (if any)
WRITTEN BY: Beverly Polzin, R.N., Department of General Surgery
REVISED BY: Carol Decker, RN, MSN, Clinical Staff Educator
REVIEWED BY: Kelly Meyer R.N., Department of General Surgery
Kowalak, J. P. (Ed.). (2009). Lippincott’s nursing procedures (5th ed.). Ambler, PA: Lippincott Williams & Wilkins.
Perry, A.G. & Potter, P.A. (2002). Clinical nursing skills & techniques. (5th ed.). St. Louis, MO: Mosby.
Perry, A.G. & Potter, P.A. (2009). Fundamentals of nursing. (7th ed.). Hall, A. & Stockert, P.A. (Eds.). St. Louis, MO: Mosby
Department of Surgery Date
Medical Director Date