Providence VA Medical Center, Rhode Island
The Only Vascular Technologist in the Network
Tucked away inconspicuously on the sixth floor is something you won't find in any other VA medical center in the VISN--not in Connecticut, not even in Boston. It's the Providence VAMC’s Vascular Laboratory, managed by Vascular Technologist Sheila Webster. Armed with nothing more than an ultrasound machine and a flow lab machine, Sheila has watched her workload quadruple over the past 9 years--from an average of 4 patient consults per day in 2002 to 12 consults per day today. That’s about 1100 diagnostic examinations a year.
"Most facilities have their Ultrasound Techs conduct vascular studies," Sheila explains. "But Vascular Technology is such a highly specialized field; there is so much to be gained by having a specialist."
So what does a Vascular Technologist do? According to Sheila, the bulk of the work—about 80%—is either a carotid artery screen (the carotid artery is an artery that supplies the head and neck with oxygenated blood) or a lower extremity arterial study screen.
A carotid artery screen is used to determine whether a patient has blockage in either of the carotid arteries in the neck. A blocked carotid artery is a serious condition and, left untreated, can lead to a stroke. Symptoms might include numbness, tingling, or weakness on one side of the body, blurry vision (sometimes like a black shade over the eye); or even slurred speech or change in mental status. The process for determining whether a patient has blockage of a carotid artery normally begins with the patient’s primary care provider or PCP. The PCP can hear a “bruit” (which is French for noise) while listening with a stethoscope placed on the neck.
Once referred to the Vascular Lab, Sheila uses an ultrasound machine to conduct the carotid artery screen--"it’s the same ultrasound machine you would use to monitor a pregnancy or for use in physical therapy," she adds. Using the ultrasound machine, Sheila is able to determine if there's a blockage and, if so, how serious. Surgery is an option, but oftentimes the patient’s condition is monitored every 6-12 months. As the Medical Center's only technologist, Sheila is well-suited to monitor and trend the status of her patients.
A lower extremity arterial screen is a study conducted using a flow lab machine to determine whether a patient has ischemia of the legs (when the legs are deprived of oxygen). Symptoms can include leg pain with walking or even at rest and/or muscle cramps. During the screening, blood pressure cuffs are placed on the patient’s thighs, calves, ankles, and feet, and a PPG (photoplethesmography) is placed on the toe to
monitor the volume/amount of blood flow under the cuffs. If the test results are normal, then the PCP can recommend other exams to identify the cause of the condition. If the test results are abnormal, a consult for the vascular surgeon is made for symptoms management or, if clinically warranted, surgery.
When asked why there's been such a large increase in the number of patients needing vascular screening, Sheila says it’s a combination of two things: the aging Veteran population and (more importantly) the level of health awareness in the general population. “Prevention is the key—don’t smoke, manage your diabetes, blood pressure, and cholesterol levels. But it’s comforting to know that there are other technologies out there that are very accessible to the patients.”
Sheila also does vein and arterial mapping prior to the placement of an AV fistula creation (a connection or passageway between an artery and a vein) for dialysis patients, venous mapping for arterial bypass surgery, and also conducts studies of people with varicose veins, working closely with the wound care nurse.
The Outpatient Vascular Laboratory at PVAMC serves Veterans every day including Wednesday afternoons under the supervision of the Chief, Surgical Services, and the Vascular Surgeon.