Vascular Care  
     
     
Frequently Asked Questions
Frequently Asked Questions

Staff Information


Barbara Mosow, Practice Manager

Discharge instructions - Fistula/ Dialysis graft


Vascular Care

Robert A. Schwartz, M.D., F.A.S.C.
Scott M. Surowiec, M.D.
Tracy A. Vaughn, RPA-C
Sheryl L. Khan, RPA-C

Arteriovenous fistula, Bovine or Gortex dialysis access graft- Discharge Instructions

1. Resume your diet and your medications as you took them prior to surgery. You may take ______________________________________________________________________ for pain relief.
 Prescription enclosed Yes or No

2. NO heavy lifting until after stitches have been removed. Protect incisions from getting hit.

3. NO driving for one day or until you are no longer taking narcotic pain medication. You may take Tylenol and drive.

4. Leave the dressing on for 72 hours (3 days), you may sponge bathe until then. If you have small tape stripes over the incision leave them in place. Please wash over the incisions daily with soap and water. You can wash over the tapes.

5. After the dressings are off, you may shower and wash the incision with soap and water. Sponge bathe if you are being dialyzed with a Permcath.

6. Use your operated arm or leg as normally as possible. Do not avoid using it for daily activities, it will become stiff and hurt more, rather than hurting less.

7. It is normal to be sore or have pain at the incisions. IF THE HAND IS PAINFUL OR ACHES PLEASE CALL AS SOON AS POSSIBLE. 315-329-7711 Tell the office staff your hand hurts, ask that your doctor be notified.

IMPORTANT Your hand can hurt if it isn't getting enough blood, it can become permanently injured so please call so that we can prevent a permanent injury.

8. Call the office when you get home to make a follow-up appointment in two (2) weeks.

9. Call the office if you develop a fever of greater than 102 degrees or cannot keep solid foods down.

10. Call the office if you have any other questions at (315)663-0508


Vascular Care
Progressive medical, surgical and minimally invasive treatment for vascular health.
4507 Medical Center Drive
Fayetteville, NY 13066
315-663-0508


Angiogram home instructions


Vascular Care

Robert A. Schwartz, M.D., F.A.S.C.
Scott M. Surowiec, M.D.
Tracy A. Vaughn, RPA-C
Sheryl L. Khan, RPA-C

Angiogram home instructions:

1. NO driving for one day.

2. Relax and take it easy for the next 2 days. No heavy lifting, straining, or yard work (mowing, plowing shoveling etc.) for 3 days.

3. Remove and replace the bandaid daily for 3 days.

4. Shower and wash the puncture sites with soap and water daily. (with the bandaid off)

5. It is normal to have some swelling, tenderness and bruising at the puncture sites.

6. If you notice an enlarging lump where the puncture site is please call the office to be examined.

7. If you begin to bleed from the puncture site lay down and have a friend or family member apply finger pressure directly over the bandaid with two hands for ten full minutes without breaks. If the bleeding has stopped after 10 minutes lie still for an hour then take it easy for the rest of the day. Call the office to be examined or 911 if the bleeding doesn't stop. If you are alone call 911 and lie down and apply pressure to the area yourself.

8. Resume your pre-angiogram diet and continue taking your Medications as you did before
 ** see 10 **

9. Drink plenty of fluids at least 40 ounces over the next 12 hours (five 8-ounce glasses of water, milk, juice or soda). This is to help flush the contrast dye through your kidneys. If you are a dialysis
patient drink only your normal amount.

10. ****If you were asked to stop taking one of your diabetes medications (containingMETFORMIN,or GLUCOPHAGE) prior to your angiogram,
__________________________________________________________________________________

11. Call the office if you develop a fever greater than 102 degrees, a rash, hives or itching or you cannot keep down solid food.

12. Call the office when you get home to schedule a follow-up appointment in two (2) weeks.

13. Call the office with any other questions or concerns at (315) 663-0508.

Vascular Care
Progressive medical, surgical and minimally invasive treatment
for vascular health.
4507 Medical Center Drive
Fayetteville, NY 13066
315-663-0508


Peritoneal Dialysis Catheter Home instructions


Vascular Care

Robert A. Schwartz, M.D., F.A.S.C.
Scott M. Surowiec, M.D.
Tracy A. Vaughn, RPA-C
Sheryl L. Khan, RPA-C


1. You may restart your diet as you ate prior to surgery.

2. Restart all your medications as they were prescribed prior
to surgery. You may take Tylenol as directed for pain OR (not both)

______________________________________________________
Prescription enclosed Yes or NO

3.You may become constipated. If you become constipated, check with your nephrologist prior to taking any laxative or using an enema so that you use the right kind for kidney failure.
*Some laxatives/enemas can make a patient with renal failure very ill or even cause death.**

4. Leave the dressing on until the PD nurse removes the dressing for your first flush (1 week) and for exit site care.

5. Sponge bathe.

6. It is normal to have sore abdominal muscles this will resolve in ~2-3 weeks.

7. Your PD or Tenchkoff catheter needs to be flushed out weekly until you are using the catheter daily. Protein in the abdominal fluid will otherwise clog the holes in the catheter and make it dysfunctional.

8. If you do not have an appointment for a flush within a week of your surgery call ______________________ to arrange an appointment with the PD nurse.

9. Call the office when you get home to make a follow-up appointment in two (2) weeks.

10. Call the office if you develop a fever of greater than 102 degrees or cannot keep solid foods down.

11. Call the office if you have any other questions at (315) 663-0508.


Vascular Care
Progressive medical, surgical and minimally invasive treatment for vascular health.
4507 Medical Center Drive
Fayetteville, NY 13066
315-663-0508


Leg Bypass Instructions


Vascular Care

Robert A. Schwartz, M.D., F.A.S.C.
Scott M. Surowiec, M.D.
Tracy A. Vaughn, RPA-C
Sheryl L. Khan, RPA-C


1. NO driving for two weeks or when your incisions are no longer tender.

2. DO NOT sit with your legs hanging down for any length of time (except for meals or to use the bathroom). You may need to rest 3-4 times a day with your legs elevated above the level of the heart, this is to prevent further swelling.

3. Please shower and wash the incision with soap and water daily.

4. You do not need to keep a dressing over the sutures unless otherwise instructed or there is drainage.

5. It is normal to have some swelling, tenderness and bruising at the incisions.

6. Call the office if you develop a fever greater than 102 degrees or you cannot keep down solid food.

7. Call the office when you get home to schedule a follow-up appointment in two (2) weeks.

8. Call the office with any other questions or concerns at (315) 329-7711.

Vascular Care
Progressive medical, surgical and minimally invasive treatment for vascular health.
4221 Medical Center Drive
Fayetteville, NY 13066
315-329-7711


Transient Ischemic attack Symptom sheet


Vascular Care

Robert A. Schwartz, M.D., F.A.S.C.
Scott M. Surowiec, M.D.
Tracy A. Vaughn, RPA-C
Sheryl L. Khan, RPA-C

Symptoms of TIA / Mini-stroke
Carotid Stenosis
Right and/or Left

If blood flow to part of your brain stops, even briefly, you may have symptoms of a stroke or a mini-stroke or TIA (Transient Ischemic Attack)

If you have any of these symptoms please seek help immediately, even if the symptoms
only last for a moment. Call our office 24 hours a day 7 days a week to speak with a physician who can answer your questions and let you know what you need to do. (315)-663-0508. After office hours and on weekends the phone call will be answered by our service and the physician will return your call. If the symptoms are getting worse or not improving go to an emergency room or call 911.

1. Temporary BLINDNESS in one eye.

2. Difficulty moving a hand or arm. Paralysis of one side of the body.

3. Slurred speech. Difficulty speaking. Inability to speak or difficulty understanding spoken or written words.

Vascular Care
Progressive medical, surgical and minimally invasive treatment for vascular health.
4507 Medical Center Drive
Fayetteville, NY 13066
315-663-0508


Instructions for Vectra cannulation


***Note Well***Do NOT use excessive compression! Do NOT use clamps! Do NOT apply elastic wrap or compression-type bandages!

1 Assess the Vectra Implant Patient with Care. Always assess patient's condition for
infection, thrombosis, or other potential problems. Confirm graft configuration, positioning, and
direction of flow; refer to the surgeon's report, patient's chart, and patient's VIP
Guidebook of Care for special instructions.

2 Check the Vectra Graft for Pulse / Thrill / Bruit. Prior to, during, and after dialysis treatment,
always palpate the Vectra Graft for pulse and thrill ( the vibration or tremble of blood
flow) and evaluate bruit (the sound of blood flow) with a stethoscope. Do NOT cannulate
if pulse, thrill, or bruit is absent!

3 Cannulate the Vectra Graft with Care. Always cannulate with needle bevel UP and at
a 45-degree angle. First insert the venous needle antegrade (with the direction of blood
flow) and then the arterial needle, preferably, retrograde (against the direction of blood
flow). Rotate sites and maintain strict adherence to aseptic techniques.

4 Confirm Needle Entry with Blood Flashback. During insertion, always confirm entry into
the graft with blood flashback in the needle hub / tubing. Once entry is confirmed, level
off the needle to ensure optimal placement. Do NOT exert excessive pressure on the
needle and NEVER confirm entry with feeling or "pop".

5 Maintain Normal Blood Flow Rates. Beginning with the first dialysis and continuing with
subsequent treatments, always use proper gauge needles required to establish and maintain
adequate blood flow rates, as prescribed by the nephrologist.

6 Remove Needles from the Vectra Graft with Care.  Following dialysis treatment, always remove
needles slowly and at the same angle of their original entry (45 degrees) and final placement.
Do NOT apply pressure to the access site, or the needles, at any time during removal.

7 Apply Gentle Digital Pressure for Rapid Hemostasis. Using a sterile gauze pad or cotton ball,
always apply gentle, non-occlusive digital pressure to compress the cannulation site and achieve
rapid hemostasis. Maintain digital pressure for about 1 to 5 minutes or until bleeding stops.

Do NOT use excessive compression! Do NOT use clamps!
Do NOT apply elastic wrap or compression-type bandages!


Vein Stripping and/or Stab Phlebectomy


Vascular Care

Robert A. Schwartz, M.D., F.A.S.C.
Scott M. Surowiec, M.D.
Tracy A. Vaughn, RPA-C
Sheryl L. Khan, RPA-C


1. Take frequent short walks around the house walking as normally as possible. (flexing the foot so the calf muscles are used- this helps prevent venous clot in the deep veins, and decrease swelling)

2. If possible, during the first 2 days avoid actions that suddenly increase venous pressures examples heavy lifting, and strenuous activity.

3. DO NOT sit with your legs hanging down for any length of time (except for meals or to use the
bathroom). You may need to rest 3-4 times a day with your legs elevated above the level of the heart, this is to prevent further swelling.  Refrain from exercise, heavy lifting and strenuous activity for the first 4 days.

4. Leave the ace wrap in place for 2 days. After that you may remove the ace wraps to shower, however they should be reapplied after your shower. Ace wraps should be worn when up morning
to bedtime for Two(2) weeks.

5. Please shower and wash the incision with soap and water daily.

6. It is normal to have some swelling, tenderness and bruising.

7. Call the office if you develop a fever greater than 102 degrees or you cannot keep down solid food. Call the office with any other questions or concerns at (315) 663-0508.

8. Call the office when you get home to schedule a follow-up appointment in ______________________.


Vascular Care
Progressive medical, surgical and minimally invasive treatment for vascular health.
4507 Medical Center Drive
Fayetteville, NY 13066
315-663-0508


VNUS Closure and Stab Phlebectomy

Vascular Care

Robert A. Schwartz, M.D., F.A.S.C.
Scott M. Surowiec, M.D.
Tracy A. Vaughn, RPA-C
Sheryl L. Khan, RPA-C

1. Take frequent short walks around the house walking as normally as possible. (flexing the foot so the calf muscles are used- this helps prevent venous clot in the deep veins, and decrease swelling)

2. If possible, during the first 4 days avoid actions that suddenly increase venous pressures examples straining, bearing down, coughing, sneazing, bending down quickly, heavy lifting, and strenuous activity.

3. DO NOT sit with your legs hanging down for any length of time (except for meals or to use the
bathroom). You may need to rest 3-4 times a day with your legs elevated above the level of the heart, this is to prevent further swelling. Refrain from exercise, heavy lifting and strenuous activity for the first 4 days.

4. Leave the ace wrap in place until your ultrasound appointment in 2-3 days. After that
appointment unless otherwise advised you may remove the ace wraps to shower, however they should be reapplied after your shower. Ace wraps should be worn when up morning to bedtime for Two(2) weeks.

5. Please shower and wash the incision with soap and water daily.

6. It is normal to have some swelling, tenderness and bruising.

7. Call the office if you develop a fever greater than 102 degrees or you cannot keep down solid food.

Call the office with any other questions or concerns at (315) 663-0508

8. Call the office when you get home to schedule a follow-up appointment in two (2) weeks. You should have an appointment for a venous ultrasound 2-4 days after your surgery.

Vascular Care
Progressive medical, surgical and minimally invasive treatment for vascular health.
4507 Medical Center Drive
Fayetteville, NY 13066
315-663-0508


Endo AAA- Home instructions

Vascular Care

Robert A. Schwartz, M.D., F.A.S.C.
Scott M. Surowiec, M.D.
Tracy A. Vaughn, RPA-C
Sheryl L. Khan, RPA-C

1. NO driving for one week or when your incisions are no longer tender.

2. DO NOT sit with your legs hanging down for any length of time (except for meals or to use the
bathroom). You may need to rest 1-2 times a day with your legs elevated above
the level of the heart, this is to prevent further swelling.

3. You may shower and wash the incision with soap and water.

4. You do not need to keep a dressing over the sutures unless otherwise instructed or there is drainage.

5. You may have a mild back ache after this procedure. We believe this is from the aneurysm sac clotting when it is excluded from the flowing blood. This causes some minor swelling in the back muscles and a mild back ache. If you think your pain is worse than this call and speak to your doctor.

6. It is normal to have some swelling, tenderness and bruising at the incisions.

7. Call the office if you develop a fever greater than 102 degrees or you cannot keep down solid food.

8. Call the office when you get home to schedule a follow-up appointment in two (2) weeks.

9. Call the office if you have any other questions or concerns at (315) 663-0508.


Vascular Care
Progressive medical, surgical and minimally invasive treatment for vascular health.
4507 Medical Center Drive
Fayetteville, NY 13066
315-663-0508


Aortic aneurysm/Bypass home instructions

Vascular Care

Robert A. Schwartz, M.D., F.A.S.C.
Scott M. Surowiec, M.D.
Tracy A. Vaughn, RPA-C
Sheryl L. Khan, RPA-C

1. NO heavy lifting.

2. NO driving for two (2) weeks.

3. You may shower and wash the incision with soap and water.

4. Tiredness, depression, and constipation are common after Aortic surgery. They will resolve
spontaneously. If you become constipated, take a laxative as needed following the instructions on the package.

5. You may be experiencing some loss of appetite. Try to take fluids and eat smaller more frequent meals to get adequate nutrition.

6. Call the office if you develop a fever of greater than 102 degrees.


7. Call the office when you get home to make a follow-up appointment in two (2) weeks.


8. Call the office if you have any other questions at (315) 663-0509; please ask for our nurse.

Vascular Care
Progressive medical, surgical and minimally invasive treatment for vascular health.
4507 Medical Center Drive
Fayetteville, NY 13066
315-663-0508


Amputation- Home instructions

Vascular Care

Robert A. Schwartz, M.D., F.A.S.C.
Scott M. Surowiec, M.D.
Tracy A. Vaughn, RPA-C
Sheryl L. Khan, RPA-C

1. No driving.

2. Always use your walker for transfers and moving about. Do not attempt to use crutches for walking. FALLING on a newly amputated limb often tears the wound open and leads to a higher
amputation. Use your best judgment when moving and ask for help rather than risk falling and traumatizing your amputation. It is generally about 6-8 weeks before the limb has healed enough to have a prosthesis fitted.

3. Tiredness, Depression and Constipation are common after an amputation. They will resolve spontaneously. If constipated you may take a laxative as needed following the instructions on the package.

4. You may be experiencing some loss of appetite. Try to take fluids and eat smaller more requent meals if necessary.

5. It is normal to have phantom limb sensations after an amputation. It is common to experience an itch or sensation like your foot /leg is still there. These sensations are experienced long term.
Phantom limb pain is not very commonly reported.

6. You may shower and wash the incision with soap and water.

7. You do not need to keep a dressing over the sutures unless otherwise instructed or there is drainage.

8. Do not wrap your amputated limb with Ace wraps or tight gauze dressings or begin using a stump shrinker until one of our doctors has authorized it.

9. Call the office if you develop a fever of greater than 102 degrees.

10. Call the office when you get home to make a follow-up appointment in two (2) weeks.

11. Call the office if you have any other questions at (315) 663-0508; Please ask to speak with our nurse.

Vascular Care
Progressive medical, surgical and minimally invasive treatment for vascular health.
4507 Medical Center Drive
Fayetteville, NY 13066
315-663-0508


Carotid Endarterectomy - Home instructions

Vascular Care

Robert A. Schwartz, M.D., F.A.S.C.
Scott M. Surowiec, M.D.
Tracy A. Vaughn, RPA-C
Sheryl L. Khan, RPA-C

1. NO driving until neck is no longer tender.

2. You may take a shower or bath. You may wash the incision with soap and water. You may shave directly over the incision. If you cut yourself apply gentle pressure with a
Kleenex, which should be satisfactory to stop the bleeding.

3. You may experience some numbness and swelling along the suture line. It is normal to have numbness in front of the incision over to the middle of your neck.

4. We will take your staples or stitches out when you come to the office for your next visit.

5. Call the office if you develop a fever greater than 102°.

6. Call the office when you get home to schedule a follow-up appointment in two (2) weeks.

7. Call the office if you have any other questions at (315) 663-0508;

8. Move your neck as normally as possible. Do not hold neck stiffly or you will develop a tension headache. If you get a headache, take a warm shower and roll your head from side to side in the warm water to loosen the muscle tension.

9. Go to bed when you get home, sleep until dinner time, get up, eat and remain up until your usual bedtime. Go to bed at your usual bedtime.


Vascular Care
Progressive medical, surgical and minimally invasive treatment for vascular health.
4507 Medical Center Drive
Fayetteville, NY 13066
315-663-0508


WOUND CARE PRESCRIPTION


Patient's Name:_________________________________________Date:______________________

Location of
Wound:___________________________________________________________________________

Product type (ie alginate):___________________________________________________________

Name of product(s):(Product size)_____________________________________________________

_________________________________________________________________________________

# dressings to be used at each dressing change (if more than one):_________________________

Frequency of Dressing Changes: ______________________________________________________


1. Cleanse the wound with soap and water, rinse well, irrigate with saline.

2. Measure the wound, stage the wound, assess granular and necrotic tissue

3. Apply____________________________________________________________________
to the base of the wound.

4. Apply_________________________________________________________________________
to the periphery of the wound.

5. Cover with_____________________________________________________________________
if drainage is moderate to heavy.

6. Secure dressing with_____________________________________________________________

7. Change dressing according to the frequency noted above or sooner if the dressing is saturated or leaking.

8. Monitor for signs and symptoms of infection.

9. Keep pressure off the wound.

10. Keep dressing clean and dry.

11. Call doctor immediately if wound (s) deteriorates or on a regular basis to report progress.

12 This patient is being followed for wound care at the Community General Wound care center 492-5980

Signature and date:

____________________________________________________________________

Vascular Care
Progressive medical, surgical and minimally invasive treatment for vascular health.
4507 Medical Center Dr.
Fayetteville, NY 13066
315-663-0508