Posted on Mar 26, 2015 2:00:00 PM by Leslie Wooldridge, GNP-BC, CUNP, BCIA-PMD

PTNS: Dealing With Difficult Ankles

Treating OAB Patients with Difficult Ankles

Most patients do not have ideal ankles where anatomy is perfect and landmarks are always where they should PTNS: Dealing With Difficult Anklesbe. Some challenging situations make getting the right response difficult at best and quite frustrating at times. Here are some tips for those difficult ankles:

Thin Ankles

Be careful not to put the needle in too far too fast. If you hit the nerve or get so close that the stimulation is intolerable, the patient may not want to continue with treatment. Go in slow and anchor the needle as soon as it is stable. Continue to test the needle placement, millimeters at a time, until you get the proper response.

Edematous Ankles

Schedule these patients in the morning when the edema should be at its lowest. While I do not have my patients wear compression socks, I know some practitioners recommend them to patients to help control edema. If there is edema, push the area to compress the edema outward from where you want to place the needle. This will give you a nice “valley” so that you can pinpoint your placement without feeling that you might not have enough needle length to get where you need to be.

Visible Veins or Spider Veins

Visible veins or spider veins: Avoid veins at all cost! Sticking the needle into a blood vessel is very uncomfortable for the patient and you will risk bleeding at the sight when removing the needle. You can cause a hematoma at the sight that might also be sore or painful after removing the needle.

If your patient is on an anti-coagulant, and this happens, put pressure on the area for at least a minute by the clock to avoid any excessive bleeding at the sight.

Tough or Leathery Skin

This is the most difficult situation. At times it is helpful to pull the skin to make it taut. Make sure you are placing the needle at a 60° angle and not straight in. Using the bevel of the needle properly will help with placement. You may also want to grab the needle lower, to prevent bending.

Avoid the following: hair follicles, open areas, scars, inflamed areas or ankles that have hardware in them.

Taking these tips into consideration will make for a much smoother and less frustrating process. And, a happier patient!

Urgent PC for OAB

This blog post reflects the opinions and experience of Leslie Wooldridge, a long-standing user of the Urgent PC Neuromodulation System, and was produced under a paid consulting agreement with Cogentix Medical.

Urgent PC is indicated for the treatment of Overactive Bladder and associated symptoms of urinary urgency, urinary frequency and urge incontinence. Treatment with Urgent PC is contraindicated for patients with pacemakers or implantable defibrillators, patients prone to excessive bleeding, patients with nerve damage that could impact either percutaneous tibial nerve or pelvic floor function or patients who are pregnant or planning to become pregnant during the duration of the treatment. Most patients don't experience side-effects. If side-effects occur, they are typically temporary and include mild pain and skin inflammation at or near the stimulation site. Caution: Federal law (USA) restricts this device to sale by or on the order of a physician. For complete instructions for use, storage, warnings, indications, contraindications, precautions, adverse reactions and disclaimer of warranties, please refer to the insert accompanying each product or online at Models are for illustrative purposes only. Urgent is a registered trademark of Cogentix Medical © 2015 Cogentix Medical. All rights reserved. 

Leslie Wooldridge, GNP-BC, CUNP, BCIA-PMD
Leslie Saltzstein Wooldridge, GNP-BC, CUNP, BCIA-PMD, is Director of the Adult Bladder Control Center, Mercy Health Partners, Muskegon, Michigan USA. Ms. Wooldridge received a Master of Science degree in nursing administration, critical care nursing and postgraduate certification as a Geriatric Nurse Practitioner from Marquette University, Milwaukee, Wisconsin. In 2015, she was honored with the Women’s Health Foundation Activist Award. She is also the recipient of the 2009 National Association for Continence Rodney J. Appell Continence Champion Award. Ms. Wooldridge has published in multiple refereed journals. She authored the Genitourinary chapter in The Nurse Practitioner in Long Term Care: Guidelines for Clinical Practice (2007). She has lectured throughout the United States on geriatrics, urology and clinical practice.
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