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Interview with CT Assist’s Danielle Bielecki, NP, RNFA on Endoscopic Vein Harvest (EVH) Training

Posted by Danielle Bielecki, NP, RNFA on Sep 29, 2017 8:29:00 AM
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When did you learn how to harvest vein?

Danielle:   I started learning open vein harvest through “skip incisions” in 2001.   When I changed jobs in 2003, there was a big effort to start using the endoscopic approach to vein harvesting.  Myself and another assistant were learning to harvest together.   We did not have anyone on staff with EVH experience, so we were trained by a company representative. 

Did harvesting vein through an endoscopic approach come easy for you?

Danielle: Endoscopic Vein Harvest (EVH) is not an easy skill to learn.  Certainly some persons are able to pick it up fairly quickly while others may take a longer time to acquire the skill.  I was grateful to have a background where I could harvest vein through the open technique.   Whenever I had an obstacle that I could not overcome, I always knew my fallback plan was to make an extra counter-incision at the area of difficulty. 

How long did it take you to feel comfortable performing EVH?

Danielle:  About 6 months, but again I had the reassurance that if I was having a hard time with something, I could open the leg with an extra incision.

Have you trained others to perform EVH?

Danielle:  Yes.

Danielle Photo with Surgical Cap.jpg

What is it like to train others?

Danielle:   It is simultaneously a rewarding and frustrating process for both the trainer and the trainee.   There is pressure to both train someone to take a nice piece of vein but also complete the harvest within a reasonable period of time.  It takes a lot of patience.   A trainee may take 2 hours or even more to harvest a full leg of vein while they are learning.    Often that means I need to participate in part of the harvesting to decrease the harvest time and move forward with the case.   I also need to be a step ahead of the trainee to guide them towards success, and also keep them out of trouble.

What advice do you have for EVH trainees?

Danielle: You need to be open to learning from multiple people who all have different ways of doing things.   It is helpful if you are willing to accept all guidance, try new techniques from each person you are learning from, even if it slows you down initially.  Ultimately you will integrate all the techniques and incorporate them into your own person approach. 

Obviously you have been harvesting vein for a long time, how have you seen EVH change over the years?

Danielle: The scopes have gotten longer, allowing the harvester to retrieve more vein with each pass of the scope, and even the ability to harvest the entire leg of vein with one small incision.   The tunnels have gotten smaller as the harvesting system has also gotten smaller.   There is much better sealing of the vessels than in the early days of EVH, allowing the harvester to have better visualization of the vein within the tunnel.

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Topics: EVH endo vein harvesting Cardiac Surgery