The Clinic is Closed

Who Should Inject Leg Spider Veins by Microsclerotherapy? Doctors or Nurses

Who should inject leg spider veins? You might think it’s a battle between doctors and nurses. Well it’s not and I am going to tell you why.  I am going to tell you who I think should inject leg spider veins and if you read to the end, I’ll tell you why I think the current system in the United Kingdom represents a gap in the law.

So what is Microsclerotherapy? Microsclerotherapy involves using a very fine needle  (hence the micro-bit) and a prescription medicine called a sclerosant (hence the sclerotherapy -bit). The sclerosant is injected into the spider vein. Successful injection is confirmed by the displacement of blood in the vein, resulting in a visual phenomenon called blanching. Microsclerotherapy requires training, skill and practice, so if the injector is appropriately trained and is competent, it really doesn’t matter whether the injector is a doctor or a nurse. Indeed, I trained a nurse at my clinic to perform Microsclerotherapy and I provided the supervision. The important aspect of her practice in my clinic was that she was part of a team of specialists. I assessed the patients; I diagnosed the condition (and let’s remember leg spider veins are not simply cosmetic, they are a medical condition) and I delegated and supervised the Microsclerotherapy if I thought that this treatment was appropriate after discussing the condition and consenting the patient. The nurse then administered the prescription by performing Microsclerotherapy within a regulated environment subject to clinical oversight, managerial oversight and within a clinical governance system that ensured safe and effective practice. That nurse whom I trained and supervised has since left and she has set up on her own as an injector of leg spider veins in a non-clinical environment, without the support of a team and without a clinical governance framework. It just so happens that she has been replaced by a doctor, a vascular surgeon in fact. So you might think that I against nurses performing Microsclerotherapy: well, NO I’m not.

What I AM against is anyone, doctor or nurse, who performs Microsclerotherapy in unregulated and unlicensed settings such beauty salons or hairdressers on their own without the support of a team and without a clinical governance framework. I have witnessed an increasing trend: that of nurse prescribers (nurses who can write prescriptions) attending a one-day course on Microsclerotherapy and then setting up in private practice in so called aesthetic clinics. In my opinion, this is a gap in the law in the UK. This trend is not only among some nurses, some doctors do the same.

Currently, the law does not regulate cosmetic clinics and cosmetic injections. So, doctors and nurses can attend a one-day “course” and immediately start treating leg spider veins. In fact, many providers of Botox® training also now provide training on Microsclerotherapy. I am not sure that the term training is appropriate here. I don’t think a one-day course given by non-specialists is sufficient training or experience.

So, the question ” who should perform Microsclerotherapy” is not a battle between doctors and nurses. In my opinion, the controversy does not centre around who should perform Microsclerotherapy; no the real issue centres around where is safe and whether existing legislation that requires medical clinics to register with the Care Quality Commission should also cover Microsclerotherapy. Appropriate training and competence are also issues that need to be addressed, in my opinion.

Leg spiders veins are a medical condition, requiring a medical diagnosis and, when indicated, they are treated by the intravenous injection of prescription medicines. Who does the injection is not as important as ensuring that existing legislation which regulates medical activities should also cover Microsclerotherapy to protect patients from harm.