The patient must sign a written consent in most institutions for the leeching procedure. You need to instruct the patient on the risks, benefits and alternative options to the leech procedure. There is a risk, albeit small, for infection and allergic reactions. Let patients know they will be placed on an oral or IV antibiotic at the time of the procedure. Make sure the patient knows that bleeding and oozing can be expected after the procedure. Also remind him or her that the leech bite will produce itching that will need to be treated after the procedure.
One can perform leeching procedures at bedside, in the operating room or in a clean office setting. The patient should bathe with antibacterial body soap for several days before the procedure if time permits. Washing the day of the procedure with distilled water is preferred to soap or chlorinated water. The use of soap, oils and perfumes retards the leech from biting. Map the target areas to be leeched over the extremity.
Where should you apply the leeches? A scarred target area may involve keloids, a raised hypertrophic scar, scar contracture or painful scarring. At the length of the scar, place leeches 1.5 to 2.5 cm apart. When the targeted area for leeching is a region for pain sympathetic block, you need to place three or six leeches along the course of the nerve. The sural nerve, dorsal intermediate cutaneous and saphenous nerves need three to four leeches. The deep peroneal and posterior tibial nerves need four to six leeches to achieve a desired regional block. When the targeted area is a region, you need to blanket the area with leeches. Space them 1.5 to 2.5 cm apart. A patient can safely tolerate up to 16 leeches in severe and resistant conditions.
When you have a well-defined target area, use an adhesive barrier. Remove the leech from the holding/warming container and place it onto the target area. Using sugar water, garlic and beer on the target areas will encourage the leeches’ feeding. Proceed to employ the feeding stimulant onto the target area. If you have resistant leeches, you can stimulate their feeding by incising the site with a small-gauged needle. Isolated corralling of the leech into a small area with the barrel from a syringe will prevent wandering. Place the leech into the barrel and place the barrel onto the desired target until the leech attaches.
The leech’s head will bite and then arch upward as a secure bite occurs. Leave the leech attached until it is full. The leech will fall off when engorged. The average leech will consume about 5 cc of blood. When the leeches have finished eating, treat them as a blood contaminate. Place the leeches in pre-measured 100-cc jar with alcohol 50 cc and dispose of them. The displacement is an estimate of blood volume loss.
There will be oozing at each leech site. Apply a topical antibiotic like gentamicin cream and a topical steroid cream to the dressing. Then apply bulky dressings. The oozing can continue for eight to 48 hours. Daily dressing changes are necessary as they will be saturated with blood.