(As written by the Regulatory Governing Bureau & Surgical Board)

Standards to maintain while practicing iMedic CSL Therapy (during inception period); to be followed in conjunction with Standards of Practice for CSL Certificants

CSL Therapists/Providers= certificants & licensees

• Certificants: To practice Incisional Sciences CSL therapy in America you need to have completed the CSL Precis class, finished a CSL approved sealed foundational course, and lastly submit a CSL Clinical Practicum.
• Licensure: To receive licensure, certificants may apply for iMedic licensure from the ACBAA Board of CSL Therapy Examiners. This involves completing an ACBAA sealed foundational course in Incisional Sciences, passing a national CSL examination(s), and meeting PPE eligibility requirements.
• Continuing Education: CSL therapists are required to complete 23 continuing education hours + a CPR class every 2yrs to maintain their licenses.
• Provider license renewal– every 2yrs
  • CEU requirements for renewal:
    • 3 CEUs in Ethics and Jurisprudence
    • 3 CEUs in Communicable Diseases
    • 1 CEU in Cultural Competence/Diversity
    • CPR Provider Level Certification
    • 16 bodywork CEUs

This requirement ensures that practitioners stay updated with the latest techniques and ethical standards.

Code of Ethics: Practitioners are expected to adhere to the CSL Certificant & Provider Code of Ethics that includes maintaining client confidentiality, obtaining informed consent, maintaining professional boundaries, and providing a safe and comfortable environment for clients.

Scope of Practice: iMedic therapists in America must work within their defined scope of practice as outlined by CSL Regulated Educational Positions. This means they should not diagnose medical conditions or provide treatments that are outside their training and qualifications; they should not give clients advice past their scope of training (Day 1-Day 7) without additional training; they should not advertise or solicit treatments outside of their scope of practice. Persons should not perform these treatments without the aligned above provisions or training. Persons should not be providing post surgical treatments to patients Day 1-7 without taking a CSL sealed and approved foundational course within Incisional Sciences.

Pain Management Awareness: Pain management awareness for an iMedic assisting a client during the first week after [plastic] surgery, while not involving diagnosis, should prioritize vigilant monitoring and responsive care during hands-on in person treatments. The iMedic should be attentive to the client’s pain levels and any discomfort they may be experiencing, without attempting to diagnose medical conditions. Additionally, they should educate clients on the expected progression of pain and potential warning signs of complications, emphasizing the importance of open communication and prompt reporting of any concerns to the surgical team. The goal is to ensure that the client’s pain is managed effectively, promoting a smooth and comfortable recovery process while maintaining a close partnership with the surgical team to ensure optimal postoperative care. Standards for assessing and managing postoperative pain and discomfort through non-pharmacological interventions are rendered from detailed physiological training in CSL PostOp trauma remodeling to introduce specialized palpable techniques.

Hygiene and Sanitation: Maintaining a clean and sanitary workspace, as well as following good personal hygiene practices, is a standard requirement to ensure client safety.

PPE & Domiciliary provisions: These standards underscore infection control and the safety of both patients and practitioners within incisional sciences treatments. These standards mandate the proper use and disposal of PPE to mitigate the risk of contamination and ensure a sterile environment.

Therapists are required to incorporate domiciliary provisions emphasizing the comprehensive care continuum in incisional sciences treatments, extending the responsibility of practitioners beyond the clinical setting. These provisions enable practitioners to address post-treatment needs and ensure patients receive necessary support and guidance in the comfort of their homes/personal accommodations, fostering a holistic and patient-centric approach to recovery and well-being with a hyperfocus on hygiene.

Client Records: iMedics must meticulously document key information, including wound status, vital signs, medication administration, and any changes in the patient’s condition. This documentation provides a critical snapshot of the patient’s postoperative progress, allowing healthcare providers to make informed decisions and adjustments to the treatment plan as needed. CSL therapists are required to maintain accurate and confidential client records (physical or digital), including intake forms, treatment notes, and progress reports for up to 5 years post treatment.

Draping and Modesty: Proper draping techniques, disposable garment usage, discreet photo taking and respect for client modesty are employed to create a safe and comfortable environment during treatment sessions. Although clients may be comfortable with nudity, at no time should a client be exposed in front of their provider, even within domiciliary environments.

Scar Management: These standards encompass responsibilities including thorough patient assessments to gauge wound conditions, adherence to strict infection control protocols, and the gentle yet meticulous cleaning of wounds using prescribed sterile solutions. Additionally, Standards of post surgical care include the application of appropriate dressings, administration of topical medications as prescribed, and proactive pain management for patient comfort.

Furthermore, patient education plays a significant role; CSL standards of care for iMedics include educating patients on how they can properly care for their wounds in between their treatments, basic scar management best professional practices to perform at home, and the importance of adherence to care instructions. Detailed documentation of wound assessments and care should be provided, along with clear communication within the healthcare team, ensuring the monitoring of progress and timely interventions when necessary.

Informed Consent: Obtaining informed consent from clients, which includes explaining the treatment process and discussing any potential risks or contraindications, is a standard practice. iMedics must discuss treatment techniques with clients before starting treatments, and explain what the client can expect to transpire during the session; they must also show what tools they will use & what emollients and astringents will be involved. 

Professionalism: Practitioners are expected to conduct themselves in a professional and ethical manner, avoiding any sexual misconduct and establishing appropriate boundaries with clients.

Collaboration with Surgical Team: iMedics must actively engage with and communicate effectively with clients’ surgical team, including surgeons, nurses, and other healthcare professionals. This collaboration begins with a clear understanding of the surgical plan, which informs the iMedic’s role in wound care, scar management, and patient recovery. iMedics should provide regular updates on the patient’s postoperative progress, promptly report any concerning changes in the wound or patient condition, and seek guidance or clarification from the surgical team when necessary. By working in unison, the surgical team and iMedics can ensure that the patient receives comprehensive and seamless care, addressing both the surgical aspect and the critical postoperative recovery phase. This standard underscores the iMedic’s dedication to fostering a patient-centric approach and the highest quality of care through effective teamwork and synergy with the surgical team.

Insurance and Liability: Carry professional liability insurance in case of unforeseen incidents.

Here are the key standards of care for a CSL Incisional Drainage Therapy appointment:

• Informed Consent: Obtain informed consent from the client before the session begins. Explain the treatment process, discuss the client’s goals and any specific concerns or issues, and ensure they understand what to expect during the session.
• Client Assessment: Conduct a thorough health assessment of the client before the Incisional treatment. Discuss their medical history, current health conditions, injuries, and any medications they are taking. Assess their physical condition and any areas of pain or discomfort. Document all notations.
• Privacy and Draping: Provide privacy for the client to undress and dress. Use proper draping techniques, disposable garments during the session, & modesty to ensure the client’s comfort while exposing only areas being worked on.
• Hygiene and Sanitation: Maintain a clean and sanitary workspace. Convert domiciliary areas to CSL PPE safe environments. Regularly disinfect [massage] tables, linens, and equipment. Practice good personal hygiene, including hand washing, removal of jewelry or watches during treatments, and maintaining trimmed nails.
• Scope of Practice: Stay within your scope of practice as a CSL therapist. Do not diagnose medical conditions or provide treatments outside your training and qualifications. This can’t be stressed enough.
• Customized Treatment: Develop an individualized treatment plan for the session based on the client’s overall health needs, specific physiologic trauma remodeling needs, & body goals. Use appropriate CSL techniques, adjusting pressure and intensity as needed throughout the session based on client verbal and physical feedback.
• Client Comfort: Regularly check in with the client during the session to assess their comfort level. Be attentive to their breath pattern, their nail beds, their turgor, their lymphatic response, their eye movement, and their balance. Adjust techniques, pressure, or positioning based on their feedback to ensure their comfort and safety. Stop session should client pass out at any time during treatment. 
• Ethical Conduct: Maintain a high level of professionalism and ethical behavior throughout the session. This includes respecting client confidentiality, establishing appropriate boundaries, and avoiding any form of sexual misconduct.
• Record Keeping: Maintain accurate and confidential client records, including intake forms, treatment notes, and progress reports. This helps in providing continuity of care and can be important for insurance and legal purposes.
• Safety Precautions: Be aware of any contraindications and precautions related to Incisional CSl Therapy. If a client presents with a condition that may require special care or if any issues arise during the session, take appropriate actions to ensure safety.
• Emergency Response Standards of care: CSL therapists are required to be well-prepared, with up-to-date certifications in basic life support (BLS) and access to necessary emergency equipment. Therapists should be vigilant in monitoring clients for signs of severe reactions, excessive bleeding, or loss of consciousness throughout the treatment process. Immediate and appropriate responses are mandated, with client safety taking precedence. In the event of an emergency, promptly activate  emergency services. Call 911, as well as clients surgical team.
• Post-Session Care: Offer guidance to clients on post-session self-care, including stretches, exercise reintroduction, faja installation/compression tips, procedure specific nutrition, basic supplements, or lifestyle recommendations that can help them maintain results in between sessions.
• Educational Materials: Provide educational materials that can be shared with clients to reinforce the importance of post-session self-care. This may include printed or digital resources on wound care, nutrition, scar management, and recommended postoperative practices.
• Follow-Up and Communication: Follow up with clients after the session to check on their well-being and progress. Maintain open and clear communication to address any questions or concerns they may have before their next treatment.

These are the basic standards of care for an individual CSL Incisional Drainge Therapy session to provide a safe, effective, and ethical treatment experience for clients while upholding the professionalism and integrity of the CSL Therapy profession. It’s important to note that these standards are not subject to regional variations or varied guidelines as every provider is held to the same standards of care set forth by affiliated licensing bodies and professional associations. These standards are implied for both certificants as well as licensed iMedics.

A standard CSL iMedic Incisional Drainage Session

A standard Incisional Drainage CSL Therapy treatment should adhere to a set of general standards and best practices to ensure therapists provide a safe, effective, and client-centered experience. Here’s a step-by-step outline of what a standard Incisional Drainage CSL Therapy appointment might look like, along with key standards for evaluation: (every accredited Incisional Sciences foundational program will be a variation or verbatim reiteration of these standards)

1. Greeting and Intake (5-30 minutes): (some of this may be captured in advance but needs to be reviewed before start of treatment)

• Greet the client warmly and professionally.
• Confirm the client’s identity 
• Review the client’s CSL approved health intake form and discuss any specific concerns or goals for the session. 
• Identify client’s pre-surgical baseline health (should be established through health intake form)
• Specifically clarify if there are any allergies or surgical implants of any kind (specifically metal)
• Assess level of physiological trauma: previous surgeries, previous childbirths, previous physical trauma (physical abuse, car accidents, substance abuse).
• Discuss complications, contraindications, and any preexisting conditions.
• Discuss CSL Journey: surgical location & team, surgery date, surgery experience, & procedures received.
• Assess & adjust clients expectations to determine a realistic baseline level
• Address any questions or concerns the client may have.

2. Client Preparation (5 minutes):

• Select Incisional materials needed for session, ie– PPE covering, medical barriers, syringe, gloves, needle (if applicable), alcohol wipes, iodine/Chlorhexidine swabs, measuring tape, dermal astringent, connective tissue measurement tool, stainless steel tools, ammonia inhalants, medical edema retarding emollients, and any qualifying devices respective lubricants.
• Place footstool aside treatment table to help client climb atop (if applicable, based on restrictive range of motion detailed by client’s procedure type)
• (if applicable) Transform domiciliary areas into CSL PPE Approved treatment spaces
• Provide clear instructions of how to prepare for the session, including removal of their faja & application of disposable garments, personal item storage, removal of jewelry, placing hair in a bun or out of treatment area, and to posture for session start (supine, prone, standing, etc).
• Leave the room to allow the client privacy to undress and ready themselves.
• Ensure the treatment room is appropriately temperatured and lit for comfort.

3. Assessment and Consultation (4 minutes):

• Re-enter the room and perform a brief visual assessment of the client’s posture, how the body is presenting [in real time], and any visible issues. Document all notations.
• Remove clients compression socks (if needed)
• Put on gloves, put on PPE disposable gown, remove any jewelry or watches; remove anything ont medically required to provide treatment.
• Take standard measurements, and photos (from the neck down) with the torso fully visible in all angles. Wipe down measuring tape with alcohol.
• Change gloves.
• Ask additional questions about presentations and previous health history as needed based on your findings during client evaluation.
• Provide clear instructions on how the session is about to go from beginning to end. Invite clients on their treatment experience; inform the client of the evaluation period for measurements and photos, of what devices you plan to use on them during the session & in what order, an overview of the benefits of each, the goals of the treatment session, & about how long the session will be.

4. Informed Consent (1 minute):

• Obtain verbal informed consent from the client, ensuring they understand and agree to the treatment plan.
• Address any specific contraindications or modifications needed based on evaluation. Document all notations (verbal & palpable).

5. Incisional Session (45 minutes to 90 minutes, as agreed upon):

• Lay barriers on table, as well as around the floor surrounding the table and treatment areas
• (if applicable) provide drain maintenance and declogging, emptying bulbs/reservoirs at the beginning of the session using at least a 20ml syringe
• Apply surgical astringent to treatment areas before starting hands-on treatment.
• Conduct a 2min iodine or Chlorhexidine wash around incisional wounds
• Begin the Incisional Drainage session using appropriate techniques and pressure based on the client’s preferences and needs
• Open lymph nodes and engage extremities even within a thoracic based treatment; at no time should an Incisional Drainage session be conducted on just one part of the body. No matter where surgery was had, the entire body should be included [in every treatment session].
• Tissue is moved from proximal to distal within 2 inches of collecting nodes (axillary, clavicular, & inguinal), but towards still-open incisions everywhere else or collecting drainage tubes. Note: Incisions do NOT have to be reopened. 
• Adjust pressure based on physiological responses never going above a 4 (on a scale of 1-10). Pressure will constantly fluctuate and change throughout the session based on the client’s response and finite presentations felt within skin layers; even within the same stroke as the therapist moves through the client’s tissue. There is never a time the client should be in excruciating or extended pain; if they are, the techniques are being done wrong and pressure should be decreased.
• Proper manual techniques encourage lifting and retracting skin, while utilizing internal tunnels [created during surgery] to move fluid through tissue layers.
• Minimal emollient is applied with the consistency of each stroke, maintaining a drag.
• Client is encouraged to conduct diaphragmatic deep breathing during techniques.
• Client is repositioned and postured throughout the session with regards to their specific procedure– bolstering as needed, or standing when needed.
• (if applicable) Devices are integrated with proper technique and adequate lubricant, stopping to assess tissue presentation in between passes. Note: Cavitation isn’t used on Incisional Drainage clients until edema is fully absolved; cavitation should be reserved for body contouring treatments.
• Continuously check in with the client regarding their comfort and pressure preferences.
• Lymph nodes are cleared constantly throughout the treatment session.
• Focus on addressing the client’s specific concerns and areas of tension.
• Avoid placing any direct pressure on fat grafts.
• There’s no direct tug on incisional lines or stitched areas.
• KT Tape may be applied as soon as Day 3 postOp but not before this time frame. Proper tape application should have spaces between tape strips. Tape shouldn’t be left on any longer than 2 days and need to be removed. Client may be massaged with tape on; client may shower with tape on.

6. Draping and Modesty (Throughout the session):

• Ensure that the client is properly draped to maintain their modesty and comfort.
• Only uncover the area being worked on at any given time.
• Genitals are covered at all times throughout the session. At no time are they to be massaged during a standard treatment.

7. Communication (Throughout the session):

• Maintain open and clear communication with the client.
• Encourage the client to provide feedback on pressure, comfort, or any discomfort.
• Educate the client on the variations between pain & discomfort. Treatments should never be painful. If the client expresses levels of pain, lighten pressure. Pressure changes, quality techniques don’t.
• Respond to the client’s needs and preferences during the session.

8. Post-Session (5 minutes):

• Signal the end of the Incisional drainage CSL session.
• Gather biohazard soiled materials in a biohazard safe bag; dispose of soiled materials accordingly.
• Step out of the room to allow the client to dress in privacy; ask the client if they will need any assistance. 
• Re-enter the room and answer any questions or address concerns the client may have.
• Review effects and results of the session.
• Provide any recommendations for post-treatment care.

9. Payment and Scheduling (5 minutes):

• Handle payment and scheduling for future appointments if applicable.
• Provide receipts or documentation as necessary.
• Make recommendations on FULL treatment journey.

10. Client Feedback and Follow-Up (2 minutes):

• Encourage the client to provide feedback on their experience.
• Thank the client for their visit and express appreciation for their feedback.
• Offer to follow up if the client has any post-session concerns.

11. Room Cleanup (10 minutes):

• Disinfect and sanitize all equipment and surfaces used during the session.
• Replace linens and prepare the room for the next client.

12. Documentation (5 minutes):

• Maintain accurate and confidential client records, including treatment notes and any specific recommendations.
• Make notes of physiological changes during the session.
• Document notable converse client shared during the session.

Standards for Evaluation:

• Assessment and understanding of the client’s needs and goals.
• Effective communication and responsiveness to the client’s feedback.
• Proper draping and modesty considerations.
• Adherence to hygiene and sanitation standards.
• Adherence to trauma remodeling lymphatic system.
• Implementation of appropriate Incisional Drainage techniques and pressure.
• Implementation of appropriate Incisional Drainage device integration & lubricant pairing.
• Informed consent and addressing contraindications.
• Professionalism and maintaining client privacy.
• Post-session care and recommendations.
• Proper room setup and cleanup.
• Documentation accuracy and confidentiality.

This structured approach to a Incisional Drainage CSL Therapy appointment, along with adherence to these standards, ensures that the therapist provides a high-quality and ethical service that promotes the client’s well-being and comfort throughout the entire session, as well as maintains ACBAA Regulatory Governing Bureau compliance.