pre procedural preparation for a radiographer
- environment safety
- check power injector, ultrasound
- history of allergy and contrast reaction
- radiation protection equipment
- pre-set procedure parameters
- check LMP? 10 or 28- days rule
- position and tubings: drips (place at left side)
- patient comfort and immobilisation
pre-procedural preparation on patient
- checking, explaining and reassurance
- vital sign monitoring (SpO2 sensor, BP cuff)
5 important things to ensure before starting the procedure
- fasting
- clotting profile and platelet count
- what can be done if RFT is abnormal
- sedation
- informed consent
explain the fasting requirement
- avoid pneumonia due to aspiration
- solid or liquid food 4-6 hours
- clear fluid 2-3 hours
explain the clotting profile and platelet count
- indicated in patients undergoing invasive procedures
PT and its derived measures of PR and INR are measures of coagulation ability
what can be done if RFT is abnormal
- avoid dehydration - protect renal function
- use lesser iodinated contrast during procedure
- use alternative agent such as CO2
explain the sedation procedure
- use of sedation increase the risk of any procedure
- benzodiazepines are commonly used, and dose should be decreased with increasing age and decreasing body weight
what is informed consent
qualified doctor who understand the risk and side effects of the procedure should be responsible for obtaining the informed consent
what is time out
- performed in the angio lab, immediately before the planned procedure is initiated
- time out represents the final recapitulation and reassurance of accurate patient identity, surgical site, and planned procedure
purpose of time out
- check correct patient
- check correct site of procedure
- check correct procedure
- check correct applicables
patients that will require special attention during procedures
- diabetic patients
- pediatrics
- elderly
- trauma patients
- patient with hypertension / renal diseases
- patients with vasospasm history
- patient with tracheostomy
- patients on ventilator
- patients with chest drain
role of radiographer during the procedure
- assist radiologist to manipulate all radiographic parameters
- do what is necessary and react promptly, no more and no less
- radiation protection
- assist in recognise and treat the complications in case it arises
what do radiographers do in case of resuscitation
- block radiation
- raise up the II
- lower down the table
- remove the B-plane if feasible
- clear all lead shields that block the way approaching the patient
general complications after angio procedure
- puncture procedure
- manipulation of catheter/ guidewire
- contrast medium being injected
complications related to the puncture procedure
- hematoma formation around the puncture site by needle
- arterial dissection
- lumen at the puncture site will be thrombosed/ obstructed
- injuries to adjacent structures
- rare: lead to abnormal communication between an artery and a vein
complication related to the manipulation of catheter/ guidewire
- perforation of blood vessel during catheter/ guidewire maniplation
- contrast extravasation
- dissection
- vasospasm
- dislodgement of plaque in blood vessel wall causing stroke
- breakage and knot forming of catheter or guidewire is very rare, this may require surgical removal
complication due to the contrast medium being injected
- overall adverse reactions relation to iodine base non-ionic contrast medium is below 0.7%
- mortality due to reaction to non-ionic contrast medium is below 1 in 250,000
common stenosed site in lower limb angiogram
pelvis and leg
goal of the procedure to treat commonly stenosed site
- re-expand the lumen
- maintain patency of the vessel
clinical features of stenosed lower limb
- trophic changes due to arterial insufficiency
- ischemic necrosis
indication of stenosed lower limb
- intermittent claudication (70% arterial stenosis)
- rest pain (90% arterial stenosis)
- gangrene
contraindication of a stenosed procedure
absolute:
- medically unstable
- multiple system dysfunction
relative:
- recent myocardial infarction
- serious arrhythmia
- severe CM allergy
- impaired renal function
- coagulopathies or serious altered coagulation profile
patient preparation for stenosis procedure
- PHx
- check creatinine
- INR,. PT, PTT, platelets
- shaving
- NPO 6 hours
- maintain hydrated
- void before procedure
- stop heparin infusion 4 hours prior
- stop metformin
stenosis procedure
seldinger technique
