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Fluoro and angio > Angio B > Flashcards

Angio B Flashcards

1
Q

pre procedural preparation for a radiographer

A
  • 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
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2
Q

pre-procedural preparation on patient

A
  • checking, explaining and reassurance
  • vital sign monitoring (SpO2 sensor, BP cuff)
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3
Q

5 important things to ensure before starting the procedure

A
  • fasting
  • clotting profile and platelet count
  • what can be done if RFT is abnormal
  • sedation
  • informed consent
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4
Q

explain the fasting requirement

A
  • avoid pneumonia due to aspiration
  • solid or liquid food 4-6 hours
  • clear fluid 2-3 hours
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5
Q

explain the clotting profile and platelet count

A
  • indicated in patients undergoing invasive procedures
    PT and its derived measures of PR and INR are measures of coagulation ability
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6
Q

what can be done if RFT is abnormal

A
  • avoid dehydration - protect renal function
  • use lesser iodinated contrast during procedure
  • use alternative agent such as CO2
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7
Q

explain the sedation procedure

A
  • 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
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8
Q

what is informed consent

A

qualified doctor who understand the risk and side effects of the procedure should be responsible for obtaining the informed consent

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9
Q

what is time out

A
  • 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
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10
Q

purpose of time out

A
  • check correct patient
  • check correct site of procedure
  • check correct procedure
  • check correct applicables
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11
Q

patients that will require special attention during procedures

A
  • 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
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12
Q

role of radiographer during the procedure

A
  • 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
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13
Q

what do radiographers do in case of resuscitation

A
  • 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
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14
Q

general complications after angio procedure

A
  • puncture procedure
  • manipulation of catheter/ guidewire
  • contrast medium being injected
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15
Q

complications related to the puncture procedure

A
  • 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
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16
Q

complication related to the manipulation of catheter/ guidewire

A
  • 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
17
Q

complication due to the contrast medium being injected

A
  • 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
18
Q

common stenosed site in lower limb angiogram

A

pelvis and leg

19
Q

goal of the procedure to treat commonly stenosed site

A
  1. re-expand the lumen
  2. maintain patency of the vessel
20
Q

clinical features of stenosed lower limb

A
  • trophic changes due to arterial insufficiency
  • ischemic necrosis
21
Q

indication of stenosed lower limb

A
  • intermittent claudication (70% arterial stenosis)
  • rest pain (90% arterial stenosis)
  • gangrene
22
Q

contraindication of a stenosed procedure

A

absolute:
- medically unstable
- multiple system dysfunction

relative:
- recent myocardial infarction
- serious arrhythmia
- severe CM allergy
- impaired renal function
- coagulopathies or serious altered coagulation profile

23
Q

patient preparation for stenosis procedure

A
  • PHx
  • check creatinine
  • INR,. PT, PTT, platelets
  • shaving
  • NPO 6 hours
  • maintain hydrated
  • void before procedure
  • stop heparin infusion 4 hours prior
  • stop metformin
24
Q

stenosis procedure

A

seldinger technique

25
Q

preparation of seldinger technique

A
  • feel pulse of right femoral artery or proceed with forearm
  • LA: xylocaine at the skin entry site
  • skin incision followed by mosquito forceps to spread the subcutaneous tissue
26
Q

procedure of seldinger technique

A
  • locate CFA
  • double wall puncture
  • remove stylet from the seldinger needle
  • once there is a good pulsatile blood return through needle, insert guide wire gently
  • remove needle (leaving GW)
  • vascular sheath introduced
  • insert GW to abdominal aorta through sheath
  • over the GW, introduced catheter to desired position
  • inject contrast
27
Q

if a narrowing is found and angioplasty is needed

A
  • balloon catheter
  • withdrawn
  • imaging-reconfirm
28
Q

if stenting is needed after angioplasty

A
  • metallic stent may be implanted to augment the effect of angioplasty
29
Q

complications of seldinger technique

A
  • hematoma at punctured site
  • pseudoaneurysm
  • abnormal communication between femoral artery and vein
  • infection at site of puncture
  • GW perforation
  • unintentional dissection
  • stent dislodgement
  • stent fracture
  • pseudoaneurysm adjacent to stented site

Fluoro and angio (9 decks)

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