P2 Flashcards
Should be assessed for any patient undergoing IR
Bleeding Risk
are those which are minimally traumatic with small access device, or those which access is obtained into a space which bleeding would be easily detected and controlled
Low Risk
Are when solid organ is traversed.
High Risk
- a blood test that measures how long it takes your blood to clot.
INR (International Normalized Ratio)
Platelet Count must be ____
> 50,000
- An important consideration in IR procedures, due to moderate sedation.
Apiration Risk
Includes pre existing conditions
CIN (contrast induced nephropathy)
procedures involving the HBT, genitourinary, or gastrointestinal
systems are considered contaminated, and require a ____
prophylactic antibiotic
Conscious sedation is typically accomplished using _____
midazolam and fentanyl
Vascular Procedure is pioneered by
Dr. Sven-Ivar Seldinger
- Most common method used for obtaining a vascular access
Seldinger Technique
- narrow in diameter used to administer local anesthesia.
Hypodermic Needles
– are used to access target vessels.
Guidewires
– spreads the overlying subcutaneous tissue and the vessel wall.
Dilators
– are tubes inserted to the access site, allows insertion and exchange of instruments into the vessel.
Sheaths
– hollow tubes also used to navigate the select target vessels
Catheter
involves in treating the vessel by expanding a balloon within the lesion and exerting outward radial pressure to fracture the lesion(plaque).
Balloon Angioplasty
- the amount of pressure required for the balloon to assume its listed diameter.
Nominal Pressure
- refers to how much pressure the balloon can safely withstand without bursting
Burst Pressure
- molds to the vasculature contour as they are inflated.
Compliant Balloons
- smaller increase in diameter per unit pressure increase.
- ideal for angioplasty of heavily calcified lesions.
Non-compliant Balloons
- most commonly used in angioplasty.
- can continue to expand with increasing pressure at a much slower rate
Semi-compliant Balloons
- are scaffolds that are placed within the vessels or ducts to maintain
the luminal surface area.
Stents
Two main categories of stents
Self Expanding Stents
Balloon Expandable Stent
- made out of nickel-titanium alloy (nitinol)
Self Expanding Stents
- they are mounted on a balloon catheter, delivered to the target lesion, the balloon is then inflated to facilitate expansion
Balloon Expandable Stent
- a technique used to cause blockage of flow within a vessel.
- embolic agents includes coils, plugs, particles, and sclerosants are delivered through catheters to carry out the occlusion.
Embolization
- workhorse of embolization, can stop bleeding or redirect blood flow.
- titanium, tungsten, platinum, nitinol, or stainless steel.
- size ranges from 0.010 to 0.035 inch, can determine the softness of the coil
Metallic Coils
- are loaded into the catheter, and are either pushed from behind using a wire, or flushed with saline.
- once they are deployed, their position cannot be adjusted
Pushable Coils
- are disc shaped or cork-like baskets woven together with nitinol wires that promotes vessel occlusion an d activation of the intrinsic clotting cascade.
- they are detachable, allowing a more precise positioning
Vascular Plugs
- are microscopic spheres or polygons with diameters between 40 and 1300 microns.
- constructed with tri-acryl gelatin(TAGM) and polyvinyl alcohol (PVA).
Particles
- a biologic agent derived from dermal gelatin. Hemostatic agent used in surgery
Gelfoam
- are agents such as sodium tetradecyl sulfate, polidocanol and ethanol. Which damages the endothelial and medial cells within a vessel wall which leads to scarring and vessel destruction, platelet activation
and coagulation cascade activation. - typically use in veins to treat lymphovascular malformation
Sclerosants
- once the procedure is done, guidewire, catheter and sheath need to be removed. The hole in the vessel needs to be closed.
- a simple manual compression for a few minutes
Closure Device
- involve draining fluid collections, sampling of tissue, intervening on the urinary bladder and gallbladder, and injecting material for therapeutic purposes.
- access thru Seldinger or Trocar Technique
Nonvascular Procedures
- drainage catheters are inserted in the body to aspirate fluid collection, or left in place for continuous drainage
Drainage Procedures
- requires the guidance of CT-scan or Ultrasound for needle placement. While ensuring there are no vital structures along the way.
Biopsy Procedures
- involves inserting an initial larger diameter needle to the edge of the
lesion. A thinner and longer needle is then inserted to the larger needle, and advanced into the lesion. - major advantage, only one puncture is made
Coaxial Technique
- uses an initial reference needle placed into the lesion, with the biopsy needle then placed in tandem, using the reference needle’s depth and trajectory
Tandem Technique
- provide cells from the lesion for cytology. Needles used range from
20 and 25 gauge
Fine Needle Biopsies (FNAB)
- larger needle (14 to 20 gauge) is used, to extract a chunk of tissue
Core Biopsy
