Interventional Radiology and Fluoroscopy Exam Preparation

Patient Monitoring and Care in Fluoroscopic Procedures

• Learning Outcomes:
  • LO 1: Interpret patient monitoring data and provide appropriate care regarding signs of complications and emergency events before, during, and after fluoroscopic procedures.
  • LO 4: Demonstrate imaging techniques for diagnostic fluoroscopic and interventional procedures, including radiation protection and the use of appropriate drugs and contrast agents.

Session Outcomes

• Comprehension of:
  • Common procedures
  • Risks and complications
  • The importance of consent
  • Multidisciplinary teamwork
  • Pre-procedural care
  • Care during examinations
  • Post-procedural care
  • Case studies for practical application.

Differences in Interventional Radiology and Fluoroscopy

• Discussion Points:
  • Identification of patients referred to Interventional Radiology and Fluoroscopy.
  • Understanding the differences in modality and the importance of vigilant care and management for patients during these procedures.

Reasons for Interventional Radiographic Procedures

• Common Conditions:
  • Blocked arteries
  • Vessel occlusion (e.g., blood clots)
  • Blood vessel malformations
  • Blocked kidneys and bile ducts
  • Internal bleeding or aneurysms
  • Varicose veins
  • Fibroids
  • Line insertions for medication;

Reasons for Fluoroscopic Procedures

• Indications:
  • Vomiting or difficulty eating/drinking
  • Change in bowel habits
  • Rectal bleeding or vomiting blood
  • Unexplained pain
  • Sudden weight loss
  • Infertility issues (especially females)
  • Joint problems such as pain or instability

Common Procedures in Interventional and Fluoroscopic Settings

• Interventional Procedures:
  • Angioplasty, Angiography, Aneurysm clips, Thrombolectomy, Thrombolysis
  • Endovascular Aneurysm Repair (EVAR), Embolisation, Stent placements, Nephrostomy, Line insertions
• Fluoroscopic Procedures:
  • Barium swallow, Contrast enema, Hysterosalpingogram, Proctogram, Sialogram, Dacrocystogram, Arthrogram

Contrast Agents

• Functionality:
  • Used to enhance visibility of structures (vessels/bowel/urinary system)
  • Differentiate between normal/abnormal tissues for diagnostic pathology
  • Dynamic imaging shows physiology and function
  • Types: Positive and negative contrast agents
  • Caution for potential adverse reactions; certain agents may need warming.

Preparing the Patient

• Considerations:
  • Justification of referral to procedure
  • Patient consent (understanding risks)
  • Contraindications identification
  • Medication adjustments pre-procedure
  • Need for sedation or analgesia
  • Implementation of WHO checklist for safety
  • Multidisciplinary team preparation is key to ensuring everyone understands their roles.

Radiation Protection

• High radiation doses in IR and fluoroscopy compared to X-rays.
• Operators can minimize exposure using:
  • Collimation
  • Low dose mode
  • Effective shielding and maintaining a safe distance.
• Protective Gear:
  • Lead aprons, thyroid shields, dosimeters, lead glasses as required.

Informed Consent

• Definition:
  • Legal requirement based on effective communication and understanding of risks.
• Challenges:
  • Difficulties in securing informed consent when patients are unwell or unable to understand.

Importance of Written Consent

• Necessary for invasive procedures; performed by the individual performing the procedure in a private setting.
• Must be documented, ensuring patient understanding and opportunity for question.

Patient History and Risk Assessment

• Importance of identifying high-risk patients and potential need for additional tests prior to procedures, such as GFR, ECG, coagulation testing.

Coagulation Status

• Importance Prior to Procedure:
  • Evaluate for bleeding risks and thrombosis potential.
  • Define coagulation to ensure appropriate management.

Identifying Contraindications

• Key Factors to Review:
  • Kidney function, diabetes, heart issues, glaucoma, allergies.
  • Effective communication required to gather these data points; may involve review of clinical notes and past imaging history.

Pre-procedural Medication Management

• Review and pause medications as necessary before procedures, especially:
  • Metformin (following protocols)
  • Anticoagulants (warfarin/heparin).

WHO Surgical Safety Checklist

• Essential in interventional procedures with invasive elements to minimize risks.
• Structured in three parts: Sign in, Time out, Sign out to ensure safety checks are complete and documented.

Monitoring During Procedures

• Continuous monitoring of vital signs (BP, HR, O2 saturation, etc.) required pre, during, and post procedure.

Case Studies Overview

• Case Studies provide practical application of monitoring, decision-making, and emergency response.

Extravasation

• Defined as contrast or injected drugs leaking into surrounding tissues, risk assessment needed to prevent compartment syndrome:
  • Symptoms may include localized pain, tightness, and swelling.

Post-procedural Care

• Importance of monitoring recovery; immediate care should include assessing vital signs and signs of infection or hematoma.

Aftercare Instructions for Patients

• After procedures, patients should receive comprehensive post-care instructions, potential risks, and emergency contacts, ensuring clarity and reassurance for recovery.

Summary of Key Considerations

• Patients undergoing fluoroscopic and interventional radiology procedures are generally higher risk due to possible comorbidities; careful preliminary assessments, multidisciplinary teamwork, risk awareness, and effective communication are essential for patient safety and care continuity.