DIAGNOSTIC AND INTERVENTIONAL PROCEDURES WITHIN THE VASCULAR ANGIOGRAPHY SUITE
1. DIAGNOSTIC AND INTERVENTIONALDIAGNOSTIC AND INTERVENTIONAL
PROCEDURES WITHIN THEPROCEDURES WITHIN THE
VASCULAR ANGIOGRAPHY SUITEVASCULAR ANGIOGRAPHY SUITE
Shibu ChackoShibu Chacko
2. AIM OF SESSIONAIM OF SESSION
AngiogramsAngiograms
AngioplastiesAngioplasties
StentingStenting
ThrombolysisThrombolysis
4. ANGIOGRAM (DIGITALLYANGIOGRAM (DIGITALLY
SUBTRACTED ANGIOGRAPHY)SUBTRACTED ANGIOGRAPHY)
A diagnostic procedure to visualise theA diagnostic procedure to visualise the
arteries to identify a stenosis or occlusionarteries to identify a stenosis or occlusion
Puncture sites can be via the radial,Puncture sites can be via the radial,
brachial or femoral arteriesbrachial or femoral arteries
Procedure involves introducing a catheterProcedure involves introducing a catheter
into the artery and injecting Contrastinto the artery and injecting Contrast
5. ANGIOPLASTYANGIOPLASTY
An interventional procedure that opens upAn interventional procedure that opens up
the artery at the point of the stenosisthe artery at the point of the stenosis
A special type of catheter with a smallA special type of catheter with a small
mounted balloon is usedmounted balloon is used
Allows increased blood flow to the distalAllows increased blood flow to the distal
vesselsvessels
6. STENTINGSTENTING
Used in combination with angioplastyUsed in combination with angioplasty
A hollow wire meshed tubeA hollow wire meshed tube
Predominantly used in the iliac arteriesPredominantly used in the iliac arteries
8. PRE-OPERATIVE CAREPRE-OPERATIVE CARE
Nil by mouth for 4Nil by mouth for 4
hourshours
AnticoagulantsAnticoagulants
MedicationsMedications
Blood testsBlood tests
IV accessIV access
DocumentationDocumentation
AllergiesAllergies
ConsentConsent
Canvas/GownCanvas/Gown
AnalgesiaAnalgesia
Is patient able to lieIs patient able to lie
flat and still?flat and still?
HandoverHandover
9. POST OPERATIVE CAREPOST OPERATIVE CARE
ProcedureProcedure FlatFlat
bedrestbedrest
ReclinedReclined
bedrestbedrest
ChairChair
AngiogramAngiogram
(Femoral)(Femoral)
½ hour½ hour 1 ½ hours1 ½ hours N/AN/A
AngiogramAngiogram
(Brachial/(Brachial/
radial)radial)
N/AN/A N/AN/A 1 hour1 hour
AngioplastyAngioplasty
StentingStenting
1 ½ hours1 ½ hours 1 ½ hours1 ½ hours 1 hour1 hour
10. POST OPERATIVE CAREPOST OPERATIVE CARE
AngiogramAngiogram Angioplasty/stentingAngioplasty/stenting
½ hourly for 1 hour½ hourly for 1 hour ½ hourly for 2 hours and½ hourly for 2 hours and
then hourly for 2 hoursthen hourly for 2 hours
BP, Pulse, Saturations,BP, Pulse, Saturations,
Respirations andRespirations and
puncture sitepuncture site
observationobservation
BP, Pulse, Saturations,BP, Pulse, Saturations,
Respirations, PunctureRespirations, Puncture
site and limbsite and limb
observationsobservations
11. POST OPERATIVE CAREPOST OPERATIVE CARE
Puncture site observationsPuncture site observations
Puncture site assessment toolPuncture site assessment tool
1. Site intact1. Site intact 2. Soft2. Soft
haematomahaematoma
3. Hard3. Hard
haematomahaematoma
4. Re-bleed4. Re-bleed
12. POST OPERATIVE CAREPOST OPERATIVE CARE
Limb observationsLimb observations
Peripheral observationPeripheral observation
Colour, Warmth, Sensation & MovementColour, Warmth, Sensation & Movement
Pedal pulsesPedal pulses
13. POST OPERATIVE CAREPOST OPERATIVE CARE
May eat and drinkMay eat and drink
MedicationsMedications
Blood testsBlood tests
14. THROMBOLYSISTHROMBOLYSIS
Aim of thrombolysisAim of thrombolysis
Break down blood clotBreak down blood clot
Restore perfusionRestore perfusion
Reveal the vascular anatomyReveal the vascular anatomy
IndicationsIndications
Acute or acute on chronic critical limbAcute or acute on chronic critical limb
ischaemiaischaemia
Graft thrombosisGraft thrombosis
15. THROMBOLYSISTHROMBOLYSIS
Method of administrationMethod of administration
DSA – femoral punctureDSA – femoral puncture
Catheter positionCatheter position
Tissue plasminogen activatorTissue plasminogen activator
Run via IVAC pumpRun via IVAC pump
16. CARE WHILST RECEIVINGCARE WHILST RECEIVING
THROMBOLYSISTHROMBOLYSIS
HDU bedHDU bed
Observations ¼ hourly for 2 hours & then ½ hourly until return to the angioObservations ¼ hourly for 2 hours & then ½ hourly until return to the angio
suitesuite
Clinical observationsClinical observations
Blood pressureBlood pressure
Heart rate & SpO2Heart rate & SpO2
Neurological observationNeurological observation
Urine outputUrine output
Neurovascular status of limbNeurovascular status of limb
Puncture site (bleeding or haematoma)Puncture site (bleeding or haematoma)
Continuous flat bed restContinuous flat bed rest
Nil by mouthNil by mouth