This document provides information about diagnostic and interventional procedures performed in a vascular angiography suite. It discusses angiograms, angioplasty, stenting, and thrombolysis procedures. Angiograms are used to visualize arteries and identify stenoses or occlusions. Angioplasty opens arteries at points of stenosis using a balloon catheter. Stenting is often used with angioplasty, employing a hollow wire mesh tube. Thrombolysis aims to break down blood clots and restore perfusion by administering tissue plasminogen activator through a catheter. The document outlines pre-operative care, post-operative care including monitoring, potential complications, and follow-up for these vascular procedures.

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

3. Reasons for proceduresReasons for procedures
AcuteAcute
 Critical limb ischemiaCritical limb ischemia
 TraumaTrauma
 GI bleedsGI bleeds
ChronicChronic
 Limb ischemiaLimb ischemia
 IntermittentIntermittent
claudicationclaudication
 Rest painRest pain
 GangreneGangrene
 UlcersUlcers

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

7. COMPLICATIONSCOMPLICATIONS
 AnaphylaxisAnaphylaxis
 HaematomaHaematoma
 Ruptured arteryRuptured artery
 Renal failureRenal failure

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

17. COMPLICATIONSCOMPLICATIONS
 BleedingBleeding
 CVACVA
 EmboliEmboli
 No IM injections!No IM injections!

18. FOLLOW-UPFOLLOW-UP
 Repeat angiogramsRepeat angiograms
 SurgerySurgery

19. QUESTIONS?QUESTIONS?
Thank youThank you