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Special Procedures


What is Special Procedures?


NMMC Radiology Department Special Procedures includes Angiography and Interventional exams. Angiography is a radiology procedure that images blood vessels through out the body. A Radiologist inserts a small tube into a blood vessel and manipulates it into a specific location and injects radio-plaque contrast material. Images are recorded during the contrast injection. The procedure can determine whether the blood vessels are diseased, narrowed, enlarged, or blocked. Interventional radiology uses fluoroscopy, CT, or Ultrasound as a guide to perform percutaneous (through the skin) procedures such as biopsies, draining fluids, inserting catheters, or dilating or stenting narrow ducts or blood vessels.

What are the Preps for Special Procedures?

Please send all patients scheduled for any Special Procedure to Pre-Admission Testing (PAT) at least 24 hours prior to appointment. Please come to outpatients between 8 a.m. and 5 p.m. Monday-Friday for radiology nurse to draw lab work, access the patient’s history, and give further instructions. We are required to have a signed written order from referring physician and a recent H&P (within 7 days). Please send a copy with the patient for their PAT visit. Patient must bring a list of all medications.

Special Notes

Routine Lab work for Angiogram: Hemogram, Basic Metobolic Panel, PT(only if patient is on Coumadin) and (PTT only if patient is on Heparin)

Routine Lab work for Biopsy: Hemogram, PT(only if patient is on Coumadin) and (PTT only if patient is on Heparin)

Discontinue the following medications prior to Special Procedures:

  • Coumadin: Hold 3 days prior to procedure
  • Ticlid: do not take day of procedure
  • Heparin: DC IV heparin 4 hours prior to procedure, call Special Procedures 377-3402 for approximate time.
  • Metformin, Glucophage, Glucophage XR, Glucovance, Avandamet, Fortamet, Riomet, Metaglip, Actoplus Met, Glumetza, Prandimet, Janumet or Kombiglyze XR.
  • Should be held 48 hours after receiving IV contrast media (dye). Patient must have normal creatinine level prior to re-starting Metformin, Glucophage, Glucophage XR, Glucovance, Avandamet, Fortamet, Riomet, Metaglip, Actoplus Met, Glumetza, Prandimet, Janumet or Kombiglyze XR. The referring Physician is responsible for your follow-up.

Patients should not eat any solid food after midnight but can have a clear liquid breakfast the day of the procedure. Clear liquids include water, apple grape cranberry juice, coffee or tea with sugar and all of the following that are not colored red; Gatorade, soft drinks, Kool-Aid, plain Jello, or ice popsicles

Insulin dependant diabetic patients should eat a light breakfast and take their insulin at least 2 hours prior to procedure.

On the day of the procedure, please instruct patient to arrive in Outpatient Admissions located on the first floor of the East Tower Building 30 minutes prior to appointment. This will allow time for admission verification, nursing staff to assess the patient and Radiologists to obtain informed consent. Routinely there is a 3 to 6 hours recovery time and the patient must have a responsible adult to dive them home. Radiology Nursing will need a contact phone number for follow-up care and education.

Special Procedure Prep Guide

Procedure Prep Estimated Time of Exam
Angiogram
Cerebral
Carotid
Aorta
Pulmonary
Shunt
Femoral
TIPS
Vascular
Stent

PAT visit 24 hours prior to appointment

Clear liquids after midnight

Exception: diabetic patients eat light breakfast and take insulin. If taking Metformin, Glucophage, Glucophage XR, Actoplus Met, Metaglip, Fortamet, Riomet, Glucovance, Avandamet, Glumetza, Prandimet, Janumet or Kombiglyze XR discontinue 48 hours after procedure. Must have normal creatinine level prior to continuance. The referring Physician is responsible for your follow-up.

Discontinue Coumadin: 3 days

Discontinue Ticlid day prior to the procedure

Discontinue Heparin 4 hours prior to exam/contact # 662-377-4068

Routine lab work: Hemogram, Basic Metabolic Panel

PT(only if patient is on Coumadin) and (PTT if patient is on Heparin)

Arrive in Outpatient Admissions 30 minutes prior to appointment


1 ½ hours for the procedure
4 to 5 hours for recovery process
Must have a responsible adult to drive patient home.
Radiology Nursing will need a contact phone number for follow-up patient care/education
Mahurkar
Shunt
Venogram
Does not require a PAT visit
Shunt and Venogram do not require lab

Mahurkar will recover 1 hour in Radiology or Dialysis.

Shunt/Venogram do not require any recovery time

Interventional CT / US
guided
Biopsies
Liver
Lung
Abdomen
Paracentesis
Thoracentesis

PAT visit 24 hours prior to appointment

Clear liquids after midnight and discontinue the following medications: Aspirin, Plavix, Pletal, Aggrenox, Lovenox, and Arixtia. These medications should be held for three (3) days prior to the exam if possible. Patients on Coumadin off five (5) to seven (7) days.

Exception: diabetic patients eat light breakfast and take insulin. If taking Metformin, Glucophage, Glucophage XR, Actoplus Met, Metaglip, Fortamet, Riomet, Glucovance, Avandamet, Glumetza, Prandimet, Janumet or Kombiglyze XR discontinue 48 hours after procedure. Must have normal creatinine level prior to continuance. The referring Physician is responsible for your follow-up.

Coumadin patients having Paracentesis and Thoracentesis off Coumadin three (3) days.

1 ½ hours for the procedure

1 to 3 hours for recovery process

Must have a responsible adult to drive patient home.

Radiology Nursing will need a contact phone number for follow-up patient care/education

How does Special Procedures work?

The basic idea of Special Procedures is the same as routine X-ray. The X-rays that pass through the body are absorbed at different rates. Each body part will have its on distinctive appearance.

For Angiography exams a bolus of contrast material "dye" is injected through a catheter into a selected blood vessel. X-ray images are captured on film or sent to a computer. The computer images can be viewed like a motion picture. The Radiologist can watch the contrast material fill blood vessels and identify defects or problems.

For Angioplasty a special balloon catheter is passed to the target vessel and inflated. If indicated a stent may be placed in the artery to maintain the opening and blood flow.

How is the Special Procedure performed?

A Radiologist will review the procedure with patient and answer any questions. The patient is given a mild sedative and the groin area is prepped usually for a femoral artery approach. Local anesthesia is injected into the skin and a small incision is made to introduce a small catheter into the femoral artery. The catheter is manipulated to a selected artery within the body. With catheter in place a bolus of contrast material "dye" in injected into the artery. The Special Procedure Team is able to image the artery by filling it with contrast with the help from X-ray and computers. The Radiologist can determine if there are any defects or abnormalities within the artery. After the procedure is completed the catheter is removed and pressure is applied to the entrance site for approximately 10 minutes. The patient is then moved to a recovery site for monitoring and observation. The patient will be restricted to bed rest and must lie supine for 4 to 6 hours. During this time Radiology Nursing will be recording vital signs and monitoring the entrance site for bleeding or swelling. Patients should be prepared to spend most of the day at the hospital for a Special Procedure. The fluids are encouraged and a meal is provided for the patient.

What are the most common uses for Special Procedures?

  • Detect atherosclerotic disease in the carotid arteries
  • Identify intracranial aneurysm or other blood vessel disorders of the brain
  • Evaluate disease in the renal artery
  • Evaluate abdominal aorta
  • Evaluate blood vessels in the legs
  • To open a narrowed or blocked artery
  • Evaluate and treat blood vessel grafts

Radiology Report Turnaround Process

A Radiologist, who is a physician experienced in Special Procedures and other radiology exams will analyze the images and send a report to the patient’s referring physician. The referring physician will inform the patient of the Special Procedure findings.

We have a departmental goal of 6 hours for Radiology Report Turnaround time. We measure the time from radiology request entry to the time the transcriptionist types the final report. The radiology report is also available via our Digital Dictation System, immediately after Radiologist completes dictation. The DVI system phone number is 377-3745. You must first enter your six (6) digit PIN number, your department number, and the patient’s medical record number to access the report.

What are the Benefits VS Risks?

Benefits-

  • Detailed, clear, and accurate image of blood vessels
  • Selective vessel for specific body organs can be imaged
  • Diagnosis and treatment can be completed with a single procedure
  • Degree of detail is not available by most noninvasive procedures

Risks-

  • Allergic reaction to contrast material "dye"
  • Blood Clot and possible blockage
  • Kidney damage
  • Damage to a blood vessel from the catheter
  • Possible stroke
  • Other imaging methods should be used for pregnant patients