DSA

low viscosity low osmolarity non-ionic

3 things contrast needs?

occlusion tortuosity grafts aneurysm

4 contraindications for puncture?

fill injector make bed QA damp dust organise pt bed advise Dr pt has arrived warm up equipment

5 things the MRT could do in prep for the procedure

jugular vein

A Tesio catheter is inserted through the:

Injector filled with contrast Table made up Patient details entered into the equipment /RIS Room damp dusted Referral form available and previous images if required Sterile trolley available Ensure equipment you require is on hand i.e filters, arm rests Lead protection available and lead for the table is in place Appropriate technical factors are selected

A patient is attending the Medical Imaging department for a femoral angiogram. Describe the procedure in relation to the Room set up

Pt supine Rubber leg filters in place with the lower limbs in the correct AP position - the toes turned in Rubber filters are positioned in between the legs and on the outside of each leg Sponges under the knees Soft straps around the knees and ankles to hold the correct position. Arms in the arm rests with hands over the chest of by the sides.

A patient is attending the Medical Imaging department for a femoral angiogram. Describe the procedure in relation to the pt position

Frame rate is 2 f/s for iliac and 1 f/s for the rest of the leg. Keep dose as low as possible by using less pulses with the screening selection and a exposure delay where possible.

A patient is attending the Medical Imaging department for a femoral angiogram. Describe the procedure in relation to the technical factors

activated partial thromboplastin (used when a pt has unexplained bleeding or clotting)

APTT?

bleeding from puncture site haematoma infection emboli

Choose any two complications of performing angiography

4

How many hours should a patient be on bed rest for, following a femoral puncture?

brachial

If a femoral puncture approach failed, which approach would be considered next?

2 p/s

What frame rate would be suitable for an iliac artery run?

Allows for a mask to be acquired

What is the importance if a 1 second injection delay for a femoral angiogram?

a) Multipurpose

What sort of catheter is used for a Aortic angiogram?

stenosis

What term is used to describe a partial blockage of a vessel?

Placed as close to the artery feeding the bleed as possible

When performing embolisation the coils must be:

wire

When using the Seldinger technique, what piece of sterile equipment is introduced through the needle?

small amount of shortening post deployment

Why is a balloon mounted stent preferred over a wall stent for angiography?

cobra

a

descending aorta

a

common iliac artery

b

omniflush/contra

b

put needle into vessel (dribble - vein) (forceful - artery) guide-wire needle removed over guide wire catheter remove wire use contrast confirm position

basic overview of what a dr would do for an atheroma?

the volume the rate PSI delay exposure

before you inject the pt what should you remember?

internal iliac artery

c

multipurpose

c

external iliac artery

d

pigtail

d

omniflush/contra

e

superficial femoral artery

e

forming a thrombus

embolisation can be defined as:

moves selected image over the masked one and eliminates the movement artifact

how does pixel shift work?

20-50

how many mls per second of contrast should be given for an Aortogram?

translumbar straight to the aorta

is femoral, brachial, and axillary areas have all failed what entry would be next?

local anesthetic into femoral artery punctures one or both walls of vessel needle withdrawn to asses flow guidewire in needle removed sheath and then catheter in guidewire removed contrast in boom!

run me throught the saldinger

what are 4 things you would expect to see in a machine in an angio room?

table that tilts DSA capable machine dose reductions variable II sizes selections of different screening (pulsed,low,med,normal)

Prevent clots formed in the lower extremities from entering the lungs

the Inferior vena cava filter is placed to:

higher

the more frames per second the ______ the radiation.

the gauge - large enough that blood doesnt come back through the canula size of the vessel - must not occlude the flow of blood when inside the vessel size of catheter - wire must move free within the catheter lumen

what are 3 things to remember about guidewires?

introducing contrast thrombosuction embolisation selective catherisation super selective catherisation

what are 4 jobs for the catheters in xray?

reduced possibility of catheter flaring reduced blood clotting on the wire no danger of unravelling

what are some advantages of a solid guidewire?

fluids only 4 hours unless diabetic must have someone stay with them over night where to present to recovery time meds

what are some important things to tell the pt after their dsa procedure?

aneurysms trauma tumour in the hand dialysis graft things occlusion/stenosis

what are some indications for doing an upper body angiogram?

pat slide clean rooms record equipment used computer work

what are some jobs the mrt has after the procedure has finished?

peripheral vascular disease arteries supplying legs is not good ischaemia in the legs pts complain of pain at rest non healing ulcers

what are some presentations for doing a lower limb angio?

set exposures enable x-ray II size assist nurses and Drs tie up gowns open sterile packs check ID radiation protection

what are some roles the MRT has during the procedure?

disable x-rays equipment moved away table lowered defib trolley used MRT assist in CPR or direct help when it arrives

what are some things to remember in an emergency?

fixed or movable

what are the 2 types of cores?

one with an cannula one with a stylet

what are the 2 types of percutaneous needles?

subclavian

what artery in normally the most accessible for an upper body angio?

INR APTT creatinine

what bloods are important to take?

multiple punctures prolonged cathertisation time damage to vessel multiple catheter changes Bed rest 4 hrs check wound tell pt to be awear of it have someone stay the night with em

what causes bleeding from the puncture site and what is the treatment?

catheter dislodges atheroma attached to wall and travels down the vessels

what causes emboli from an angio?

inadequate compression after catheter withdrawl

what causes haematoma as a result of angio?

series of images with contrast

what defines an angiography run?

digital subtraction angiography

what does DSA stand for?

1 p/s

what frame rate would you expect to use for a popliteal artery?

3-6 p/s

what frame rate would you expect to use in the aorta?

15 p/s

what frame rate would you expect to use in the left ventricle?

.5-1 p/s

what frame rate would you expect to use in the tibial artery?

prothrombin time (how quickly the body clots) should be about 1

what is INR?

series of images combined into one image

what is a view trace?

deposition of fatty substance causing areas of thickening

what is atheroma?

adds bones to subtracted image

what is land marking?

25-30%

what is the accepted residue stenosis percentage post angioplasty?

280 mOs/kgH2O

what is the human serum and also CSF osmolarity?

french scale 1fr - 1/3 mm 2fr - 2/3 mm 3fr - 1 mm

what is the measurements of catheters measured in?

femoral artery

what is the most common appraoch for an atheroma?

active bleeding

what is the primary indication for performing a Superior mesenteric angiogram?

pixel shift

what is this an example of?

270-290

what is visipaque osmolarity?

teflon

what material a catheter is made from has the least resistance?

warfarin heparin metformin

what meds are important for the pt with interventional stuff?

20 mls, 10 mls/sec 300 PSI

what volume, rate and PSI would you expect to use for a renal?

40 mls, 20 mls/sec 600 PSI

what volume, rate and PSI would you expect to use for an aorta?

tangled collection of abnormal blood vessels and bad communication between arterial and venous vessels

whats AVM?

frames per second the faster the flow the bigger the vessel the faster the frame rate needed

whats a frame rate?

image with no contrast

whats a mask?

injects contrast at a really fast rate

whats a pressure injector?

increased chance of clots forming on the catheter

whats a problem with a end hole and side hole catheter?

xray showing the vessel full with contrast to guide the Dr to the correct point

whats a road map?

thin hollow tube with a stiffer dilator through the centre and protruding past outer tube

whats a sheath?

stiffer so can be more versatile

whats an advantage of a wrapped guidewire?

cramping in the legs normally set off by exercise

whats claudication?

kidney function

whats creatinine a measure of?

thrombus has broken off and carried to other parts of the body can block shit and you die

whats embolism?

cold numb digits causes occlusions

whats raynauds disease?

lack of versatility more floppy

whats some disadvantages of a solid guide wire?

blood may clot on the wire may unravel increased chance of abrasion to vessel

whats some disadvantages of wrapped guidewire?

remain sterile no air check expire date correct temp

whats some things to remember when you are using the pump injector?

stenosis in the left anterior descending artery

whats the arrow pointing to?

stenosis in the right coronary artery

whats the arrows pointing to

predisposes patient to occlusion as result of thrombus

whats the prob with an atheroma?

used to facilitate introduction of the vessel

whats the purpose of a dilator?

allows for correction of motion artifacts in subtracted images

whats the purpose of pixel shifting?

view trace

whats this an example of?

coronary graft study

whats this an image of?

left ventricular angiogram

whats this image from?

wasnt as accurate higher dose needed processing

whats wrong with the oild way they did dsa before the digital part?

when bone edges are over vessels i.e tib fib or obterator foramen

when is pixel shift most commonly used?

stenosis and occlusions

when is view trace so important?

hard ons

when performing angioplasty, the material causing the stenosis will response according to its composition. Which type of plaque may crack during angioplasty?

reduce the chance of trauma to the wall enhance mixing of contrast with the blood

when would you use a end hole and side hole catheter?

smaller vessels

when would you use a end hole only catheter?

50% increase in normal diameter of the vessel

whens there an anuerysm?

smokers young people with diabeties old people

who is atheroma more common in?

larger little or no tortuosity less complications feeds easily into the aorta

why would you rather enter femoral than brachial arteries?

tortuous vessel

why would you want a movable core?