Preoperative workup
History and examination including risk factor evaluation
ABI's pre-angio (these have usually been performed in OPD and need not be repeated if within 6 weeks).
- Bloods:
- FBC,U&E,
- Coag.screen,
- T/S
- Risk factors - fasting glucose and lipids
- Ensure informed consent has been obtained, form completed and signed and the side is recorded in notes and consent form (if appropriate). The patient should be given an information leaflet and invited to ask any questions.
- Mark side of angio on patient and initial mark.
- Write up 1 litre of normal saline IV for 12 hours prior to angiogram (contrast is nephrotoxic especially in volume depleted patients)
- Bed rest for 6-24 hours post angio (read the procedure note)
- Patient who are on heparin may need to have the infusion stopped - please chekc with a senior team member. Normally, this will be stopped early in the morning (4am) and the coag checked at 8am.
- Warfarin must be stopped and normally the INR must be <1.4 at the time of the procedure.
- Where an angioplasty is expected, clopidogrel is often givne the evening before (150mg) but check with consultant/SpR in each case. This should not normally be given, for example, where a patient requires a spinal anaesthetic for toe amputation etc. at the same time.
Post angiogram
- Intra-arterial sheath is usually removed in recovery and direct pressure applied for 30 minutes.
- bed rest and fasting for 4 hours afterwards with 15 minute observations including inspecion of puncture site
Evening ward round and next morning
- Check groin for bleeding/haematoma - early intervention is important. Call for senior help if in doubt.
- Check peripheral circulation - palpate pusles, use a doppler etc.
- Beware risk of retroperitoneal bleed (tachycardia, hypotension, unexplained tachycardia), pseudoaneurysm in the groin or worseing ischaemia requiring intervention.
- Stop heparin (if used) the morning after the procedure and begin Clopidogrel 75mg once daily.
- Patient may usually be discharged within 48 hours if there are no other surgical/medical issues.
- Postoperative ABIs/TBIs should be recorded before discharge if there is space/time in the laboratory.
Allergy
Prior to ordering any x-rays with iv contrast (e.g. IVP, CT with iv contrast, Angiogram etc.) please check if patient has any allergy, asthma or hay fever. Check with radiology department if patient needs steroid cover prior to examination - different protcols may be used such as 32mg prednisolone 8pm night before test and 32mg again 8am morning of test.
Stop Glucophage in diabetic patients 48 hous before contract administration.
