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Procedural Patient Management
Amanda L. Scott, DO; Kenneth H. Cho, MD, MBA; Keith B. Quencer, MD
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KEY FACTS

  • Preprocedure Work-Up

    • Informed Consent

      • Sedation

        • Time Out

          PREPROCEDURE WORK-UP

          • Provide High-Quality Care

            • Prioritize Patient's Overall Health

              • Systematic Approach to Preprocedural Care

                • Patient Referral

                  • Key Questions in Advance Planning

                    • Patient Contact

                      • Cardiac Risk Stratification

                        • Contrast-Induced Acute Kidney Injury

                          • Preprocedure Performance Status

                            • Informed Consent

                              • Exceptions to Informed Consent

                                Sedation

                                • Level of Sedation

                                  • Moderate Sedation

                                    • Presedation Checklist

                                      Universal Protocol

                                      • Brief

                                        • Rationale, History

                                          • Time Out

                                            • Debrief

                                              Iodinated Contrast Reactions

                                              • Prophylaxis Regimens

                                                • Treatment of Reactions

                                                  Monitoring

                                                  • Intraprocedural Monitoring

                                                    • Postprocedure Monitoring/Discharge

                                                      Selected References

                                                      1. ACR Contrast Reaction Card: Adults. American College of Radiology. Updated February 24, 2022. Accessed April 13, 2022. https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast-Reaction-Card-Adult.pdf
                                                      2. ECOG Performance Status Scale. ECOG-ACRIN Cancer Research Group. Accessed April 13, 2022. https://ecog-acrin.org/resources/ecog-performance-status/
                                                      3. Gurbani S: The role of IR in the patient-centered care paradigm. Society of Interventional Radiology. Accessed April 13, 2022. http://rfs.sirweb.org/2016/02/29/the-role-of-ir-in-the-patient-centered-care-paradigm/
                                                      4. MELD calculator. Organ Procurement and Transplantation Network: US Dept. of Health and Human Services. Accessed April 13, 2022. https://optn.transplant.hrsa.gov/data/allocation-calculators/meld-calculator/
                                                      5. ACR Manual On Contrast Media: ACR Committee on Drugs and Contrast Media. American College of Radiology, 2021 https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf
                                                      6. Asgharpour M et al: Intravenous contrast agents in diabetic patients taking metformin; an updated review on current concepts. J Nephropathol. 9(1): e05, 2020. https://nephropathol.com/Article/jnp-10894
                                                      7. Kodzwa R: ACR manual on contrast media: 2018 updates. Radiol Technol. 91(1):97-100, 2019
                                                      8. Patel IJ et al: Society of Interventional Radiology consensus guidelines for the periprocedural management of thrombotic and bleeding risk in patients undergoing percutaneous image-guided interventions-part II: recommendations: endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol. 30(8):1168-84.e1, 2019
                                                      9. Peng Y et al: Child-Pugh versus MELD score for the assessment of prognosis in liver cirrhosis: a systematic review and meta-analysis of observational studies. Medicine (Baltimore). 95(8):e2877, 2016
                                                      10. Rafiei P et al: Society of Interventional Radiology IR pre-procedure patient safety checklist by the Safety and Health Committee. J Vasc Interv Radiol. 27(5):695-9, 2016
                                                      11. Taslakian B et al: Patient evaluation and preparation in vascular and interventional radiology: what every interventional radiologist should know (part 1: patient assessment and laboratory tests). Cardiovasc Intervent Radiol. 39(3):325-33, 2016
                                                      12. Taslakian B et al: Patient evaluation and preparation in vascular and interventional radiology: what every interventional radiologist should know (part 2: patient preparation and medications). Cardiovasc Intervent Radiol. 39(4):489-99, 2016
                                                      13. Cho KJ: Carbon dioxide angiography: scientific principles and practice. Vasc Specialist Int. 31(3):67-80, 2015
                                                      14. Wichmann JL et al: Contrast-induced nephropathy. Circulation. 132(20):1931-6, 2015
                                                      15. Olsen JW et al: Moderate sedation: what radiologists need to know. AJR Am J Roentgenol. 201(5):941-6, 2013
                                                      16. Steele JR et al: Quality improvement in interventional radiology: an opportunity to demonstrate value and improve patient-centered care. J Vasc Interv Radiol. 23(4):435-41; quiz 442, 2012
                                                      17. Johnson S: Sedation and analgesia in the performance of interventional procedures. Semin Intervent Radiol. 27(4):368-73, 2010
                                                      18. Kadoi Y: Perioperative considerations in diabetic patients. Curr Diabetes Rev. 6(4):236-46, 2010
                                                      19. Papaspyros SC et al: Briefing and debriefing in the cardiac operating room. Analysis of impact on theatre team attitude and patient safety. Interact Cardiovasc Thorac Surg. 10(1):43-7, 2010
                                                      20. Wiggins TF et al: Sedation, analgesia, and monitoring. Clin Colon Rectal Surg. 23(1):14-20, 2010
                                                      21. ACR Manual on Contrast media. Version 7, 2010
                                                      22. Hawkins IF et al: Carbon dioxide in angiography to reduce the risk of contrast-induced nephropathy. Radiol Clin North Am. 47(5):813-25, v-vi, 2009
                                                      23. Lasser EC: Nonionic iodinated contrast media reactions. AJR Am J Roentgenol. 192(2):W80; author reply W81, 2009
                                                      24. Stahel et al: The 5th anniversary of the "Universal Protocol": pitfalls and pearls. Patient Safety in Surgery 3:14, 2009
                                                      25. Singh J et al: Iodinated contrast media and their adverse reactions. J Nucl Med Technol. 36(2):69-74; quiz 76-7, 2008
                                                      26. Ead H: From Aldrete to PADSS: Reviewing discharge criteria after ambulatory surgery. J Perianesth Nurs. 21(4):259-67, 2006
                                                      27. Devereaux PJ et al: Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk. CMAJ. 173(6):627-34, 2005
                                                      28. Bettmann MA: Frequently asked questions: iodinated contrast agents. Radiographics. 24 Suppl 1:S3-10, 2004
                                                      29. Michota FA et al: The preoperative evaluation: use the history and physical rather than routine testing. Cleve Clin J Med. 71(1):63-70, 2004
                                                      30. American Society of Anesthesiologists task force on sedation and analgesia by non-anesthesiologists: practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 96(4):1004-17, 2002
                                                      31. A follow-up review of wrong site surgery. Sentinel Event Alert. (24):1-3, 2001
                                                      32. Institute of Medicine (US) Committee on Quality of Health Care in America: Crossing the quality chasm: a new health system for the 21st century. National Academies Press, 2001
                                                      33. Kamath PS et al: A model to predict survival in patients with end-stage liver disease. Hepatology. 33(2):464-70, 2001
                                                      34. Lee TH et al: Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 100(10):1043-9, 1999
                                                      35. Oken MM et al: Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 5(6):649-55, 1982
                                                      36. Cassileth BR et al: Informed consent -- why are its goals imperfectly realized? N Engl J Med. 302(16):896-900, 1980
                                                      37. Faden RR et al: Decision-making and informed consent: a study of the impact of disclosed information. Soc Indic Res. 7(1-4):313-36, 1980
                                                      38. Child CG et al: Surgery and portal hypertension. Major Probl Clin Surg. 1:1-85, 1964
                                                      Related Anatomy
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                                                      Related Differential Diagnoses
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                                                      References
                                                      Tables

                                                      Tables

                                                      KEY FACTS

                                                      • Preprocedure Work-Up

                                                        • Informed Consent

                                                          • Sedation

                                                            • Time Out

                                                              PREPROCEDURE WORK-UP

                                                              • Provide High-Quality Care

                                                                • Prioritize Patient's Overall Health

                                                                  • Systematic Approach to Preprocedural Care

                                                                    • Patient Referral

                                                                      • Key Questions in Advance Planning

                                                                        • Patient Contact

                                                                          • Cardiac Risk Stratification

                                                                            • Contrast-Induced Acute Kidney Injury

                                                                              • Preprocedure Performance Status

                                                                                • Informed Consent

                                                                                  • Exceptions to Informed Consent

                                                                                    Sedation

                                                                                    • Level of Sedation

                                                                                      • Moderate Sedation

                                                                                        • Presedation Checklist

                                                                                          Universal Protocol

                                                                                          • Brief

                                                                                            • Rationale, History

                                                                                              • Time Out

                                                                                                • Debrief

                                                                                                  Iodinated Contrast Reactions

                                                                                                  • Prophylaxis Regimens

                                                                                                    • Treatment of Reactions

                                                                                                      Monitoring

                                                                                                      • Intraprocedural Monitoring

                                                                                                        • Postprocedure Monitoring/Discharge

                                                                                                          Selected References

                                                                                                          1. ACR Contrast Reaction Card: Adults. American College of Radiology. Updated February 24, 2022. Accessed April 13, 2022. https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast-Reaction-Card-Adult.pdf
                                                                                                          2. ECOG Performance Status Scale. ECOG-ACRIN Cancer Research Group. Accessed April 13, 2022. https://ecog-acrin.org/resources/ecog-performance-status/
                                                                                                          3. Gurbani S: The role of IR in the patient-centered care paradigm. Society of Interventional Radiology. Accessed April 13, 2022. http://rfs.sirweb.org/2016/02/29/the-role-of-ir-in-the-patient-centered-care-paradigm/
                                                                                                          4. MELD calculator. Organ Procurement and Transplantation Network: US Dept. of Health and Human Services. Accessed April 13, 2022. https://optn.transplant.hrsa.gov/data/allocation-calculators/meld-calculator/
                                                                                                          5. ACR Manual On Contrast Media: ACR Committee on Drugs and Contrast Media. American College of Radiology, 2021 https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf
                                                                                                          6. Asgharpour M et al: Intravenous contrast agents in diabetic patients taking metformin; an updated review on current concepts. J Nephropathol. 9(1): e05, 2020. https://nephropathol.com/Article/jnp-10894
                                                                                                          7. Kodzwa R: ACR manual on contrast media: 2018 updates. Radiol Technol. 91(1):97-100, 2019
                                                                                                          8. Patel IJ et al: Society of Interventional Radiology consensus guidelines for the periprocedural management of thrombotic and bleeding risk in patients undergoing percutaneous image-guided interventions-part II: recommendations: endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol. 30(8):1168-84.e1, 2019
                                                                                                          9. Peng Y et al: Child-Pugh versus MELD score for the assessment of prognosis in liver cirrhosis: a systematic review and meta-analysis of observational studies. Medicine (Baltimore). 95(8):e2877, 2016
                                                                                                          10. Rafiei P et al: Society of Interventional Radiology IR pre-procedure patient safety checklist by the Safety and Health Committee. J Vasc Interv Radiol. 27(5):695-9, 2016
                                                                                                          11. Taslakian B et al: Patient evaluation and preparation in vascular and interventional radiology: what every interventional radiologist should know (part 1: patient assessment and laboratory tests). Cardiovasc Intervent Radiol. 39(3):325-33, 2016
                                                                                                          12. Taslakian B et al: Patient evaluation and preparation in vascular and interventional radiology: what every interventional radiologist should know (part 2: patient preparation and medications). Cardiovasc Intervent Radiol. 39(4):489-99, 2016
                                                                                                          13. Cho KJ: Carbon dioxide angiography: scientific principles and practice. Vasc Specialist Int. 31(3):67-80, 2015
                                                                                                          14. Wichmann JL et al: Contrast-induced nephropathy. Circulation. 132(20):1931-6, 2015
                                                                                                          15. Olsen JW et al: Moderate sedation: what radiologists need to know. AJR Am J Roentgenol. 201(5):941-6, 2013
                                                                                                          16. Steele JR et al: Quality improvement in interventional radiology: an opportunity to demonstrate value and improve patient-centered care. J Vasc Interv Radiol. 23(4):435-41; quiz 442, 2012
                                                                                                          17. Johnson S: Sedation and analgesia in the performance of interventional procedures. Semin Intervent Radiol. 27(4):368-73, 2010
                                                                                                          18. Kadoi Y: Perioperative considerations in diabetic patients. Curr Diabetes Rev. 6(4):236-46, 2010
                                                                                                          19. Papaspyros SC et al: Briefing and debriefing in the cardiac operating room. Analysis of impact on theatre team attitude and patient safety. Interact Cardiovasc Thorac Surg. 10(1):43-7, 2010
                                                                                                          20. Wiggins TF et al: Sedation, analgesia, and monitoring. Clin Colon Rectal Surg. 23(1):14-20, 2010
                                                                                                          21. ACR Manual on Contrast media. Version 7, 2010
                                                                                                          22. Hawkins IF et al: Carbon dioxide in angiography to reduce the risk of contrast-induced nephropathy. Radiol Clin North Am. 47(5):813-25, v-vi, 2009
                                                                                                          23. Lasser EC: Nonionic iodinated contrast media reactions. AJR Am J Roentgenol. 192(2):W80; author reply W81, 2009
                                                                                                          24. Stahel et al: The 5th anniversary of the "Universal Protocol": pitfalls and pearls. Patient Safety in Surgery 3:14, 2009
                                                                                                          25. Singh J et al: Iodinated contrast media and their adverse reactions. J Nucl Med Technol. 36(2):69-74; quiz 76-7, 2008
                                                                                                          26. Ead H: From Aldrete to PADSS: Reviewing discharge criteria after ambulatory surgery. J Perianesth Nurs. 21(4):259-67, 2006
                                                                                                          27. Devereaux PJ et al: Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk. CMAJ. 173(6):627-34, 2005
                                                                                                          28. Bettmann MA: Frequently asked questions: iodinated contrast agents. Radiographics. 24 Suppl 1:S3-10, 2004
                                                                                                          29. Michota FA et al: The preoperative evaluation: use the history and physical rather than routine testing. Cleve Clin J Med. 71(1):63-70, 2004
                                                                                                          30. American Society of Anesthesiologists task force on sedation and analgesia by non-anesthesiologists: practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 96(4):1004-17, 2002
                                                                                                          31. A follow-up review of wrong site surgery. Sentinel Event Alert. (24):1-3, 2001
                                                                                                          32. Institute of Medicine (US) Committee on Quality of Health Care in America: Crossing the quality chasm: a new health system for the 21st century. National Academies Press, 2001
                                                                                                          33. Kamath PS et al: A model to predict survival in patients with end-stage liver disease. Hepatology. 33(2):464-70, 2001
                                                                                                          34. Lee TH et al: Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 100(10):1043-9, 1999
                                                                                                          35. Oken MM et al: Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 5(6):649-55, 1982
                                                                                                          36. Cassileth BR et al: Informed consent -- why are its goals imperfectly realized? N Engl J Med. 302(16):896-900, 1980
                                                                                                          37. Faden RR et al: Decision-making and informed consent: a study of the impact of disclosed information. Soc Indic Res. 7(1-4):313-36, 1980
                                                                                                          38. Child CG et al: Surgery and portal hypertension. Major Probl Clin Surg. 1:1-85, 1964