The IRad App

cgm 11.2014 ©

General Info

How to order IR procedure

  • Epic Order
    • Must have an Epic order for the correct procedure
    • Be as specific as possible in the comments section (right versus left, etc.)
    • Prior to the procedure, order all lab tests desired for any fluids
  • Phone call to IR
    • After correct Epic order placed, must call IR
    • See phone numbers tab for list of phone #
    • If leaving a message for scheduler, must include
    • 1. Patient name and MRN
    • 2. Desired procedure
    • 3. Ordering physian name and pager #
    • 4. Number hours patient NPO
    • 5. Platelets and INR (within last 30 days)
    • 6. Anticoagulation (lovenox, coumadin, plavix, etc)
    • 7. Is patient consentable?
    • 8. Does patient require general anesthesia?

Consent

  • Will obtain informed consent upon patient arrival to IR dept
  • If patient has additional concerns prior to coming to IR dept, we are happy to obtain consent in patient's hospital room
  • If patient unable to consent, next of kin will be contacted either in person or via telephone
  • If next of kin not available for consent and procedure is an emergency, will need emergency consent from ordering MD
  • Consent is always obtained either by the staff MD, resident, or nurse practitioner.

Sedation/General Anesthesia

  • If patient requires/requests general anesthesia, must select option in Epic AND inform scheduler/IR resident/IR staff so that anesthesia can be notified
  • Recommendations for number or hours NPO prior to each procedure listed under each procedure w/in The IRad App
  • All children under 8 years old require general anesthesia

Lab Values

  • All lab values in The IRad App obtained from recent 2013 SIR guidelines found at
  • http://www.jvir.org/article/S1051-0443(12)01238-9/fulltext#t0005
  • Exceptions to these guidelines are made case by case, per staff discretion
  • If procedure is an emergency and lab values are not within normal limits, call IR
  • Lab values must be drawn within 30 days of procedure
  • Patients on anticoagulation often have PT/INR rechecked morning of procedure
  • If patient had lab values drawn at outside facility, must upload into Epic

Contrast Allergy

  • Patient must be premedicated if procedure requires contrast
  • Prednisone 50 mg PO at 13 hours, 7 hours, and 1 hour prior to procedure
  • and Benadryl 50 mg PO 1 hour prior to procedure
  • If procedure emergent and patient not premedicated, call IR

After hours/Weekends/Holidays

  • After 5 pm, weekends, and holidays, the call team provides coverage for procedures
  • Epic order must be placed AND call radiology resident at 929-0694

The IRad App

Phone Numbers

Emergent 8am-5pm M-F

  • First, IR scheduler 53224
  • Second, IR resident pager
  • Third, IR staff pager

Emergent 5pm-7am M-F

  • First, 929-0694
  • Second, IR staff pager

Emergent weekend/holiday

  • First, 929-0694
  • Second, IR staff pager

Nonemergent inpatient

Call IR scheduler 53224

Nonemergent outpatient

Call IR scheduler 53224, leave a message

Tube/drain question 8am-5pm

Page 978-2016 or 929-3317

Tube/drain question 5pm-7am

Page 929-0694

Tube/drain question wknd/holiday

Page 929-0694

The IRad App

Vascular Procedures

The IRad App

Venous Access/Lines

The IRad App

Temporary Dialysis Catheter

General Info

  • Dual lumen temporary dialysis catheter
  • For short term dialysis while hospitalized
  • Catheter ready to use immediately
  • Right internal jugular vein access preferred (over left internal jugular vein access preferred over common femoral vein access)
  • Can be converted to a tunneled dialysis catheter for long term dialysis
  • NPO status

  • Usually not needed
  • Local anesthesia with lidocaine
  • If patient desires sedation, then NPO 6 hours prior to procedure
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤2 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 3-5 days before procedure for INR ≤2
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Do not withhold
  • Plavix (Clopidogrel): Withhold 0-5 days before procedure
  • Ticlid (Ticlopidine): Withhold 0-5 days before procedure
  • ReoPro (Abciximab): Withhold 12-24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold immediately before procedure
  • Aggrastat (Tirofiban): Withhold immediately before procedure
  • Argatroban: Do not withhold
  • Angiomax (Bivalirudin): Do not withhold
  • Pradaxa (Dabigatran): Do not withhold
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR central line
  • Specify "temporary dialysis catheter placement" in comments section
  • Will place right internal jugular venous access unless otw specified
  • If left internal jugular or common femoral venous access desired, must specify in comments section
  • Catheter Exchange

  • Catheter can be exchanged
  • NPO status, lab values, anticoagulation all the same as for placement
  • Epic Order = IR central line
  • Specify "temporary dialysis catheter exchange" in comments section
  • Specify if want indwelling catheter tip sent for cultures
  • Conversion to tunneled dialysis catheter

  • If catheter placed by IR, then can be converted to a tunneled dialysis catheter
  • See conversion of temporary to tunneled dialysis catheter
  • Catheter Removal

  • Catheter can be removed at bedside with 2-3 minutes venous pressure to obtain hemostasis
  • The IRad App

    Trialysis Catheter

    General Info

  • Dual lumen temporary dialysis catheter with an additional single lumen that functions as a central venous catheter
  • For short term dialysis while hospitalized
  • Catheter ready to use immediately
  • Right internal jugular vein access preferred (over left internal jugular vein access preferred over common femoral vein access)
  • Can be converted to a tunneled dialysis catheter for long term dialysis
  • NPO status

  • Usually not needed
  • Local anesthesia with lidocaine
  • If patient desires sedation, then NPO 6 hours prior to procedure
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤2 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 3-5 days before procedure for INR ≤2
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Do not withhold
  • Plavix (Clopidogrel): Withhold 0-5 days before procedure
  • Ticlid (Ticlopidine): Withhold 0-5 days before procedure
  • ReoPro (Abciximab): Withhold 12-24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold immediately before procedure
  • Aggrastat (Tirofiban): Withhold immediately before procedure
  • Argatroban: Do not withhold
  • Angiomax (Bivalirudin): Do not withhold
  • Pradaxa (Dabigatran): Do not withhold
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR central line
  • Specify "trialysis catheter placement" in comments section
  • Will place right internal jugular venous access unless otw specified
  • If left internal jugular or common femoral venous access desired, must specify in comments section
  • Catheter Exchange

  • Catheter can be exchanged
  • NPO status, lab values, anticoagulation all the same as for placement
  • Epic Order = IR central line
  • Specify "trialysis catheter exchange" in comments section
  • Specify if want indwelling catheter tip sent for cultures
  • Conversion to tunneled dialysis catheter

  • If catheter placed by IR, then can be converted to a tunneled dialysis catheter
  • See conversion of temporary to tunneled dialysis catheter
  • Catheter Removal

  • Catheter can be removed at bedside with 2-3 minutes venous pressure to obtain hemostasis
  • The IRad App

    Apheresis Catheter

    General Info

  • Dual lumen apheresis catheter
  • Catheter ready to use immediately
  • Right internal jugular vein access preferred (over left internal jugular vein access preferred over common femoral vein access)
  • NPO status

  • Usually not needed if first catheter placement
  • Local anesthesia with lidocaine
  • If patient desires sedation, then NPO 6 hours prior to procedure
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤2 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 3-5 days before procedure for INR ≤2
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Do not withhold
  • Plavix (Clopidogrel): Withhold 0-5 days before procedure
  • Ticlid (Ticlopidine): Withhold 0-5 days before procedure
  • ReoPro (Abciximab): Withhold 12-24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold immediately before procedure
  • Aggrastat (Tirofiban): Withhold immediately before procedure
  • Argatroban: Do not withhold
  • Angiomax (Bivalirudin): Do not withhold
  • Pradaxa (Dabigatran): Do not withhold
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR apheresis cath
  • Specify "apheresis catheter placement" in comments section
  • Will place right internal jugular venous access unless otw specified
  • If left internal jugular or common femoral venous access desired, must specify in comments section
  • Catheter Exchange

  • Catheter can be exchanged
  • NPO status, lab values, anticoagulation all the same as for placement
  • Epic Order = IR apheresis cath
  • Specify "apheresis catheter exchange" in comments section
  • Specify if want indwelling catheter tip sent for cultures
  • Catheter Removal

  • Catheter can be removed at bedside with 2-3 minutes venous pressure to obtain hemostasis
  • The IRadd App

    PICC

    General Info

  • Peripherally inserted central venous catheter
  • Single, double, or triple lumen PICC
  • Usually place double lumen unless otw specified
  • Catheter is ready to use immediately
  • NOT recommended if patient may potentially need dialysis (tunneled PICC would be recommended instead)
  • Placed into cephalic or basilic vein
  • Catheter exits in region of biceps
  • Prefer to place in non-dominant arm
  • NPO status

  • Usually not needed
  • Local anesthesia with lidocaine
  • If patient desires sedation, then NPO 6 hours prior to procedure
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤2 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 3-5 days before procedure for INR ≤2
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Do not withhold
  • Plavix (Clopidogrel): Withhold 0-5 days before procedure
  • Ticlid (Ticlopidine): Withhold 0-5 days before procedure
  • ReoPro (Abciximab): Withhold 12-24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold immediately before procedure
  • Aggrastat (Tirofiban): Withhold immediately before procedure
  • Argatroban: Do not withhold
  • Angiomax (Bivalirudin): Do not withhold
  • Pradaxa (Dabigatran): Do not withhold
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR PICC line
  • Specify "PICC placement" in comments section
  • Will place double lumen PICC unless otw specified
  • If single lumen or triple lumen PICC desired, must specify in comments section
  • Catheter Maintenance

  • Catheter should be flushed after each use or at least once a day
  • If catheter not functioning, cath flow suggested
  • If catheter not functioning despite cath flow, call IR (may need exchanged)
  • Catheter Exchange/Repositioning

  • Catheter can be exchanged or repositioned
  • NPO status, lab values, anticoagulation all the same as for placement
  • Epic Order = IR PICC line
  • Specify "PICC exchange" or "PICC repositioning" in comments section
  • Specify if want indwelling PICC tip sent for cultures
  • Catheter Removal

  • Catheter can be removed at bedside with 2-3 minutes venous pressure to obtain hemostasis
  • The IRad App

    Triple Lumen Central Venous Catheter

    General Info

  • Same triple lumen catheter placed in MICU
  • Catheter ready to use immediately
  • Right internal jugular vein access preferred (over left internal jugular vein access preferred over common femoral vein access)
  • NPO status

  • Usually not needed
  • Local anesthesia with lidocaine
  • If patient desires sedation, then NPO 6 hours prior to procedure
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤2 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 3-5 days before procedure for INR ≤2
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Do not withhold
  • Plavix (Clopidogrel): Withhold 0-5 days before procedure
  • Ticlid (Ticlopidine): Withhold 0-5 days before procedure
  • ReoPro (Abciximab): Withhold 12-24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold immediately before procedure
  • Aggrastat (Tirofiban): Withhold immediately before procedure
  • Argatroban: Do not withhold
  • Angiomax (Bivalirudin): Do not withhold
  • Pradaxa (Dabigatran): Do not withhold
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR central line
  • Specify "triple lumen central venous catheter placement" in comments section
  • Will place right internal jugular venous access unless otw specified
  • If left internal jugular or common femoral venous access desired, must specify in comments section
  • Catheter Exchange

  • Catheter can be exchanged
  • NPO status, lab values, anticoagulation all the same as for placement
  • Epic Order = IR central line
  • Specify "triple lumen central venous catheter exchange" in comments section
  • Specify if want indwelling catheter tip sent for cultures
  • Catheter Removal

  • Catheter can be removed at bedside with 2-3 minutes venous pressure to obtain hemostasis
  • The IRad App

    Tunneled Dialysis Catheter

    General Info

  • Dual lumen tunneled dialysis catheter
  • Recommended for patients needing long term dialysis
  • Not recommended if patient bacteremic
  • Catheter is ready to use immediately
  • Right internal jugular vein access preferred (over left internal jugular vein access preferred over common femoral vein access)
  • If these veins occluded, can place translumbar or transhepatic tunneled dialysis catheter
  • Internal jugular access - catheter exits a few inches below clavicle
  • Common femoral access - catheter exits a few inches lateral to groin/inguinal region
  • Translumbar access - catheter exits through the flank via lumbar vein
  • Transhepatic access - catheter exits through the RUQ via hepatic vein
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR tunneled catheter
  • Specify "tunneled dialysis catheter placement" in comments section
  • Will place right internal jugular venous access unless otw specified
  • If left internal jugular vein, common femoral vein, translumbar, or transhepatic access desired, must specify in comments section
  • Catheter Maintenance

  • Catheter should be flushed after each use
  • If catheter not functioning, cath flow suggested
  • If catheter not functioning despite cath flow, call IR (may need exchanged)
  • Catheter Exchange

  • Catheter can be exchanged
  • NPO status, lab values, anticoagulation all the same as for placement
  • Epic Order = IR tunneled catheter
  • Specify "tunneled dialysis catheter exchange" in comments section
  • Specify if want indwelling catheter tip sent for cultures
  • Catheter Removal

  • Catheter should not be removed at bedside b/c risk of catheter breakage
  • NPO status, lab values, anticoagulation all the same as for placement
  • Epic order = IR VAD removal
  • Specify "tunneled dialysis catheter removal" in comments section
  • Specify if want indwelling catheter tip sent for cultures
  • The IRad App

    Chemoport Catheter

    General Info

  • Single lumen chemoport catheter
  • Dual lumen chemoport catheter for chemotherapy available upon request (must be special ordered)
  • Dual lumen chemoport catheter for apheresis (Vortex) available upon request
  • Right internal jugular vein access preferred over left internal jugular vein access over subclavian vein access
  • Injection port usually a few inches below clavicle
  • Not recommended if patient bacteremic
  • Chemoport for chemotherapy ready to use immediately (prefer to wait at least 48 hours)
  • Vortex chemoport for apheresis cannot be used for two weeks
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR port placement
  • Specify "chemoport placement" in comments section
  • Will place single lumen chemoport for chemotherapy unless otw specified
  • If double lumen chemoport for chemotherapy or apheresis (Vortex) chemoport desired, must specify in comments section
  • Will place right internal jugular venous access unless otw specified
  • If left internal jugular or subclavian venous access desired, must specify in comments section
  • Catheter Maintenance

  • Catheter should be flushed after each use
  • If catheter not functioning, cath flow suggested
  • If catheter not functioning despite cath flow, call IR (may need checked)
  • Chemoport can be checked in IR if nonfunctioing
  • Catheter Exchange

  • Catheter and/or injection port can be exchanged
  • NPO status, lab values, anticoagulation all the same as for placement
  • Epic order = IR port placement
  • Specify "chemoport catheter exchange" in comments section
  • Specify if want indwelling catheter tip sent for cultures
  • Catheter Removal

  • NPO status, lab values, anticoagulation all the same as for placement
  • Epic order = IR VAD removal
  • Specify "chemoport catheter removal" in comments section
  • Specify if want indwelling catheter tip sent for cultures
  • The IRadd App

    Tunneled PICC

    General Info

  • Single, double, or triple lumen tunneled PICC
  • Will place double lumen unless otw specified
  • Not a peripherally placed catheter (called a tunneled PICC b/c catheter identical to traditional PICC)
  • Not recommended if patient bacteremic
  • Catheter is ready to use immediately
  • Right internal jugular vein access preferred over left internal jugular vein access
  • Catheter usually exits a few inches below clavicle
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR PICC line
  • Specify "tunneled PICC placement" in comments section
  • Will place double lumen tunneled PICC unless otw specified
  • If single lumen or triple lumen PICC desired, must specify in comments section
  • Will place right internal jugular venous access unless otw specified
  • If left internal jugular access desired, must specify in comments section
  • Catheter Maintenance

  • Catheter should be flushed after each use or at least once a day
  • If catheter not functioning, cath flow suggested
  • If catheter not functioning despite cath flow, call IR (may need exchanged)
  • Catheter Exchange

  • Catheter can be exchanged
  • NPO status, lab values, anticoagulation all the same as for placement
  • Epic order = IR PICC line
  • Specify "tunneled PICC exchange" in comments section
  • Specify if want indwelling catheter tip sent for cultures
  • Catheter Removal

  • Catheter should not be removed at bedside b/c risk of catheter breakage
  • NPO status, lab values, anticoagulation all the same as for placement
  • Epic order = IR VAD removal
  • Specify "tunneled PICC removal" in comments section
  • Specify if want indwelling catheter tip sent for cultures
  • The IRad App

    Temporary to tunneled dialysis catheter conversion

    General Info

  • Temporary dialysis catheter or trialysis catheter must have been placed by IR
  • Not recommended if patient bacteremic
  • Catheter is ready to use immediately
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR tunneled catheter
  • Specify "temporary to tunneled dialysis catheter conversion" in comments section
  • Catheter Maintenance

  • Catheter should be flushed after each use
  • If catheter not functioning, cath flow suggested
  • If catheter not functioning despite cath flow, call IR (may need exchanged)
  • Catheter Removal

  • Catheter should not be removed at bedside b/c risk of catheter breakage
  • NPO status, lab values, anticoagulation all the same as for placement
  • Epic order = IR VAD removal
  • Specify "tunneled dialysis catheter removal" in comments section
  • Specify if want indwelling catheter tip sent for cultures
  • The IRad App

    IVC filter/venography

    The IRad App

    IVC filter placement

    General Info

  • Removable IVC filter
  • Usually deployed via common femoral vein access and positioned just below renal veins
  • Occasionally deployed via right internal jugular vein access
  • NPO status

  • Usually not needed
  • Local anesthesia with lidocaine
  • If patient desires sedation, then NPO 6 hours prior to procedure
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤2 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 3-5 days before procedure for INR ≤2
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Do not withhold
  • Plavix (Clopidogrel): Withhold 0-5 days before procedure
  • Ticlid (Ticlopidine): Withhold 0-5 days before procedure
  • ReoPro (Abciximab): Withhold 12-24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold immediately before procedure
  • Aggrastat (Tirofiban): Withhold immediately before procedure
  • Argatroban: Do not withhold
  • Angiomax (Bivalirudin): Do not withhold
  • Pradaxa (Dabigatran): Do not withhold
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR IVC filter
  • Specify "IVC filter placement" in comments section
  • Post procedure monitoring

  • Patients will follow up in IR clinic for abdominal xray and venous ultrasound
  • IVC filters can be removed in the future if no longer needed
  • The IRad App

    IVC filter removal

    General Info

  • Removed via right internal jugular vein access
  • NPO status

  • Usually not needed
  • Local anesthesia with lidocaine
  • If patient desires sedation, then NPO 6 hours prior to procedure
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤2 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 3-5 days before procedure for INR ≤2
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Do not withhold
  • Plavix (Clopidogrel): Withhold 0-5 days before procedure
  • Ticlid (Ticlopidine): Withhold 0-5 days before procedure
  • ReoPro (Abciximab): Withhold 12-24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold immediately before procedure
  • Aggrastat (Tirofiban): Withhold immediately before procedure
  • Argatroban: Do not withhold
  • Angiomax (Bivalirudin): Do not withhold
  • Pradaxa (Dabigatran): Do not withhold
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR IVC filter
  • Specify "IVC filter removal" in comments section
  • Post procedure monitoring

  • Must be monitored for at least 2 hours post procedure
  • The IRad App

    Adrenal vein/Parathyroid sampling

    General Info

  • Adrenal vein samplig: used for identification of primary aldosteronism
  • Selective venous sampling for primary hyperparathyroidism: preoperative localization of functioning parathyroid adenoma which cannot be localized by imaging
  • NPO status

  • Usually not needed
  • Local anesthesia with lidocaine
  • If patient desires sedation, then NPO 6 hours prior to procedure
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤2 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 3-5 days before procedure for INR ≤2
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Do not withhold
  • Plavix (Clopidogrel): Withhold 0-5 days before procedure
  • Ticlid (Ticlopidine): Withhold 0-5 days before procedure
  • ReoPro (Abciximab): Withhold 12-24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold immediately before procedure
  • Aggrastat (Tirofiban): Withhold immediately before procedure
  • Argatroban: Do not withhold
  • Angiomax (Bivalirudin): Do not withhold
  • Pradaxa (Dabigatran): Do not withhold
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR venogram
  • Specify "adrenal vein sampling" or "parathyroid sampling" in comments section
  • Post procedure monitoring

  • Must be monitored for at least 2 hours post procedure
  • The IRad App

    Dialysis fistula/graft declot

    General Info

  • Nonfunctioning or poorly functioning dialysis fistula or graft
  • Will assses venous outflow and usually assess arterial inflow
  • Usually combination of chemical and mechanical thrombectomy
  • Usually involves angioplasty and sometimes stent placement
  • Will ensure patient goes to dialysis following procedure if indicated
  • If declot unsuccessful, will place tunneled dialysis catheter
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤2 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 3-5 days before procedure for INR ≤2
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Do not withhold
  • Plavix (Clopidogrel): Withhold 0-5 days before procedure
  • Ticlid (Ticlopidine): Withhold 0-5 days before procedure
  • ReoPro (Abciximab): Withhold 12-24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold immediately before procedure
  • Aggrastat (Tirofiban): Withhold immediately before procedure
  • Argatroban: Do not withhold
  • Angiomax (Bivalirudin): Do not withhold
  • Pradaxa (Dabigatran): Do not withhold
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR dialysis access intv
  • If declot unsuccessful, will place tunneled dialysis catheter
  • Post procedure monitoring

  • Must be monitored for at least 2 hours
  • Will send to dialysis following procedure if indicated
  • The IRad App

    Embolization

    The IRad App

    Arterial Embolization

    General Info

  • Usually have CTA first (noncontrast, arterial phase, delayed images)
  • Examples:
    • Hemoptysis needing bronchial artery embolization
    • Trauma
    • Pseudoaneurysm or aneurysm
    • AVM
    • Pre-SIRS sphere treatment (commonly embolize at least gastroduodenal artery)
    • Thrombocytopenia/splenomegaly needing splenic artery embolization
    • Renal cancer needing embolization for presurgical planning
    • Angiomyelolipoma needing embolization of renal artery
    • Bone tumor needing embolization for presurgical planning
    • Benign prostatic hypertrophy needing prostatic artery embolization
    • Portal vein embolization to induce liver hypertrophy
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR visceral arteriogram
  • Specify if embolization also desired in comments section
  • Post embolization monitoring

  • Patient usually monitored overnight (23 hour obs)
  • Post embolization syndrome – nausea, vomiting, fever, pain usually w/in first 72 hours
  • Bedrest w/o bathroom priveleges four hours after procedure
  • The IRad App

    GI bleeding

    General Info

  • Usually have recent upper GI or lower GI w/ active bleeding, nuclear medicine tagged RBC study, or CTA
  • CTA GI bleed protocol preferred over tagged RBC study
  • If large gastric varices needing embolization, can perform balloon retrograde transvenous obliteration (BRTO) or balloon antegrade transvenous obliteration (BATO)
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR visceral arteriogram
  • Will embolize any areas of active bleeding
  • Post embolization monitoring

  • Patient usually monitored overnight (23 hour obs)
  • Post embolization syndrome – nausea, vomiting, fever, pain usually w/in first 72 hours
  • If BRTO/BATO, patient admitted to MICU overnight with balloon inflated and then brought back to IR following day
  • Bedrest w/o bathroom priveleges four hours after procedure
  • The IRad App

    Uterine Artery Embolization

    General Info

  • Embolization of the right and left uterine arteries
  • Generally for symptomatic uterine fibroids and occasionally adenomyosis
  • Patient usually seen in IR clinic prior to and following procedure
  • Patient usually gets pelvic MRI prior to procedure
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Some patients prefer general anesthesia
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR uterine fibroid embo
  • Post embolization monitoring

  • Patient monitored overnight (23 hour obs) with morphine PCA
  • Post embolization syndrome – nausea, vomiting, fever, pain usually w/in first 72 hours
  • Bedrest w/o bathroom priveleges four hours after procedure
  • The IRad App

    Gonadal Vein Embolization

    General Info

  • Embolization of right and/or left gonadal vein secondary to vericocele or pelvic congestion syndrome
  • Patient usually seen in IR clinic prior to and following procedure
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR embolization
  • Specify "gonadal vein embolization" in comments section
  • Specify right, left, or bilateral
  • Post embolization monitoring

  • Patient monitored overnight (23 hour obs) with morphine PCA
  • Post embolization syndrome – nausea, vomiting, fever, pain usually w/in first 72 hours
  • The IRad App

    Chemoembolization

    General Info

  • Embolization of right and/or left hepatic artery with microspheres and doxorubicin for HCC or liver mets
  • Patient usually seen in IR clinic prior to and following procedure
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR chemoembolization
  • Post embolization monitoring

  • Patient monitored overnight (23 hour obs) with morphine PCA
  • Post embolization syndrome – nausea, vomiting, fever, pain usually w/in first 72 hours
  • Bedrest without bathroom priveleges for four hours after procedure
  • The IRad App

    SIRS-Spheres (Y-90)

    General Info

  • For colorectal mets, neuroendcrine tumors such as carcinoid, breast mets, infiltrative hepatocellular carcinoma
  • Two step process: 1st commonly embolize gastroduodenal artery 2nd inject beta radiating isotope into right or left hepatic artery
  • Patient usually seen in IR clinic prior to and following procedure
  • Patient seen in Rad Onc clinic prior
  • Rad Onc present for procedure
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR yttrium-90
  • Post embolization monitoring

  • Patient monitored overnight (23 hour obs) with morphine PCA
  • Post embolization syndrome – nausea, vomiting, fever, pain usually w/in first 72 hours
  • Bedrest without bathroom priveleges for four hours after procedure
  • The IRad App

    Portal vein embolization

    General Info

  • CT abdomen with volume measurements before procedure
  • Embolization of right or left portal vein to induce hypertrophy of healthy liver
  • Patient usually seen in IR clinic prior to and following procedure
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Some patients prefer general anesthesia
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR embolization
  • Specify "portal vein embolization" in comments section
  • Specify right or left portal vein in comments section
  • Post embolization monitoring

  • Patient monitored overnight (23 hour obs) with morphine PCA
  • Post embolization syndrome – nausea, vomiting, fever, pain usually w/in first 72 hours
  • The IRad App

    Thrombolysis

    General Info

  • Catheter directed thrombolysis
  • For patients with DVT, limb threatening thromboses, IVC thrombosis, Paget-Schroetter syndrome, SVC syndrome, May Thurner syndrome
  • Usually infuse heparin at constant rate through catheter overnight w/ patient monitored in ICU
  • Not recommended if recent stroke or spinal cord hemorrhage
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Some patients prefer general anesthesia
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR embolization
  • Specify "portal vein embolization" in comments section
  • Specify right or left portal vein in comments section
  • Post embolization monitoring

  • Patient usually monitored overnight in MICU
  • Call IR immediately if new neurological findings concerning for stroke
  • The IRad App

    Angioplasty/Stenting

    General Info

  • Arteries and veins can be balloon angioplasied or stented to treat areas of stenosis
  • Examples
    • Renal artery stenting for renal artery stenosis
    • Renal artery angioplasty for fibromuscular dysplasia
    • Iliac artery angioplasty and/or stenting
    • SMA or celiac artery angioplasty for ischemia
    • Transplant liver hepatic artery angioplasty and/or stenting
    • Transplant liver hepatic vein or IVC angioplasty and/or stenting
    • SVC stenting for SVC syndrome
    • Subclavian vein angioplasty for Paget-Schroetter syndrome
    • Left common iliac vein stenting for May-Thurner syndrome
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • If arterial, Epic order = IR arteriogram visceral
  • If venous, Epic order = IR venogram
  • Specify right, left, or bilateral
  • Post embolization monitoring

  • Patients monitored at least 6 hours and sometimes overnight (23 hour obs)
  • The IRad App

    TIPS

    General Info

  • Transjugular intrahepatic portosystemic shunt
  • For patients with variceal bleeding, refractory ascites, portal hypertensive gastropathy, Budd-Chiari syndrome, hepatorenal syndrome
  • Not recommended if have right heart failure or encephalopathy
  • Balloon assisted ante/retrograde transvenous occlusion is an alternative to TIPS if gastric variceal bleeding (BRTO/BATO)
  • Occasionally, TIPS need revised if not functioning well
  • NPO status

  • General anesthesia
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Withhold 5 days
  • Lovenox (therapeutic dose): Withhold two doses or 24 hours before procedure
  • Heparin (unfractionated): Witthold 2-4 hours before procedure
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Short acting NSAIDS (Advil, Motrin, Diclofenac, Ketoprofen, Indomethacin): Withhold 24 hours before procedure
  • Intermediate acting NSAIDS (Naproxen, Sulindac, Diflunisal, Celecoxib): Withhold 2-3 days before procedure
  • Long acting NSAIDS (Meloxicam, Nabumetone, Piroxicam): Witthold 10 days before procedure
  • Epic Order

  • Epic order = IR TIPS
  • If TIPS revision, must specify "TIPS revision" in comments section
  • Post embolization monitoring

  • Monitored overnight (23 hour obs) sometimes in MICU
  • If signs of tachycardia, hypotension, drop in Hct, call IR (patient may need embolization)
  • Will follow up patient in clinic with TIPS ultrasound
  • The IRad App

    Non Vascular Procedures

    The IRad App

    Paracentesis

    NPO status

  • Usually not needed
  • Local anesthesia with lidocaine
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤2 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 3-5 days before procedure for INR ≤2
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Do not withhold
  • Plavix (Clopidogrel): Withhold 0-5 days before procedure
  • Ticlid (Ticlopidine): Withhold 0-5 days before procedure
  • ReoPro (Abciximab): Withhold 12-24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold immediately before procedure
  • Aggrastat (Tirofiban): Withhold immediately before procedure
  • Argatroban: Do not withhold
  • Angiomax (Bivalirudin): Do not withhold
  • Pradaxa (Dabigatran): Do not withhold
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR paracentesis
  • Fluid studies must be ordered prior to procedure
  • Fluid is not saved in IR and is taken immediately following procedure to lab
  • Specify if certain volume requested to be removed, otw will drain up to about 12 liters
  • Specify if want albumin given during procedure
  • The IRad App

    Thoracentesis

    NPO status

  • Usually not needed
  • Local anesthesia with lidocaine
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤2 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 3-5 days before procedure for INR ≤2
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Do not withhold
  • Plavix (Clopidogrel): Withhold 0-5 days before procedure
  • Ticlid (Ticlopidine): Withhold 0-5 days before procedure
  • ReoPro (Abciximab): Withhold 12-24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold immediately before procedure
  • Aggrastat (Tirofiban): Withhold immediately before procedure
  • Argatroban: Do not withhold
  • Angiomax (Bivalirudin): Do not withhold
  • Pradaxa (Dabigatran): Do not withhold
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR thoracentesis
  • Specify right or left
  • Fluid studies must be ordered prior to procedure
  • Fluid is not saved in IR and is taken immediately following procedure to lab
  • Specify if certain volume requested to be removed, otw will drain up to about 1.5 liters
  • IR will order chest xray post procedure
  • The IRad App

    Lumbar puncture

    Diagnostic lumbar puncture

  • Will obtain opening pressure
  • Fluid studies must be ordered prior to procedure
  • Fluid is not saved in IR and is taken immediately following procedure to lab
  • Therapeutic lumbar puncture

  • Fluid removed to decrease intracranial pressure
  • No fluid saved or sent to lab
  • Specify if want opening and/or closing pressure
  • Intrathecal chemotherapy administration

  • Must order type and amount of intrathecal chemotherapy
  • Must specify if want diagnostic lumbar puncture as well
  • NPO status

  • Usually not needed
  • Local anesthesia with lidocaine
  • If patient desires sedation, then NPO 6 hours prior to procedure
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR lumbar puncture
  • Must specify "diagnostic", "therapeutic" or "chemotherapy injection"
  • Must specify if want closing pressure
  • CSF fluid studies must be ordered when epic order placed
  • Post procedure monitoring

  • Patient counseled on post procedure nausea and headache (usually treated w/ over the counter medications and lying flat)
  • If patient with severe headache after procedure not relieved with over the counter meds, call IR (may have CSF leak)
  • If any new neurologic deficits post procedure, call IR immediately
  • The IRad App

    Drains/Tubes

    The IRad App

    Abscess drain/aspiration (intra-abdominal/intra-thoracic)

    General Info

  • If abscess large enough then prefer to leave a drain, otw will aspirate only
  • IR will follow tube daily while patient in hospital
  • If patient goes home with a drain, IR will schedule follow up for drainage catheter check/removal
  • Tube will be attached to bulb or drainage bag
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR abscess drain
  • If multiple fluid collections/abscesses, must specify which abscess or abscesses to be drained
  • Specify right, left, or bilateral (if applicable)
  • Fluid studies must be ordered prior to procedure
  • Fluid is not saved in IR and is taken immediately following procedure to lab
  • Catheter Maintenance

  • Inpatient: Flush tube q8 hours with 10ml normal saline
  • Outpatient: Flush tube at least once a day with 10 ml normal saline
  • Patient should keep a log of daily output (excluding flushes) and bring to f/u IR visit
  • Catheter Exchange/Repositioning

  • Drain/Tube Exchange or Repositioning
  • Catheter Removal

  • IR will remove drain at bedside or at follow up drain check appointment
  • The IRad App

    Abscess drain/aspiration (superficial/subcutaneous)

    General Info

  • If abscess large enough then prefer to leave a drain, otw will aspirate only
  • IR will follow tube daily while patient in hospital
  • If patient goes home with a drain, will schedule follow up for drainage catheter check/removal
  • Tube will be attached to bulb or drainage bag
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR abscess drain
  • If multiple fluid collections/abscesses, must specify which abscess or abscesses to be drained
  • Specify right, left, or bilateral (if applicable)
  • Fluid studies must be ordered prior to procedure
  • Fluid is not saved in IR and is taken immediately following procedure to lab
  • Catheter Maintenance

  • Inpatient: Flush tube q8 hours with 10ml normal saline
  • Outpatient: Flush tube at least once a day with 10 ml normal saline
  • Patient should keep a log of daily output (excluding flushes) and bring to f/u IR visit
  • Catheter Exchange/Repositioning

  • Drain/Tube Exchange or Repositioning
  • Catheter Removal

  • IR will remove drain at bedside or at follow up drain check appointment
  • The IRad App

    Chest tube

    General Info

  • Usually for pneumothorax, pleural effusion, empyema, or abscess
  • IR will follow tube daily while patient in hospital
  • IR will order chest xrays as needed
  • IR will remove tube at bedside
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR thoracentesis
  • Specify "chest tube placement" in comments section (otw will remove pleural fluid only)
  • Specify right, left or bilateral
  • Fluid studies must be ordered when epic order placed
  • Fluid is not saved in IR and is taken immediately following procedure to lab
  • Catheter Maintenance

  • If for pneumothorax, keep tube to low wall suction and do not flush
  • If for abscess, flush tube q8 hours with 10ml normal saline
  • Catheter Exchange/Repositioning

  • Drain/Tube Exchange or Repositioning
  • Catheter Removal

  • Call IR and NP or resident will remove at bedside
  • Patient should not go home w/ chest tube in place
  • If patient needs pleural fluid drained outside of hospital, need tunneled pleural catheter
  • The IRad App

    Tunneled pleural/peritoneal catheter

    General Info

  • Allows patient to drain pleural or peritoneal fluid outside the hospital
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Tunneled pleural catheter
    • Epic order = IR thoracentesis
    • Specify "tunneled pleural drain placement" in comments section
    • Specify right or left
  • Tunneled peritoneal catheter
    • Epic order = IR paracentesis
    • Specify "tunneled peritoneal drain placement" in comments section
  • Catheter Maintenance

  • Inpatient: Flush tube q8 hours with 10ml normal saline
  • Outpatient: Flush tube at least once a day with 10 ml normal saline
  • The IRad App

    Nasogastric/Dobhoff tube

    General Info

  • Performed in main radiology (unless NG tube being placed for IR performed gastrostomy tube placement)
  • 8am-5pm Monday-Friday: call 4-2500
  • After 5 pm Monday-Friday, weekends, and holidays page 978-8509
  • The IRad App

    Gastrostomy tube

    General Info

  • Can be placed inpatient or outpatient
  • Drink thin barium the night before procedure
  • NG tube must be in place for procedure (can be placed during the procedure by IR)
  • Will return for gastrostomy tube check the day after procedure
  • Will return for T-tac removal in clinic within 2-3 weeks after placement
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR gastrointestinal
  • Specify "gastrostomy tube placement" in comments section
  • Catheter Exchange/Repositioning

  • IR placed gastrostomy tubes routinely exchanged every 6 months
  • For PEG tube exchange (ie tube placed by surgery or GI), best if tube has been in place for a few months
  • Epic order = IR gastrointestinal
  • Specify "gastrostomy tube exchange" in comments section
  • Drain/Tube Exchange or Repositioning
  • Catheter Maintenance

  • IR will schedule follow up for tube exchange
  • Tubes routinely exchanged every 6 months
  • Conversion of G-tube into gastrojejunostomy tube

    General Info

  • For PEG tube coversion (ie tube placed by surgery or GI), best if tube has been in place for a few months
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR gastrointestinal
  • Specify "gastrostomy tube to gastrojejunostomy tube conversion" in comments section
  • Catheter Exchange/Repositioning

  • IR placed gastrojejunostomy tubes routinely exchanged every 6 months
  • Epic order = IR gastrointestinal
  • Specify "gastrojejunostomy tube exchange" in comments section
  • Drain/Tube Exchange or Repositioning
  • Catheter Maintenance

  • IR will schedule follow up for tube exchange
  • Routinely exchanged every 6 months
  • The IRad App

    Cholecystostomy tube

    General Info

  • Tubes usually left in place for at least 6 weeks
  • Tube will exit the RUQ and be attached to a drainage bag
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR abscess drain
  • Specify "cholecystostomy tube placement" in comments section
  • Fluid studies must be ordered prior to procedure
  • Fluid is not saved in IR and is taken immediately following procedure to lab
  • Catheter Exchange/Repositioning

  • Drain/Tube Exchange or Repositioning
  • Catheter Maintenance

  • Inpatient: Ask IR how much to flush
  • Outpatient: Flush tube at least once a day with 10 ml normal saline
  • Catheter Removal

  • IR will remove drain at follow up drain check appointment
  • The IRad App

    Biliary tube

    General Info

  • Initial placement is internal-external tube (internal part of the drain in small bowel and external part of the drain exiting upper abdomen)
  • Tube will exit the upper abdomen and be attached to a drainage bag
  • Can be internalized (biliary stent placement and tube removal) in the future as needed
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • If patient desires general anesthesia, must let scheduler know
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Withhold 5 days
  • Lovenox (therapeutic dose): Withhold two doses or 24 hours before procedure
  • Heparin (unfractionated): Witthold 2-4 hours before procedure
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Short acting NSAIDS (Advil, Motrin, Diclofenac, Ketoprofen, Indomethacin): Withhold 24 hours before procedure
  • Intermediate acting NSAIDS (Naproxen, Sulindac, Diflunisal, Celecoxib): Withhold 2-3 days before procedure
  • Long acting NSAIDS (Meloxicam, Nabumetone, Piroxicam): Witthold 10 days before procedure
  • Epic Order

  • Epic order = IR biliary
  • Specify "biliary tube placement" in comments section
  • If internalizing the tube, specify "biliary stent placement" in comments section
  • Catheter Exchange/Repositioning

  • Biliary tubes can be exchanged for larger tubes
  • Biliary tube exchange/repositioning sometimes involves angioplasty
  • Epic order = IR biliary
  • Specify "biliary drain exchange" or "biliary drain repositioning" or "biliary drain removal" in the comments section
  • Specify if want tube upsized, otw same size tube will be placed
  • Drain/Tube Exchange or Repositioning
  • Catheter Maintenance

  • Inpatient: Ask IR how much to flush
  • Outpatient: Flush tube at least once a day with 10 ml normal saline
  • Catheter Removal

  • IR will remove drain at follow up drain check appointment
  • The IRad App

    Nephrostomy/Nephroureteral tube

    General Info

  • Nephrostomy tube
    • Tip looped in renal pelvis
    • Tube will exit the flank and be attached to drainage bag
    • Important that nephrostomy tube does not get clamped
  • Nephroureteral tube
    • Tip looped in bladder (usually placed in preparation for percutaneous stone removal)
    • Tube will exit the flank and be attached to drainage bag
    • Specify preferred access site (upper, mid, lower pole)
    • Specify if more than one nephroureteral tube requested

    NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR nephrostomy
  • Specify "nephrostomy tube placement" or "nephroureteral tube placement" in comments section
  • Specify right, left, bilateral, or tranplant kidney
  • If nephroureteral tube, specify upper, mid, and/or lower pole access
  • If nephroureteral tube, specify if more than one tube needs to be placed
  • Catheter Exchange/Repositioning

  • Epic order = IR nephrostomy
  • Specify "nephrostomy exchange" in comments section
  • Specify right, left, bilateral, or tranplant kidney
  • Specify if want tube upsized, otw will place same size
  • Drain/Tube Exchange or Repositioning
  • Catheter Maintenance

  • Inpatient: Flush tube q8 hours with 10ml normal saline
  • Outpatient: Flush tube at least once a day with 10 ml normal saline
  • IR will schedule follow up for tube exchange
  • Tubes are routinely exchanged every 3 months
  • Catheter Removal

  • IR will remove drain at follow up drain check appointment
  • Ureteral Stents

  • Placement or exchange of ureteral stents via an existing nephrostomy tube
  • Sometimes involves angioplasty of the ureter
  • Epic order = IR ureteral stent
  • Specify if want placement, exchange, or removal
  • Specify right, left, bilateral, or tranplant kidney
  • The IRad App

    Drain/Tube Exchange or Repositioning

    NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR abscess drain
  • Must specify "drain exchange/repositioning" in comments section
  • Must specify if want tube upsized, otw same size tube will be placed
  • The IRad App

    Biopsies/FNA

    The IRad App

    Thyroid FNA

    General Info

  • Usually performed in ultrasound department
  • Call 5-4723 to schedule
  • Obtain samples as requested by cytopathology (present during procedure to assess samples)
  • Pathology results usually back within one week
  • We do not discuss pathology results with patient
  • NPO status

  • Usually not needed
  • Local anesthesia with lidocaine
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤2 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 3-5 days before procedure for INR ≤2
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Do not withhold
  • Plavix (Clopidogrel): Withhold 0-5 days before procedure
  • Ticlid (Ticlopidine): Withhold 0-5 days before procedure
  • ReoPro (Abciximab): Withhold 12-24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold immediately before procedure
  • Aggrastat (Tirofiban): Withhold immediately before procedure
  • Argatroban: Do not withhold
  • Angiomax (Bivalirudin): Do not withhold
  • Pradaxa (Dabigatran): Do not withhold
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR biopsy
  • Specify "thyroid nodule biopsy" in comments section
  • Post Biopsy Monitoring

  • No monitoring required post procedure if patient did not receive conscious sedation
  • The IRad App

    Liver Biopsy

    General Info

  • Random liver biopsy
    • Usually obtain samples from left hepatic lobe
    • Not recommended for patient’s who are coagulopathic ( transjugular random liver biopsy is recommended)
    • Pathology results usually back within one week
    • We do not discuss pathology results with patient
  • Liver mass biopsy
    • Will obtain samples as requested by cytopathology (present during procedure to assess samples)
  • Transjugular liver biopsy
    • For patients with massive ascites, coagulopathy, obesity
    • Hepatic pressures and right atrial pressures can be obtained during the procedure

    NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR biopsy
  • Specify "random liver biopsy", "liver mass biopsy", or "transjugular liver biopsy" in comments sectionin comments section
  • Post Biopsy Monitoring

  • Must be monitored for at least 4 hours post procedure for hemorrhage or pneumothorax
  • If signs of tachycardia, hypotension, drop in Hct, call IR (patient may need embolization)
  • The IRad App

    Kidney Biopsy

    General Info

  • Random renal biopsy
    • Obtain samples from right or left kidney (or transplant kidney)
    • Blood pressure control important pre and post procedure
    • Pathology results usually back within one week
    • We do not discuss pathology results with patient
  • Renal mass biopsy
    • Will obtain samples as requested by cytopathology (present during procedure to assess samples)
    • Blood pressure control important pre and post procedure

    NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Withhold 5 days
  • Lovenox (therapeutic dose): Withhold two doses or 24 hours before procedure
  • Heparin (unfractionated): Witthold 2-4 hours before procedure
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Short acting NSAIDS (Advil, Motrin, Diclofenac, Ketoprofen, Indomethacin): Withhold 24 hours before procedure
  • Intermediate acting NSAIDS (Naproxen, Sulindac, Diflunisal, Celecoxib): Withhold 2-3 days before procedure
  • Long acting NSAIDS (Meloxicam, Nabumetone, Piroxicam): Witthold 10 days before procedure
  • Epic Order

  • Epic order = IR biopsy
  • Specify "random renal biopsy" or "renal mass biopsy" in comments section
  • If renal mass biopsy, specify right or left
  • Post Biopsy Monitoring

  • Must be monitored for at least 6 hours post procedure for hemorrhage or pneumothorax
  • If signs of tachycardia, hypotension, drop in Hct, call IR (patient may need embolization)
  • The IRad App

    Lung Biopsy/FNA

    General Info

  • Plan to biopsy lung masses however occasionally will FNA only
  • Patient’s with emphysema have increased risk of pneumothorax development
  • If outpatient, patient need to be prepared to stay in hospital overnight due to risk of pnemothorax
  • If post biopsy pneumothorax, will place a chest tube and patient will spend at least one night in the hospital
  • Will obtain samples as requested by cytopathology (present during procedure to assess samples)
  • Pathology results usually back within one week
  • We do not discuss pathology results with patient
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR biopsy
  • Specify "lung mass biopsy" in comments section
  • Specify right or left
  • Post Biopsy Monitoring

  • Must be monitored for at least 4 hours post procedure for hemorrhage/massive hemoptysis or pneumothorax
  • If signs of tachycardia, hypotension, drop in Hct, call IR (patient may need embolization)
  • Will obtain post biopsy chest xray to assess for pneumothorax
  • If post biopsy pneumothorax requiring chest tube placement, will place chest tube and patient will get admitted at least overnight
  • The IRad App

    Pancreatic Mass FNA

    General Info

  • Often use transgastric approach for pancreatic head mass FNA
  • Will obtain samples as requested by cytopathology (present during procedure to assess samples)
  • Pathology results usually back within one week
  • We do not discuss pathology results with patient
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR biopsy
  • Specify "pancreatic mass FNA" in comments section
  • Post Biopsy Monitoring

  • Must be monitored for at least 4 hours post procedure for hemorrhage or pneumothorax
  • If signs of tachycardia, hypotension, drop in Hct, call IR (patient may need embolization)
  • The IRad App

    Bone/soft tissue/muscle biopsy

    General Info

  • Specify if sample sent for cytopathology and then will obtain samples as requested by cytopathology
  • Specify if sample sent for cultures and have ordered in Epic prior to procedure
  • Pathology results usually back within one week
  • We do not discuss pathology results with patient
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR biopsy
  • Specify "bone biopsy", "soft tissue mass biopsy", or "muscle biopsy" in comments section
  • Specify right or left (if applicable)
  • If vertebral body, must specify exact level (ex. L4)
  • Specify if sample sent for cytopathology and then will obtain samples as requested by cytopathology
  • Specify if sample sent for cultures and have ordered in Epic prior to procedure
  • Post Biopsy Monitoring

  • Must be monitored for at least 2 hours post procedure
  • The IRad App

    Other Biopsies

    General Info

  • Adrenal mass biopsy (Usually do not biopsy pheochromocytoma)
  • Mediastinal mass biopsy
  • Pelvic mass biopsy
  • Lymph node biopsy
  • Head and neck biopsies (parotid mass, cervical lymph node)
  • Nerve blocks (celiac axis nerve block or suprascapular nerve block performed under CT guidance)
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR biopsy
  • Specify "pelvic mass biopsy" in comments section
  • Specify exact intra-pelvic organ to be biopsied
  • Specify right or left (if applicable)
  • Post Biopsy Monitoring

  • Must be monitored for at least 4 hours post procedure for hemorrhage
  • If signs of tachycardia, hypotension, drop in Hct, call IR (patient may need embolization)
  • The IRad App

    Cryoablation/RFA

    The IRad App

    Renal mass cryoablation or RFA

    General info

  • Usually for patients with small tumor, high surgical risk, multiple recurrent tumors, borderline kidney function, or only one kidney
  • Patient usually seen in IR clinic prior to and following procedure
  • NPO status

  • General anethesia
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Withhold 5 days
  • Lovenox (therapeutic dose): Withhold two doses or 24 hours before procedure
  • Heparin (unfractionated): Witthold 2-4 hours before procedure
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Short acting NSAIDS (Advil, Motrin, Diclofenac, Ketoprofen, Indomethacin): Withhold 24 hours before procedure
  • Intermediate acting NSAIDS (Naproxen, Sulindac, Diflunisal, Celecoxib): Withhold 2-3 days before procedure
  • Long acting NSAIDS (Meloxicam, Nabumetone, Piroxicam): Witthold 10 days before procedure
  • Epic Order

  • Epic order = IR cryoablation
  • Specify "renal mass cryoablation" or "renal mass RFA" in comments section
  • Specify right or left
  • Post Biopsy Monitoring

  • Patient usually monitored overnight (23 hour obs)
  • The IRad App

    Liver mass RFA

    General Info

  • RFA = radiofequency ablation
  • For hepatocellular carcinoma and mets
  • Patient usually seen in IR clinic prior to and following procedure
  • NPO status

  • General anethesia
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Withhold 5 days
  • Lovenox (therapeutic dose): Withhold two doses or 24 hours before procedure
  • Heparin (unfractionated): Witthold 2-4 hours before procedure
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Short acting NSAIDS (Advil, Motrin, Diclofenac, Ketoprofen, Indomethacin): Withhold 24 hours before procedure
  • Intermediate acting NSAIDS (Naproxen, Sulindac, Diflunisal, Celecoxib): Withhold 2-3 days before procedure
  • Long acting NSAIDS (Meloxicam, Nabumetone, Piroxicam): Witthold 10 days before procedure
  • Epic Order

  • Epic order = IR radiofrequency ablation
  • Specify "liver mass RFA" in comments section
  • Post Biopsy Monitoring

  • Patient usually monitored overnight (23 hour obs)
  • The IRad App

    Lung mass RFA or cryoablation

    General Info

  • RFA = radiofequency ablation
  • For inoperabable tumors, status post pneumonectomy, poor surgical candidate
  • Patient usually seen in IR clinic prior to and following procedure
  • NPO status

  • General anethesia
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Withhold 5 days
  • Lovenox (therapeutic dose): Withhold two doses or 24 hours before procedure
  • Heparin (unfractionated): Witthold 2-4 hours before procedure
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Short acting NSAIDS (Advil, Motrin, Diclofenac, Ketoprofen, Indomethacin): Withhold 24 hours before procedure
  • Intermediate acting NSAIDS (Naproxen, Sulindac, Diflunisal, Celecoxib): Withhold 2-3 days before procedure
  • Long acting NSAIDS (Meloxicam, Nabumetone, Piroxicam): Witthold 10 days before procedure
  • Epic Order

  • Epic order = IR radiofrequency ablation
  • Specify "lung mass RFA" in comments section
  • Specify right or left
  • Post Biopsy Monitoring

  • Patient usually monitored overnight (23 hour obs)
  • The IRad App

    Bone cryoablation

    General Info

  • RFA = radiofequency ablation
  • For primary bone tumors (like osteoid osteoma) and painful bone mets
  • Can perform cementoplasty to fill bone lesion immediately after RFA
  • Patient usually seen in IR clinic prior to and following procedure
  • NPO status

  • General anethesia
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Withhold 5 days
  • Lovenox (therapeutic dose): Withhold two doses or 24 hours before procedure
  • Heparin (unfractionated): Witthold 2-4 hours before procedure
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Short acting NSAIDS (Advil, Motrin, Diclofenac, Ketoprofen, Indomethacin): Withhold 24 hours before procedure
  • Intermediate acting NSAIDS (Naproxen, Sulindac, Diflunisal, Celecoxib): Withhold 2-3 days before procedure
  • Long acting NSAIDS (Meloxicam, Nabumetone, Piroxicam): Witthold 10 days before procedure
  • Epic Order

  • Epic order = IR radiofrequency ablation
  • Must specify "bone RFA" in comments section
  • If vertebral body, must specify level (ex. L4)
  • Must specify right or left (if applicable)
  • Post Biopsy Monitoring

  • Patient usually monitored overnight (23 hour obs)
  • The IRad App

    Intercostal nerve cryoablation

    General Info

  • For neuralgia
  • Patient usually seen in IR clinic prior to and following procedure
  • NPO status

  • General anethesia
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR cryoablation
  • Specify "intercostal nerve cryoablation" in comments section
  • Specify right or left (if applicable)
  • Specify level (example, T8-9)
  • Post Biopsy Monitoring

  • Patient usually monitored overnight (23 hour obs)
  • The IRad App

    Joint Injection/Aspiration

    The IRad App

    Joint Aspiration

    General Info

  • Joints routinely aspirated: Hip, Shoulder, Knee, Elbow, Foot, Wrist, Ankle
  • NPO status

  • Usually not needed
  • Local anesthesia with lidocaine
  • If patient desires sedation, then NPO 6 hours prior to procedure
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤2 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 3-5 days before procedure for INR ≤2
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Do not withhold
  • Plavix (Clopidogrel): Withhold 0-5 days before procedure
  • Ticlid (Ticlopidine): Withhold 0-5 days before procedure
  • ReoPro (Abciximab): Withhold 12-24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold immediately before procedure
  • Aggrastat (Tirofiban): Withhold immediately before procedure
  • Argatroban: Do not withhold
  • Angiomax (Bivalirudin): Do not withhold
  • Pradaxa (Dabigatran): Do not withhold
  • NSAIDS: Do not withhold
  • Epic Order

  • Specify joint to be aspirated in comments section
  • Specify right, left, or bilateral
  • Fluid studies must be ordered at the time epic order placed
  • Fluid is not saved in IR and is taken immediately following procedure to lab
  • The IRad App

    Joint Injection

    General Info

  • Can inject joint with steroids
  • Can inject joint with contrast for MRI or CT arthrogram
  • Joints routinely injected: Hip, Knee, SI joint, Shoulder, Elbow, Foot, Wrist, Ankle, Iliopsoas bursa
  • NPO status

  • Usually not needed unless SI joint injection
  • For SI joint injection, NPO 6 hours prior to procedure
  • Local anesthesia with lidocaine
  • If patient desires sedation, then NPO 6 hours prior to procedure
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤2 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 3-5 days before procedure for INR ≤2
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Do not withhold
  • Plavix (Clopidogrel): Withhold 0-5 days before procedure
  • Ticlid (Ticlopidine): Withhold 0-5 days before procedure
  • ReoPro (Abciximab): Withhold 12-24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold immediately before procedure
  • Aggrastat (Tirofiban): Withhold immediately before procedure
  • Argatroban: Do not withhold
  • Angiomax (Bivalirudin): Do not withhold
  • Pradaxa (Dabigatran): Do not withhold
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR joint injection
  • Specify joint to be injected in comments section
  • Specify right, left, or bilateral
  • If ordering MRI or CT arthogram, must have the MRI or CT order in Epic AND arthrogram order
  • Epic order = IR joint aspiration
  • The IRad App

    Epidural Steroid Injection

    NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR epidural steroid inj
  • The IRad App

    Facet Joint Injection

    General Info

  • Lumbar or sacral epidural steroid injection
  • NPO status

  • NPO 6 hours prior to procedure
  • Conscious sedation used
  • Platelets

  • ≥50,000 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • INR

  • ≤1.5 preferred (or at staff discretion)
  • Drawn within 30 days prior to the procedure
  • Anticoagulation

  • Coumadin (Warfarin): Withhold 5 days before procedure for INR ≤1.5
  • Aspirin: Do not withhold
  • Lovenox (therapeutic dose): Withhold one dose or 12 hours before procedure
  • Heparin (unfractionated): No consensus
  • Arixtra (Fondaparinux): Withhold for 2-3 days if CrCl ≥50 mL/min or withhold for 3-5 days if CrCl ≤50 mL/min
  • Plavix (Clopidogrel): Withhold 5 days before procedure
  • Ticlid (Ticlopidine): Withhold 7 days before procedure
  • ReoPro (Abciximab): Withhold 24 hours before procedure for aPTT≤50 seconds
  • Integrillin (Eptifibatide): Withhold 4 hours before procedure
  • Aggrastat (Tirofiban): Withhold 4 hours before procedure
  • Argatroban: Defer procedure until off medication or if emergent, withhold for 4 hours before procedure
  • Angiomax (Bivalirudin): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • Pradaxa (Dabigatran): Defer procedure until off medication or if emergent and CrCl ≥50 mL/min, withhold for 2-3 hours or CrCl ≤50 mL/min, withhold for 3-4 hours
  • NSAIDS: Do not withhold
  • Epic Order

  • Epic order = IR facet injection procedure
  • Must specify facet joint level to be injected in comments section (ex. right L4-5)
  • Must specify right, left, or bilateral
  • The IRad App

    Directions to IR

    From the medicine lounge:

    Take the elevators located closest to the lounge down to the basement

    Turn right and go down hall past cytopathology

    Go past the post office, then turn right

    Turn left at the large pipes on the wall

    Continue down this hall past the sign that says interventional radiology (which will lead you into the patient waiting room

    Go through the double door on the right (this leads to patient holding area)

    Go through double doors in patient holding area to enter interventional suite

    The IRad App