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VASCULAR SYSTEM
The vascular system, also called the circulatory system , is made up of the vessels that carry blood and lymph through the body. The arteries and veins carry blood throughout the body, delivering oxygen and nutrients to the body tissues and taking away tissue waste matter. The Circulatory system has two complex systems of intimately associated vessels. Through these vessels, fluid is transported throughout the body in a continuous unidirectional flow. The Major portion of the circulatory system transport blood and is called blood-vascular system The Minor portion called the lymphatic system, collects fluid from the tissue spaces. ANGIOGRAPHY Is a diagnostic procedure that uses imaging to show your provider how your blood flows through your blood vessels. An injected contrast material makes it easy to see where blood is moving and where blockages are. Your provider can use X-rays or other types of imaging for your angiogram. Test allows your healthcare provider to see how blood circulates in blood vessels at specific locations in your body. Providers use an angiogram of your heart, neck, kidneys, legs or other areas to locate the source of an artery or vein issue. ANATOMY AND PHYSIOLOGY : 3 Main types of blood vessels:
- Arteries – carry blood away from your heart
- Veins – carry blood back toward your heart
- Capillaries – the smallest blood vessels connect arteries and veins PATHOLOGY: Atherosclerosis A buildup of plaque, which is a deposit of fatty substances, cholesterol, cellular waste products, calcium, and fibrin in the inner lining of an artery. Is the most common cause of vascular disease. Blood clot A blood vessel may be blocked by an embolus (a tiny mass of debris that moves through the bloodstream) or a thrombus (a blood clot). Coronary artery disease. Heart attack, angina (chest pain) Cerebrovascular disease. Stroke, transient ischemic attack (a sudden or temporary loss of blood flow to an area of the brain, usually lasting less than 5 minutes but not longer than 24 hours, with complete recovery) Peripheral arterial disease. Claudication (limping because of pain in the thigh, calf, and/or buttocks that occurs when walking), critical limb ischemia (lack of oxygen to the limb/leg at rest) Vascular disease of the great vessels. Aortic aneurysm (a bulging, weakened area in the wall of a blood vessel resulting in an abnormal widening or ballooning) Peripheral venous disease
Deep vein thrombosis (also called DVT; a blood clot in a deep vein located within the muscles of the leg), varicose veins Lymphatic vascular diseases Lymphedema (swelling caused by interruption of the normal drainage pattern in the lymph nodes) Genitourinary vascular diseases Vascular erectile dysfunction PREPARATIONS: In some cases, angiograms are performed on an emergency basis. More commonly, though, they're scheduled in advance, giving you time to prepare. Angiograms are performed in the catheterization (cath) lab of a hospital. Your health care team will give you specific instructions and talk to you about any medications you take. General guidelines include: Don't eat or drink anything after midnight before your angiogram. Take all your medications to the hospital with you in their original bottles. Ask your doctor about whether to take your usual morning medications. If you have diabetes, ask your doctor if you should take insulin or other oral medications before your angiogram. Before the procedure Before your angiogram procedure starts, your health care team will review your medical history, including allergies and medications you take. The team may perform a physical exam and check your vital signs — blood pressure and pulse. You'll also empty your bladder and change into a hospital gown. You may have to remove contact lenses, eyeglasses, jewelry and hairpins After the procedure When the angiogram is over, the catheter is removed from your arm or groin and the incision is closed with manual pressure, a clamp or a small plug You'll be taken to a recovery area for observation and monitoring. When your condition is stable, you return to your own room, where you're monitored regularly. You'll need to lie flat for several hours to avoid bleeding if the catheter was inserted in the groin. During this time, pressure may be applied to the incision to prevent bleeding and promote healing. You may be able to go home the same day, or you may have to remain in the hospital overnight. Drink plenty of fluids to help flush the dye from your body. If you're feeling up to it, have something to eat. Ask your health care team when to resume taking medications, bathing or showering, working, and doing other normal activities. Avoid strenuous activities and heavy lifting for several days. Your puncture site is likely to remain tender for a while. It may be slightly bruised and have a small bump. Call your doctor's if :
- You notice bleeding, new bruising or swelling at the catheter site
- You develop increasing pain or discomfort at the catheter site
- You have signs of infection, such as redness, drainage or a fever
- There's a change in temperature or color of the leg or arm that was used for the procedure
- Weakness or numbness in the leg or arm where the catheter was inserted You develop chest pain or shortness of breath
- If the catheter site is actively bleeding and doesn't stop after you've applied pressure to the site, contact 911 or emergency medical services. If the catheter site suddenly begins to swell, contact 911 or emergency medical services. MATERIALS: ANGIOGRAPHY KIT o Angiography Drape
Position patient supine Part Position Center midsagittal plane to grid Maintain shoulders in same transverse plane Support under knees Center IR at level of iliac crest and ensure that pubic symphysis is included Apply gonad shielding as appropriate Respiration Suspended Central Ray Perpendicular to IR midline at level of iliac crests. Is usually performed with the patient in the supine position for simultaneous frontal and lateral imaging. An aortogram may also be used to evaluate an abdominal aneurysm. Refers to a minimally invasive x-ray examination of the body's main artery, the aorta. It is used to diagnose diseases of the aorta, such as an aortic aneurysm. HAND PA Patient position Seat patient at end of radiographic table Part Position Rest forearm on table with palmar surface of hand against IR Spread digits slightly Shield gonads Central Ray Perpendicular to third MCP (Metacarpophalangeal) joint FEMUR AP Patient Position Position patient supine with toes up Adjust pelvis to place ASIS equidistant from table Part Position Center affected femur to midline of grid Image distal femur by placing bottom of IR 2 inches (5 cm) below knee joint Central Ray Perpendicular to midfemur and center of IR AORTOGRAPHY Is usually performed with the patient in the supine position for simultaneous frontal and lateral imaging. An aortogram may also be used to evaluate an abdominal aneurysm. Refers to a minimally invasive x-ray examination of the body's main artery, the aorta. It is used to diagnose diseases of the aorta, such as an aortic aneurysm ANATOMY AND PHYSIOLOGY : THORACIC AORTA PART Brachiocephalic Artery - is a blood vessel that branches off your aorta in your upper chest. It's the first branch of your aortic arch, which is the curved, top part of your aorta that
resembles the rounded handle of a cane. Your brachiocephalic artery helps supply blood to the upper right side of your body. Ascending Aorta - is the first part of the aorta, which is the largest blood vessel in your body. Right Coronary - supplies blood to the right ventricle, the right atrium, and the SA (sinoatrial) and AV (atrioventricular) nodes, which regulate the heart rhythm. Intercostal Arteries - are arranged in two groups, anterior and posterior. The anterior intercostal arteries are branches of the internal thoracic. The posterior intercostal arteries are branches of the superior intercostal artery. Left Common Carotid Artery - is the second and longest branch of the aortic arch. It supply blood to your brain, face and neck. Left Subclavian Artery - starts at your aortic arch. Move oxygen-rich blood from your heart to your upper body Left Coronary Artery - supplies blood to the left side of the heart muscle (the left ventricle and left atrium). Descending Thoracic Aorta - supplying your body with oxygen-rich blood. It's the main artery that carries blood through your chest and belly. ABDOMINAL AORTA PART Hepatic Artery – is soft oxygenated blood vessel that supplies oxygen-rich blood to the liver, duodenum, and pancreas. Right Renal Artery – originates from the anterolateral aspect of the aorta and runs in an inferior course behind the inferior vena cava to reach the right kidney, while the left renal artery originates slightly higher and from a more lateral aspect of the aorta, and runs almost horizontally to the left kidney Right Common Iliac Artery – is a short artery transporting blood from the aorta towards the pelvic region and lower extremity. Sometimes this paired artery is also referred to as its plural form common iliac arteries. The left and right common iliac arteries are the terminal branches of the abdominal aorta Splenic Artery – also known as the lienal artery, is an unpaired artery arising as the longest branch of the celiac trunk. This artery supplies the spleen, as well as large portions of the pancreas and stomach. Left Renal Artery – connects to the left kidney. Carries blood from the kidney and ureter to the inferior vena cava Abdominal Aorta – is the largest blood vessel in the body. This artery is responsible for transporting oxygen rich blood from your heart to the rest of your body. PATHOLOGY :
Suspended Central Ray Perpendicular to enter L3.The central ray enters the elevated side approximately 2 inches (5 cm) lateral to the palpable spinous process ABDOMEN AP (SUPINE) Patient Position Position patient supine Part Position Center midsagittal plane to grid Maintain shoulders in same transverse plane Apply gonad shielding as appropriate Respiration Suspended Central Ray Perpendicular to IR midline at level of iliac crest ANGIOCARDIOGRAPHY Refers specifically to radiologic imaging of the heart and associated structures. Coronary arteriography typically is performed at the same time to visualize the coronary arteries. Cardiac catheterization is a more general term that is used to describe placing a catheter in the heart ANATOMY AND PHYSIOLOGY: Right coronary artery (RCA): The RCA supplies blood to your right atrium and right ventricle (where deoxygenated blood goes before heading to the lungs). Its branches supply the sinoatrial (SA) and atrioventricular (AV) nodes. These nodes send electrical signals through your heart, so the heart muscles know when to contract. Branches of the RCA also deliver blood to one-third of your interventricular septum, which is the wall between your heart’s two lower chambers. Left main coronary artery (LMCA): The LMCA supplies blood to your left atrium and left ventricle. This is where oxygenated blood arrives from your lungs before your heart pumps it out to the rest of your body. Its branches supply blood to the other two-thirds of your interventricular septum. PATHOLOGY: •Coronary Artery Disease - is caused by plaque buildup in the wall of the arteries that supply blood to the heart. •Cardiac Arrhythmia - is an irregular heartbeat. Occur when the electrical signals that coordinate the heart's beats don't work properly. The faulty signaling causes the heart to beat too fast (tachycardia), too slow (bradycardia) or irregularly. Aneurysm - a bulge in a blood vessel caused by a weakness in the blood vessel wall, usually where it branches. As blood passes through the weakened blood vessel, the blood pressure causes a small area to bulge outwards like a balloon.
- Valvular disease - is when any valve in the heart has damage or is diseased.
- Cardiomyopathy - is a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body. •Pericarditis - is swelling and irritation of the thin, saclike tissue surrounding the heart. PREPARATIONS:
Before your angiogram procedure starts, your health care team will review your
medical history, including allergies and medications you take. The team may perform a physical exam and check your vital signs — blood pressure and pulse.
You'll also empty your bladder and change into a hospital gown. You may have to
remove contact lenses, eyeglasses, jewelry and hairpins.
For the procedure, you lie on your back on an X-ray table. Because the table may be
tilted during the procedure, safety straps may be fastened across your chest and legs. X-ray cameras will move over and around your head and chest to take pictures from many angles.
An IV line is inserted into a vein in your arm. You may be given a sedative through
the IV to help you relax, as well as other medications and fluids. You'll be very sleepy and may drift off to sleep during the procedure, but you'll still be able to be easily awakened to follow any instructions.
A small amount of hair may be shaved from your groin or arm where a flexible tube
(catheter) will be inserted. The area is washed and disinfected and then numbed with an injection of local anesthetic.
A small incision is made at the entry site, and a short plastic tube (sheath) is inserted
into your artery. The catheter is inserted through the sheath into your blood vessel and carefully threaded to your heart or coronary arteries.
Threading the catheter shouldn't cause pain, and you shouldn't feel it moving
through your body. Tell your health care team if you have any discomfort.
Dye (contrast material) is injected through the catheter. When this happens, you may
have a brief sensation of flushing or warmth. But again, tell your health care team if you feel pain or discomfort.
The dye is easy to see on X-ray images. As it moves through your blood vessels, your
doctor can observe its flow and identify any blockages or constricted areas. Depending on what your doctor discovers during your angiogram, you may have additional catheter procedures at the same time, such as a balloon angioplasty or a stent placement to open up a narrowed artery. Other noninvasive tests, such as ultrasound, may help your doctor evaluate identified blockages.
When the angiogram is over, the catheter is removed from your arm or groin and the
incision is closed with manual pressure, a clamp or a small plug.
You'll be taken to a recovery area for observation and monitoring. When your
condition is stable, you return to your own room, where you're monitored regularly.
During this time, pressure may be applied to the incision to prevent bleeding and
promote healing.
You may be able to go home the same day, or you may have to remain in the
hospital overnight. Drink plenty of fluids to help flush the dye from your body. If you're feeling up to it, have something to eat.
Ask your health care team when to resume taking medications, bathing or showering,
working, and doing other normal activities. Avoid strenuous activities and heavy lifting for several days.
Your puncture site is likely to remain tender for a while. It may be slightly bruised and
have a small bump. MATERIALS:
- Stent
- Guidewire
- Catheter
- Introducer sheath
PATHOLOGY:
Deep Vein Thrombosis (DVT) – a blood clot in a vein, usually the leg PREPARATIONS: BEFORE
- Your healthcare provider will explain the procedure to you. Ask them any questions you have about the procedure.
- You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if anything is not clear.
- Tell your healthcare provider if you have ever had a reaction to any contrast dye. Tell your provider if you are allergic to iodine.
- Tell your provider if you are sensitive to or are allergic to any medicines, latex, tape, or anesthetic medicines (local and general).
- Follow any directions you're given for not eating or drinking before the test.
- Tell your provider if you are pregnant or think you may be pregnant.
- Tell your provider about all medicines you are taking. This includes prescriptions, over-the-counter medicines, and herbal supplements.
- Tell your provider if you have a bleeding disorder. Also tell your provider if you are taking any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. You may need to stop taking these medicines before the test.
- Tell your provider if you have any kidney problems.
- You will need to have someone drive you home after the test if the healthcare provider gives you medicine to relax (sedative) during the test.
- Follow any other instructions your provider gives you to get ready. DURING You may have the venogram done as an outpatient or as part of your stay in a hospital. The way the test is done may vary depending on your condition and your healthcare provider's practices. Generally, a lower leg venogram follows this process blood flows.
- When the test is done, the healthcare provider will flush the IV site and remove the needle from the vein. The healthcare provider will put a pressure dressing over the puncture site.
- You will be asked to remove your jewelry or other objects that might get in the way of the test.
- You will be asked to remove clothing. You will be given a gown to wear.
- The healthcare provider may use a pen to mark places on your leg where pulses are before the test. This will make it easier for the medical team to check the pulses after the test.
- You will lie on your back on the X-ray table.
- The healthcare provider will clean an area on your foot. Then they will put an IV (intravenous) line into a vein in your foot.
- The healthcare provider will inject the contrast dye. You may feel some effects when the dye is added to the IV line. These effects include a flushing sensation, a brief headache, nausea, or vomiting. These effects usually last for a few moments. Let the healthcare provider know if you are having problems breathing, itchy skin, or hives.
- The healthcare provider will take X-rays at timed intervals as the dye moves through your legs. AFTER After the procedure, the medical team will watch your heart rate, breathing rate, and blood pressure. They will also check the pulses in your feet, as well as the temperature, color, and sensation in your legs. They will watch the injection site for redness, warmth, swelling, and tenderness. You can go back to your normal activities and diet as directed by your healthcare provider. Drink plenty of fluids to keep from getting dehydrated. This will also help the contrast dye to leave your body. Call your healthcare provider right away if you have any of these:
- Fever of 100.4°F (38.0°C) or higher or chills
- Pain, redness, or swelling at the injection site
- Bleeding or other drainage from the injection site Your healthcare provider may give you additional instructions, depending on your situation MATERIALS:
- Radiographic table
- One or two x-ray tubes
- Video monitor
- Intravenous line/Catheter
- Ultrasound machine CONTRAST MEDIA: Iodine-based contrast Low osmolar contrast medium with concentration of 300 mg/ml is used. POSITIONS AND PROJECTIONS: AP PROJECTION Image Receptor : 10 x 12 inch (24 x 30 cm) lengthwise Position of the patient: -Place the patient in the supine position -Adjust the patient’s pelvis so that it is not rotated. This is accomplished by placing the ASIS equidistant from the table -Place the patient’s arm in a comfortable position -Medially rotate the lower limb and foot approximately 15 to 20 degrees to place the femoral neck parallel with the plane of IR, unless this maneuver is contraindicated or other instructions are given. -Place a support under the knee and a sandbag across the ankle. This makes it easier for the patient to maintain this position. -Shield Gonads -Respiration; Suspend Central Ray:
Atherosclerosis that is severe enough to cause symptoms carries a high risk of stroke and can lead to brain damage and death. •Cerebral aneurysm - (also known as a brain aneurysm) is a weak or thin spot on an artery in the brain that balloons or bulges out and fills with blood. The bulging aneurysm can put pressure on the nerves or brain tissue. It may also burst or rupture, spilling blood into the surrounding tissue (called a hemorrhage). PREPARATIONS: BEFORE *Must remove all clothing and jewelry *Wear a hospital gown *A local anesthetic will be given where an incision is made prior to the placement of the catheter *the catheter will be positioned with the carotid arteries and contrast dye will be injected During the injection of the contrast dye you may have the warm feeling *A regular X - ray will be used to take pictures of the blood vessels in the brain *A technologist and Radiologist will stay with you while the procedure is being performed *You will awake during the procedure which can take from one to two hours to complete MATERIALS: *Catheter *Automatic Injector *Standard Tube Collimators *Biplane Imaging CONTRAST MEDIA: *Iodine Based Contrast Agents - to highlight the blood supply in the blood vessels tissues and organs POSITIONS AND PROJECTIONS: SIMULTANEOUS BIPLANE (OBLIQUE PROJECTION) Part Position Place the image receptor in a 35 degree RPO position Raise the patients chin to superimpose the inferior margin of the mandible on to the occiput so that as much of the neck as possible is expose in the frontal image. Move the patients shoulder inferiorly so that they are removed as possible from the lateral image ANTEROPOSTERIOR AXIAL OBLIQUE PROJECTION( TRANSORBITAL) Part Position From the position for the basic AP transorbital projection ,rotate the patients head approximately 30degrees toward the injected side. Angle the central ray 20 degrees cephalad and center it to the mid orbit of the uppermost side CARDIAC CATHERIZATION A minor surgical procedure involving the introduction of specialized catheters into the heart and surrounding vasculature for the purpose of diagnostic evaluation and therapy (intervention) associated with a variety of cardiovascular-related disorder in both children and adults. Cardiac catheterization, also known as coronary angiogram , Coronary angiography - The most definitive procedure for visualizing the coronary anatomy. The anatomic information gained from this procedure may include the presence and extent of obstructive coronary artery disease, thrombus formation, coronary artery collateral flow, coronary anomalies, aneurysms, and spasm. Coronary artery size can also be determined.
ANATOMY AND PHYSIOLOGY :
AORTA the largest artery in the body, and the blood it carries is rich with oxygen HEART the muscle that pumps blood to the rest of your body VENA CAVA the largest vein in the body, and carries oxygen poor blood back to the heart PATHOLOGY:
- Coronary artery disease is a narrowing or blockage of your coronary arteries, usually due to plaque buildup. - Cardiomyopathies is a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body. Cardiomyopathy can lead to heart failure. The main types of cardiomyopathies include dilated, hypertrophic and restrictive cardiomyopathy - Myocardial infarction happens when one or more areas of the heart muscle don't get enough oxygen. This happens when blood flow to the heart muscle is blocked. - Valvular heart disease Valvular heart disease is when any valve in the heart has damage or is diseased - Congenital heart disease are present at birth and can affect the structure of a baby's heart and the way it works. They can affect how blood flows through the heart and out to the rest of the body
- Aortic dissection is a serious condition in which a tear occurs in the inner layer of the body's main artery (aorta). Blood rushes through the tear, causing the inner and middle layers of the aorta to split (dissect) PREPARATIONS:
Your doctor will explain the procedure to you and give you a chance to ask any
questions.
You will be asked to sign a consent form that gives your permission to do the test.
Read the form carefully and ask questions if anything is unclear.
Tell your doctor if you have ever had a reaction to any contrast dye; if you are
allergic to iodine; or if you are sensitive to or are allergic to any medicines, latex, tape, and anesthetic agents (local and general)
You will need to fast (not eat or drink) for a certain period before the procedure. Your
doctor will tell you how long to fast, usually overnight
If you are pregnant or think you could be, tell your doctor.
Tell your doctor if you have any body piercings on your chest or abdomen (belly).
Tell your doctor of all medicines (prescription and over-the-counter), vitamins, herbs,
and supplements that you are taking.
You may be asked to stop certain medicines before the procedure. Your doctor will
give you detailed instructions
Your doctor may request a blood test before the procedure to see how long it takes
your blood to clot. Other blood tests may be done as well
ANATOMY AND PHYSIOLOGY :
Splenic vein - (formerly the lienal vein) is a blood vessel that drains blood from the spleen, the stomach fundus and part of the pancreas. Superior mesenteric vein - is a blood vessel that drains blood from the small intestine (jejunum and ileum). Inferior mesenteric vein - (IMV) is a blood vessel that drains blood from the large intestine Left gastric vein - (or coronary vein) is a vein carrying deoxygenated blood. It runs from right to left along the lesser curvature of the stomach, between the two layers of the lesser omentum, to the esophageal opening of the stomach, where it receives some esophageal veins. Right gastric vein - Also called as pyloric vein. It drains blood from the lesser curvature of the stomach into the hepatic portal vein. It is part of the portal circulation. Cystic vein - It accompanies the cystic duct, usually ends in the right branch of the portal vein. It is usually not present, and the blood drains via small veins in the gall-bladder bed directly to the parenchyma of the liver. Drains the blood from the gall-bladder. Paraumbilical veins - are small veins around the falciform ligament. It drain venous blood from the anterior part of the abdominal wall and diaphragm directly into the liver, and communicate with other anterior abdominal wall veins. This flow is considered the cause of focal fatty infiltration and focal fatty sparing of the liver, and when there is systemic venous obstruction, may cause hepatic pseudo lesions. PATHOLOGY: Abernethy malformation - is a very rare congenital vascular malformation defined by diversion of portal blood away from liver. It is commonly associated with multiple congenital anomalies Cavernous transformation of the portal vein - the formation of venous channels within or around a previously thrombosed portal vein. Portal hypertension - elevated pressure in your portal venous system. The portal vein is a major vein that leads to the liver. The most common cause of portal hypertension is cirrhosis (scarring) of the liver. Portal vein thrombosis - is a narrowing or blockage of the portal vein by a blood clot Portal venous gas - is the accumulation of gas in the portal vein and its branches PREPARATIONS: 1.Assess vital signs every 15 minutes × 4, then every 30 minutes × 4, then hourly × 4, and then every 4 hours until 24 hours after the procedure.
2.Observe for bleeding and swelling at the puncture site each time vital signs are taken. You can drink a total of 12 ounces of water between midnight and 2 hours before your scheduled arrival time. Do not drink anything else. Do not drink anything starting 2 hours before your scheduled arrival time. This includes water.
Before your procedure, talk with the healthcare provider who prescribes your insulin
or other medications for diabetes. They may need to change the dose of medications you take for diabetes. Ask them what you should do the morning of your procedure.
Your care team will check your blood sugar levels during your procedure.
A diuretic is a medication that makes you urinate (pee) more often.
Hydrochlorothiazide (Microzide®) and furosemide (Lasix®) are common diuretics.
If you take any diuretics, ask the healthcare provider doing your procedure what to
do. You may need to stop taking them the day of your procedure. During procedure
A staff member will bring you into the procedure room when it’s time. Your
healthcare provider will help you onto the exam table where you’ll lie on your back.
Your care team will attach you to equipment to track your pulse, breathing, and
blood pressure. You will get oxygen through a thin tube that rests below your nose, and general anesthesia.
Your healthcare provider will numb the upper right part of your abdomen. The IR
doctor will do the procedure. Then, they will remove the catheter and put a bandage over where the needle went into your skin. After procedure
When you wake up after your procedure, you’ll be in the PACU. A nurse will be keeping track of
your temperature, pulse, blood pressure, and oxygen levels. You may get oxygen through a tube resting below your nose or a mask covering your nose and mouth. You may also have compression boots on your lower legs. These gently inflate and deflate to help blood flow in your legs.
Tell your nurse if you’re feeling pain. They may give you medication for your pain.
Your care team will tell you when it’s safe to go home. You will need a responsible care partner to
go with you. MATERIALS: Flouroscopic unit with llTV system Spot film device X-ray cassette Lead apron High voltage generator Gauge pieces Iodine solution for local scrubbing Local anaesthesia for adults for general anaesthesia for paediatric practice Gloves Syringe 10ml Spinal needle Cotton wool, bandage Mask and caps surgical blade Injection of diazepam if needed
DURING Procedure
You will need to have vital signs taken like blood, pressure heart rate, and oxygen
flow
You will be given pain medication so you feel no pain, but you will be awake for the
whole procedure
The area where the doctor is working will be cleaned and shaved so that no infection
occurs.
The doctor will guide the catheter in to your artery and inject the dye
The technologist will tell you to hold your breath each picture takes about 10 second.
The X-ray that is used in this procedure is very sensitive to motion so not moving is very important. AFTER Procedure
The catheter will be removed you should lie completely still to stop any bleeding that
may occur.
You can begin to eat and an IV fluid will be given to help flush all the dye that is left
Your blood pressure and other vital signs remained monitored
Some renal angiograms take half an hour others can take longer
MATERIALS:
Flouroscopic unit with llTV system Spot film device X-ray cassette Lead apron High voltage generator Gauge pieces Iodine solution for local scrubbing Local anaesthesia for adults for general anaesthesia for paediatric practice Gloves Syringe 10ml Spinal needle Cotton wool, bandage Mask and caps surgical blade Injection of diazepam if needed CONTRAST MEDIA: Gadolinium POSITIONS AND PROJECTIONS: TRANSLUMBAR POSTEROANTERIOR (PA) Patient Position Patient prone Part Position centered to table, arms at side of body head in lateral position shin supported, slight internal rotation of legs Respiration Suspended Central Ray Vertical beam to center of film, through midsagittal plane at level of kidney hilum PERCUTANEOUS SPLENOGRAPHY
Is defined as the Radiographic demonstration of the splenoportal – intrahepatic venous circulation and its tributaries by means of the rapid transcutaneous injection of a radiopaque medium into the splenic substance. It is a radiological examination to evaluate the patency and structural defects or any pathophysiology of the spleen portal veins and liver by injecting a radiological contrast media into it. ANATOMY AND PHYSIOLOGY : Splenic hilum - transmits the splenic vessels and nerves and provides attachment to the gastrosplenic and splenorenal Splenic artery - is the blood vessel that supplies oxygenated blood to the spleen. Splenic vein – is to drain the venous blood from the spleen Periarteriolar lymphoid sheath (PALS) - a portion of the white pulp of the spleen. They are populated largely by T cells and surround central arteries within the spleen Marginal zone - is to trap particulate antigen from the circulation and present the antigen to the lymphocytes of the spleen. Primary follicle - serve as a filter for antigen and bring B cells into contact with antigen presented by FDCs in order to start a germinal center reaction Red pulp - is composed of connective tissue known also as the cords of Billroth and many splenic sinusoids that are engorged with blood, giving it a red color. Its primary function is to filter the blood of antigens, microorganisms, and defective or worn-out red blood cells PATHOLOGY: Splenomegaly - A variety of disorders can cause the spleen to enlarge, sometimes to 2kg or more. Any conditions that cause a rapid breakdown of blood cells, such as haemolytic anaemias, can place great strain on the spleen and make it enlarge. Other causes of splenomegaly include infections (such as glandular fever), liver disease and some cancers (such as Hodgkin’s disease, leukaemia and lymphoma). Hypersplenism - It seems that an enlarged spleen is sometimes overactive and will destroy more blood cells than necessary. Symptoms depend on which blood component is lacking. Splenic rupture - Certain disorders, including glandular fever, can occasionally make the enlarged spleen delicate enough to spontaneously rupture. A sudden blow to the abdomen can split the outer capsule of the spleen and cause bleeding into the abdominal cavity. There are various degrees of splenic rupture. When bleeding is life threatening, surgery to remove the spleen (splenectomy) is needed. PREPARATIONS:
Patient should be nil by mouth at least 8 to 10 hours prior to the examination
Fluid intakes should not be restricted the infants and diabetic patient
An Iodine sensitivity test also can be performed.
A preliminary radiograph can be performed with placing a marker close to the spleen.
Puncture site should be cleared carefully with Iodine solution scrubbing
