Consults for Radiology Procedures

Radiology Procedures are performed by 3 separate consult services depending on the procedure requested

These pagers are covered 24/7, often by the same person for up to a week at a time (home call, not night float), so kindly reserve overnight pages for true urgent/emergent indications and save non-emergent communications until the morning.

 

Consult Service

Vascular IR

CT/US Procedures

Fluoro/Neuro/MSK fluoroscopy
EPIC Order “Inpt Consult to Interventional Radiology” “Inpt Consult for Adult Image-Guided Procedures (CT/US)” Call 20878 (Fluoroscopy) for scheduling & orders
Contact # (weekdays) #20840 (MD desk) #20120 (MD desk) #20878 (Fluoro techs)
Contact # (nights & weekends) Pager only Pager only #37185 (ER reading room)
Service Pager 835-5105 835-0770 N/A
Procedure Requested

Active bleeding à Embolizations

Cholecystostomy

PTC (biliary drains)

Nephrostomy

Tunneled lines

Dialysis interventions

G-tube placement

IVC Filter

Drain repositioning

Abscess drainage

Biopsies

Paracentesis**

Thoracentesis**

Dobhoff tube placements**

Lumbar punctures**

Joint injections / aspirations

Esophograms

Upper GI Series

Small bowel follow-through

Contrast enemas

**Requires failed bedside/Inpt medicine procedures service attempt

Specific procedural questions

  • Pre-Procedure (contact consult services for case-specific requirements, guidelines below):
    • NPO @ MN prior to procedure if sedation is to be used (majority of cases). Local only cases do not require pt to be NPO (see IR or CT/US procedures consult note for details).
    • Labs required within 1 month of procedure or sooner if there is a clinical situation that can affect those lab values. Think Warfarin and INR, for example:
      • INR <1.5 for most procedures
      • Platelets >50K
  • Anticoagulation
    • Google “SIR anticoagulation guidelines 2019”
    • VUMC IR guidelines based on SIR 2019 guidelines are included at end of section 

Inpt biopsies for malignancy: Inpt biopsies are lowest priority on the CT/US procedures service given resource availability and will more than likely get bumped. We recommend that these get scheduled outpt.

  • Place an outpt consult to image guided procedures at time of discharge/through discharge tab in EPIC to facilitate outpt biopsies

Drain management

  • Best to discuss directly with service that placed the drain (IR vs. CT/US vs. surgery)
  • Flush with 10 mL sterile saline q shift while inpt (flush into drain towards the pt and then place back to gravity or accordion suction bag)
  • If drain output decreases, either:
    • The collection (e.g. abscess) has been drained
    • The drain is clogged, malfunctioning, or mispositioned
      • Start with making sure there are no kinks in the drain, the 3 way is not clogged, and that the accordion drain is functioning
      • Next, ensure the drain flushes appropriately. What this means is: you can flush the drain with 10 ml of saline and when you place back to gravity/accordion drainage bag you get back what you flushed in. There should be no leakage around the drain at the skin at baseline or during flushing
    • If the drain is functioning, and there is still no output, obtain a CT w/ IV contrast to evaluate the collection and ongoing need for drainage.
    • If the collection remains, and drain is appropriately positioned within the drain, it is likely clogged/malfunctioning. First ensure proper suction/3-way direction. If this is not the issue, you can consider instilling tPA into the catheter for 2 hours
      • Would avoid in the setting of therapeutic anticoagulation given increased risk of bleeding unless discussed with procedural service.
      • Epic order: Alteplase (TPA) injection/infusion options → percutaneous drainage → 2mg or 4mg
    • If this doesn’t improve output in 48 hours, consider repositioning drain (VIR consult)
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