Appendix A: Routine Evaluation, Consultation, Notes and Orders

Consultation | Pre-op Note | Pre-op Orders | Pre-medications | Post-op Note | Post-op Orders

• Pre-Procedure Consultation and Patient Evaluation
  1. Review chart
  2. Pertinent history from patient / chart
  3. Physical exam - focused exam based on planned procedure
     • Mark distal pulses for arterial procedures
     • Check for ascites in biliary or abdominal biopsy cases
     • Complicating patient factors (contractures, scoliosis, weight, etc.)
  4. Explain procedure and possible additional interventions
     • PVD: Angioplasty, stenting, and/or thrombolysis
     • Renovascular disease: Angioplasty, stenting
     • Hemorrhage, tumor, vascular malformation: Embolization or infu-sion therapy
     • DVT: Lytic therapy, angioplasty, stenting
     • CVC: Retrieval, repositioning, lytic therapy, angioplasty, stenting
     • Pulmonary: IVC filter placement or lytic therapy
  5. Obtain signed consent for diagnostic procedure and possible inter-ventions
  6. Place note, orders and consent in patient's chart

N.B. Patients often ask what time they are scheduled for their proce-dure. Do not commit to a specific time unless the patient is specifically scheduled as the first case. Patients must be made aware that the schedule can change for a variety of reasons, and that many of our cases are emergencies. Remember that patients may become very upset if their procedure is not done "on time".

Consultation | Pre-op Note | Pre-op Orders | Pre-medications | Post-op Note | Post-op Orders

• Pre-Procedure Consultation Note
  General format - modify as appropriate for specific procedure
  1. Interventional Radiology: Date/Time
  2. Brief history and indications for procedure
  3. Previous diagnostic procedures (arteriograms, CT, etc.)
  4. Previous related procedures
  5. Past Medical History (HTN, DM, myeloma or other malignancy, cardiac disease, stroke, bleeding problems, glaucoma, prostate or voiding problems)
  6. Risk factors for cardiovascular disease (tobacco, lipid disorders)
  7. Infectious diseases (hepatitis, HIV, TB)
  8. Allergies (include previous contrast reactions - describe)
  9. Medications - list w/ dosages
  10. Social History (include tobacco and ETOH)
  11. Physical Examination (Include BP and peripheral pulses, evaluate potential puncture sites for accessibility, wounds, scars, signs of infection)
  12. Labs (PT, PTT, INR, PLTS, HCT, BUN, CR)
  13. EKG - Radiology - Vascular Lab
  14. Plan: Describe anticipated procedure(s) to be performed
  15. Consent: Note that procedure and alternatives were explained and patient (or family) understands and gives written informed consent

Consultation | Pre-op Note | Pre-op Orders | Pre-medications | Post-op Note | Post-op Orders

• Pre-Procedure Orders
  General guideline - modify as appropriate for specific procedure
  1. Patient for (name procedure) on (date)
  2. Clear liquids p midnight
  3. Continue routine meds
     • Hold antihypertensive meds if possible renal angioplasty
  4. IV or heplock tonight
  5. IVF per H/O
  6. Call H/O for DBP>110
  7. Void on call to Interventional Radiology
  8. Consent obtained and on chart
  9. H/O to review and cosign these orders

Consultation | Pre-op Note | Pre-op Orders | Pre-medications | Post-op Note | Post-op Orders

• Pre-Procedure Medications
  General guideline - modify as appropriate for specific procedure
  • Routine Premedications
    N.B. All benzodiazepines (including Ativan) are contraindicated in patients with known sensitivity to benzodiazepines or with angle closure glaucoma. Atropine is contraindicated in patients with angle closure glaucoma or bladder outlet obstruction (e.g. BPH)
    1. Ativan 1.0 mg PO HS (night before procedure)
    2. Ativan 1.0 mg PO on call to Interventional Radiology
    3. Atropine 0.4 mg IM/IV on call to Interventional Radiology
  • Heparinized Patient
    • If patient is on a heparin drip, heparin should be stopped three to four hours prior to an arterial punctures or percutaneous nonvascular intervention. This does not apply to venous studies, pulmonary angiograms, or acute arterial thrombosis where thrombolytic therapy is planned.
  • Anesthesia Cases
    • Premedication per anesthesiology
  • Pediatric Cases Not Under Anesthesia
    • Premedication per pediatrics H/O

Consultation | Pre-op Note | Pre-op Orders | Pre-medications | Post-op Note | Post-op Orders

• Post-Procedure Note
  1. Interventional Radiology: Date/Time
  2. Procedure(s) performed
  3. Radiologists performing procedure
  4. Contrast (type and amount)
  5. Medications given (include time and dosage)
  6. Fluids (I/O)
  7. Drains, catheters left in place (if applicable)
  8. Complications (state if none)
  9. Condition and disposition following procedure
  10. Preliminary Report

Consultation | Pre-op Note | Pre-op Orders | Pre-medications | Post-op Note | Post-op Orders

• Post-Procedure Orders
  • Orders following invasive procedures vary greatly with the nature and complexity of the procedure performed. Standard orders for selected procedures are given in Appendix B (Brief Procedure Descriptions) and standard pre-printed orders in current use at KUMC are reproduced in Appendix C.