B-07: Angioplasty, Venous

• Indications
  • Symptomatic venous stenosis or for clot maceration during venous lytic therapy
• Contraindications
  • Contrast allergy (premedicate)
  • Fresh thrombus (requires preliminary lytic therapy)
• Patient Evaluation
  • Ability to lie still, hold breath, and cooperate during procedure
• Preprocedure Orders
  • Routine
• Tools
  • Micropuncture entry set
  • Vascular sheath appropriate to balloon size
  • Angioplasty balloon - usually 8-10mm high pressure
  • Bentson, Glide, Rosen, 5Fr. diagnostic catheter
  • Heparin
• Entry site
  • Jugular, basilic, femoral or combined
• Technique
  • Cross lesion with Bentson or Glide and diagnostic catheter. Give heparin if patient not already receiving anticoagulation. Exchange for Rosen. Position balloon over Rosen and dilate. Check results by injecting through sheath
• Post-procedure Note
  • Note angioplasty results, residual stenosis or thrombus, and collaterals
  • Note pressure measurements if obtained
• Post-procedure Orders
  • Additional orders following venous angioplasty
    1. Heparin 500-1000 U/hr. IV
    2. Begin coumadin per H/O - titrate dose for PT=16-18 sec. Continue x 6 months

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