B-19: IVC Filter Placement

• Indications
  • Pulmonary embolism with contraindications to anticoagulation
  • Pulmonary embolism while adequately anticoagulated
  • Deep venous thrombosis with nonadherent thrombus
  • Prophylactic for orthopedic, pelvic, or spinal trauma, or septic thrombophlebitis
  • Venous thrombosis with minimal pulmonary reserve
• Contraindications
  • Contrast allergy (premedicate or use CO₂)
• Patient Evaluation
  • Ability to cooperate during procedure
  • High probability V/Q scan or positive pulmonary angiogram
  • Contrast or Doppler venogram to assess femoral veins
• Preprocedure Orders
  • Routine
  • Anticoagulation need not be interrupted for procedure
• Tools
  • Micropuncture access set
  • .038 guide wire, 6 Fr. pigtail
  • Vascular dilators sizes 8, 10 and 12 Fr.
  • IVC Filter and delivery system appropriate to entry site used
• Entry site
  • Right common femoral vein
  • Right internal or external jugular vein
  • Left common femoral vein
  • Basilic vein (Simon-Nitinol filter only)
• Technique
  • Micropuncture access into venous system. Pigtail catheter to distal IVC. IVC-gram to localize renal veins, rule out caval thrombosis, and measure cava at filter placement site. Dilate entry site and introduce filter delivery sheath. Introduce and implant filter. Implantation technique varies with filter type. Repeat IVC-gram to evaluate placement.
• Post-procedure Note
  • Record filter type and insertion location (infrarenal, suprarenal)
• Post-procedure Orders
  • Femoral Vein Approach
    1. Resume previous medication and diet orders.
    2. Check and record vital signs (BP, HR, Respiratory Rate), _____groin puncture site for bleeding, hematoma, and check distal pulses (dorsalis pedis and posterior tibial)
       • q 15 min x 2, then
       • q 30 min x 4, then
       • q 1 hour x 4, then
       • q 4 hours if stable.
    3. Bed rest x 24 hr. keeping ____hip and leg straight (no flexion of hip) x 8 hr.. May turn slightly (less than 30·) to side of puncture after 2 hr. Log-roll with assistance. May elevate HOB 30· after 6 hr.
    4. Notify H/O if any changes occur
  • Jugular Vein Approach
    1. Bed rest x 24hr.with HOB elevated 60·
    2. Check VS (HR, BP, RR), check right IJ or EJ puncture for bleeding or hematoma
       • q 15 min x 2, then
       • q 30 min x 4, then
       • q 1 hour x 4, then
       • q 4 hours if stable
    3. If bleeding or hematoma at puncture site occurs, elevate hob to 90 degrees, apply light manual compression, and call H/O
    4. Resume other previous orders and medications.
    5. H/O to review and cosign these orders

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