For tracking and data base purposes please add all consults to the shared "PERT Patients" roster on EPIC whether or not they meet criteria
IR Extension Numbers and plan to help expedite procedures
Direct Angio Suite Extension
Direct Angio Suite Extension
Direct Angio Suite Extension
In case IR MD is scrubbed and can't answer
Civic 13890
General 78962
Central Lines and CDT
Direct Angio Suite Extension
Direct Angio Suite Extension
Do not delay CDT to place central or arterial lines
IR has offered to place lines (by request) in order to expedite procedures
IVC Filters and CDT
Direct Angio Suite Extension
IVC Filters and CDT
Let IR know in advance if an IVC filter will be required
They can place these at the end of catheter directed therapies
Catheter directed thrombolysis
These procedures take under an hour on average
Consists of a PA catheter through a 5F or 6F introducer
Total of 20mg intracatheter Alteplase over 15 hours will be given. (1mg/catheter/hr over 5 hours followed by 0.5mg/catheter/hr for 10 hours
This plan will require reconsideration if the patient does not improve or deteriorates
Patients may become unstable during the procedure and require a change in plan (systemic thrombolysis) and/or intervention (intubation, Inotropes/Pressors)
These patients may need to be accompanied to the angio suite and/or have experienced hands readily available to intervene
anticoagulation PRe and Post catheter directed thrombolysis
Anticoagulation before CDT
Anticoagulation before CDT
Anticoagulation before CDT
Unless anticoagulation is contraindicated, do not hold anticoagulation for any catheter directed therapies.
All procedures can be performed while fully anticoagulated
Anticoagulation after CDT
Anticoagulation before CDT
Anticoagulation before CDT
Don't forget to re-start full dose unfractionated heparin after CDT
Remember CDT will deliver 0.5mg, or as much as only 1mg of Ateplase per catheter, per hour
The patient must still be systemically anticoagulated unless contraindicated
We choose unfractionated heparin during catheter directed infusions due to is reversibility if bleeding occurs
You can resume LMWH 2 hours after catheters are removed if no bleeding at the access sites
LMWH can be started at the same time the unfractionated heparin infusion is turned off
PA Catheter and Introducer removal post CDT
Once the alteplase infusion is complete, the venous catheters can simply be removed first by removing the PA catheter followed by the introducer
Introducer is 5F or 6F in size
Do not interrupt anticoagulation for catheter removal
Hold pressure for 15-20 minutes per side
IR is also willing to come to remove the catheters at the ICU MD's discretion
Transition to LMWH as above (see "Anticoagulation after CDT")
Aspiration embolectomies
Catheters are 12 F in size
No catheter will be left in situ
These procedures take longer (1.5-2+ hours)
Patients may become unstable during the procedure and require a change in plan (CDT, or systemic thrombolysis) and/or intervention (intubation, Inotropes/Pressors)
These patients may need to be accompanied to the angio suite and/or have experienced hands readily available to intervene
If patients are becoming unstable while awaiting procedures
Intermediate High-Risk (submassive) PEs can become High-RIsk (massive) PEs and require systemic thrombolysis
It is important to establish whether or not there will be delays for IR procedures (ie if IR is tied up with another case, or if they anticipate the case will be lengthy.
Remember that there are other options for variable dosing of systemic therapy if you don't think the patient will be stable enough to wait for a procedure