Interventional Radiology - Pre-Procedure Patient Preparation Guide for Adult Patients Undergoing Elective Procedures

• Instructions for all patients
• How to use the table
• Arterial procedures
• Neurovascular procedures
• Venous procedures
• Non-vascular intervention
• Nil by Mouth policy. Think Drink
• Prehydration regimens
• Management of coagulopathy and anticoagulation

THE REFERRING TEAM MUST REQUEST THE PROCEDURE ON ICE

All Patients

• Hospital gown prior to coming down to radiology theatres.
• Consent
  • If the patient has signed a consent form for the procedure it must accompany them
  • Otherwise they will be consented by an interventional radiologist on arrival in radiology theatres
  • Form 4 consent MUST be completed on the ward by the clinical team. The interventional radiologist will counter-sign, as the second signatory on Form 4. Please liaise with radiology theatres if you need assistance
• All notes (including buff folders), drug chart and observation charts must accompany the patient to radiology theatres
• There is no need to stop aspirin or clopidogrel unless specifically stated in the guidance
• Jewellery which can be removed should be left on the ward
• Hearing aids and false teeth should be removed for GA cases. They should remain in place for all other cases
• Spectacles should not be removed
• Source isolated patients MUST be discussed with radiology theatres prior to leaving ward
• Continue routine medication unless instructed otherwise (see table for anticoagulation and antiplatelet medications)

Contact us if

• The patient may require sedation. This must be discussed with an interventional radiologist before making the patient nil by mouth
• The patient is attending for a procedure not covered in this guide
• There is a prior history (or family history) of bleeding disorder
• There is a history of bleeding following a procedure which required transfusion or intervention to manage it
• If you have any queries or are unsure about any aspect of the patient’s workup

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How to use the table

Click on images below to enlarge

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Nil by Mouth policy. Think Drink

Patients can eat and drink freely up to 6 hours before the procedure
Between 6 hours and 2 hours of the procedure adult patients can drink up to 250ml clear, still, unflavoured water
Patients should be nil by mouth from 2 hours before the procedure

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Prehydration regimens

Note that routine prehydration is required for some procedures (see "Additional requirements" column)
All patients to be encouraged to drink oral clear fluids unless otherwise specified
Nephrotoxic drugs should be stopped WHERE POSSIBLE.

If prehydration is necessary then choose one of the following:
EITHER
Glucose 4% / sodium chloride 0.18% ("dextrose saline") 2 litres in 24 hours (for 12hrs pre-procedure, 12 hours post-procedure)
OR
Sodium chloride 0.9% ("normal saline") 1 litre in 12 hours (for 4 hours pre-procedure and 8 hours post-procedure)

Clinical judgement should be exercised when pre-hydrating patients in whom there is a risk of fluid overload - eg. those with cardiac or renal failure

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Management of coagulopathy and anticoagulation

Some procedures can be done on patients who are therapeutically anticoagulated. These are clearly documented in the table (by a green box). For all other procedures cessation of anticoagulation is necessary. See advice below

For patients on warfarin or iv unfractionated heparin, the level of INR or APTTR allowable for the procedure to proceed is documented in the table
Direct oral anticoagulants (DOACS: apixaban, dabigatran, edoxaban and rivaroxaban) have variable effects on coagulation screens. A patient on a DOAC may still be anticoagulated despite an INR of 1.

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