Interventional Radiology

Who Are We?
How We Can Help
How Can We Work Together?

 Gail Egan Sansivero, MS, ANP
Nurse Practitioner
Community Care Physicians
Instructor of Radiology
Albany Medical College
Albany, New York

 

What is Interventional Radiology?

             Interventional radiologists are specially trained radiologists who specialize in using imaging coupled with minimally invasive technology.  We use imaging (ultrasound, x-rays, CT, MRI and other imaging modalities) to diagnose and treat many symptoms and diseases.  We typically offer services in hospitals, free standing surgical centers and ambulatory office practices. 

             You may know us because we place/manage gastrostomy, gastro-jejunostomy tubes, drains and vascular access devices.  We also treat arterial and venous disease, perform angioplasty (“balloons”) and place stents, offer local tumor therapy for benign and malignant tumors and manage many biliary and urological problems. 

Some First Steps in Establishing a Long Term Relationship with IR

  • Look for a practice willing to see you in consultation prior to treatment

  • Ask about the IR groups’ experience with vascular access and feeding tubes

  • Ask how the practice handles after hours calls from consumers

  • Help the IR staff by communicating your specific needs and preferences

  • Bring any prior imaging studies & records with you to your initial consultation appointment

  • Avoid groups with a “one size fits all” mentality

Where Do I Begin?

  • Learn about your own infusion  & nutrition needs
  • How long will I need to have a device?
  • What do I need my device need to do?
    • Infusions?
    • Transfusions?
    • Blood sampling?
    • Harvesting/Dialysis/Apheresis?
    • Contrast injection for scans?
  • How many hours per day or week will I need infusions?
  • What flow rate will I typically need?
  • Will I have more than one infusion running at a time?
  • Do I need a pump?  If so, is it portable?
  • Will I need to refrigerate my infusions?
  • Once I mix my infusions, for how long are they stable/safe to use?

 Think about your own lifestyle and preferences

  • How do you feel about an externally visible device?
  • Do you want to be able to swim?
  • If you are considering a port, will you access yourself?
  • Are there other physical activities or limitations that influence device placement or type?
  •         Consider sports, occupational and family activities

 Consider your current health situation

  • Do you have any allergies (to medicines, topical solutions or adhesives) that will influence device selection, placement or maintenance?
  • Can you manipulate small objects such as injection caps, clamps and needles?
  • Are you able to read small labels?
  • Do you have other medical devices/stomas that might influence device placement?

What are my Vascular Access Choices?

 Peripheral Devices

             Peripheral Cannula or IV
                        Short catheter for infusions that are not irritating to veins
                        May last up to 72hrs
                        Good for short term access
                        May be used immediately upon insertion

             Midline Catheters
                        Relatively short catheters (less than 12cm) placed in the arm
                        Used for infusions up to ~ 2 weeks
                        Used for infusions which are not irritating to veins
                        May be used immediately upon insertion

 Central Vascular Access Devices (Central VADs)

 What makes a device central ?

            Catheter tip resides in the superior vena cava
            Other tip locations are unusual & generally limited to use when access is limited.

 Non-tunneled, non-cuffed central VADs (Hohn catheters, TLCs, PICCs)
         Short insertion time, easy removal
            Suitable for short term infusions which require central delivery
            May be placed in emergent or problematic clinical situations

 Tunneled, cuffed catheters (Hickman®, Broviac®)
         Suitable for long term infusions, esp when infusion times are prolonged
            Easy to use once inserted
            A portion of device is always external

 Implanted ports (Port-A-Cath®, Power Port®, X-Port, Jet Port, InfusaPort)
         Ideal for long term intermittent infusions
            More invasive to place/remove
            Minimal impact on activity/lifestyle when not in use
            Requires needle “stick” to access

What are My Feeding Tube Options?

 Gastrostomy Tubes
            The tip of these tubes resides in the stomach.
            Can be used for nutrition, decompression and medication delivery
            Can be placed surgically, via scope or in IR through abdominal wall
                        Tubes placed via scope can last indefinitely
                        Tubes with balloons need routine changes ~ every 3 months

 Gastro-Jejunostomy Tubes
            A dual system tube with one portion in stomach, one in jejunum
            “G” portion usually used for meds, “J” portion used for nutrition
            Can be placed surgically or in IR through abdominal wall
                        Tubes with balloons need routine changes ~ every 3 months

 Buttons
            Available in G or G-J configurations
            Less tubing external, requires “lock and key” for access

How Do I Find an IR Practice? 

  • Ask other consumers
  • Ask Oley
  • Call your local hospital’s interventional radiology and surgery departments
  • Ask to speak to a vascular access nurse, IV Team nurse or PICC nurse at your local hospital
  • Association for Vascular Access
         www.avainfo.org
        1-877-924-2821
     
  • Society of Interventional Radiology
           www.sirweb.org
              1-800-488-7284

 

 Help!  I’m admitted to the hospital and I know more about my device than the staff!  What should I do? 

  • If you’re up to it, teach the staff about your device and your usual infusion routine
  • Ask your admitting physician to write specific orders addressing use of your device

Flush
Dressing change
Cap/extension set change
Availability for blood sampling

  • Hang a sign (we’re used to reminders!)
  • Consider continuing your own access device management if you can
  • Remind staff to practice aseptic technique!

Hand washing
Barrier precautions
Appropriate prep of access sites before access