Purpose Guidewires are used in conjunction with catheters to navigate to a target, in addition they provide support and in the majority of cases, catheters, balloons and other devices are advanced into position over a previously positioned wire. Nearly all guidewires are constructed with a relatively flexible tip section of variable length and a less flexible shaft of variable stiffness. The performance of a guidewire depends…

Purpose An access kit allows the least traumatic (i.e. smallest) initial needle puncture of the target and provides a method to convert the 22G puncture to standard 0.035-inch guidewire access. Description A typical set comprises: A one- or two-part 22G needle for the initial puncture A short 0.018-inch guidewire with flexible tip and supportive shaft An interlocked dilator system. This varies from kit to kit. Those…

Purpose The ideal biopsy needle provides a diagnostic tissue sample at the lowest possible risk. Description Needles are usually characterised by their mechanism of action into aspiration and core biopsy needles. Aspiration needles Purpose To safely provide a sample of a few cells for cytological, biochemical and microbiological analysis. Cytology can be enough to confirm malignancy but doesn't give any “architectural” information. Description Most aspiration samples…

Purpose Puncture needles are vital for getting from the skin to the target as a prelude to access with a guidewire, aspiration of fluid or placement of a drain. Not all needles are equal and you need to know what to request. Description You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member.…

Outpatient clinics are an essential component of contemporary practice. Some interventional radiologists have held outpatient clinics for many years but for others, this will be a new experience. The functions of the clinic should simply be extensions of various aspects of daily practice. The challenge of the clinic is to deliver this in time-limited encounters. Broadly speaking, the roles of the clinic can be understood as…

Oh dear, we are still in the introductory section and already complications are rearing their ugly heads. One thing is certain, during a career in interventional radiology, there will be cases which do not follow the script. There are of course many things that can and do go wrong. Your job is to: Minimize predictable/preventable errors Recognize problems as early as possible Limit damage to the…

Pain control – forward planning Many interventional radiology procedures do not require any analgesia; some procedures are intrinsically painful, especially if they are prolonged, and others are unpredictably uncomfortable. The procedure will be simpler and the patient less distressed if pain can be kept to a minimum; they will be even happier if pain can be avoided altogether. Preventing severe pain is likely to increase everyone's…

Sedation is used to relax patients during procedures but does not relieve or prevent pain. Hence, sedation is often used in combination with analgesia. Sedation is useful in patients undergoing prolonged interventional procedures and can also be valuable in anxious or hypertensive patients. Remember that sedation may result in respiratory depression and aspiration of gastric contents; in addition, there is a small but significant mortality. Children…

Most vascular computed tomography (CT) and magnetic imaging resonance (MRI), the vast majority of angiographic procedures, and many nonvascular interventions rely on contrast media to reveal the anatomy. Contrast media can be broadly classified according to their use and also their chemical structure. X-ray contrast affects tissue X-ray attenuation, ultrasound contrast affects tissue and blood reflectivity and MRI contrast affects tissue relaxation times. The Royal College…

Formal and clearly documented safety checks and briefings are mandatory and essential if you want to reduce predictable and preventable errors during procedures. It has been clearly demonstrated that safety checks performed immediately before and after every surgical operation reduce patient morbidity regardless of the environment. The surgical safety checklist has been adopted worldwide and similar checks should be used in interventional radiology. This chapter builds…