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Transjugular Intrahepatic Portosystemic Shunt

Background Transjugular intrahepatic portosystemic shunt (TIPS), introduced in the 1980s, is a procedure that is performed with imaging to connect the portal vein to the hepatic vein through the liver. Sequelae of advanced liver disease and cirrhosis include portal hypertension, which is defined by increased pressure in the portal circulation due to high resistance to blood flow through the cirrhotic liver; a TIPS will decrease this…

Transcatheter Aortic Valve Replacement

Background The most common valvular disease of the heart in adults is aortic stenosis (AS) with a noted increased incidence with aging. , Patients typically experience a slow decline in the aortic valve area over many years. The tipping point is the development of symptoms, after which there is increased mortality if the AS is left untreated. , Patients may experience shortness of breath, chest discomfort,…

Thyroid Uptake and Scan

Background Radioactive iodine (RAI) uptake and scan is a direct, noninvasive test used to assess the function of the thyroid gland. RAI uptake and scan is frequently interchangeable with “RAI scan” or “RAI uptake” in clinical practice. However, the RAI test involves two separate phases including the uptake and the scan. Thus, to be clear, RAI uptake and scan will be the term used in this…

Thyroid Ablation

Background Thyroid ablation is a procedure where the thyroid tissue is destroyed via radioactive iodine (RAI), percutaneous ethanol injection, radiofrequency, or laser ablation. The most common form of thyroid ablation used in the United States is RAI, in the form of 131 I. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member.…

Stress Tests

Background Cardiac stress tests are common procedures that are performed to evaluate patients for evidence of coronary artery disease (CAD). The gold standard for the diagnosis of CAD is cardiac catheterization and angiography; however, this is an invasive procedure that is not indicated for all patients. Therefore, many patients with a low to intermediate risk for CAD will undergo stress testing first to ascertain whether a…

Speech-Language and Swallow Evaluations

Background As a whole, speech-language pathology assessments are conducted for the examination of speech, language, cognitive abilities, and swallowing safety and function. Within the medical setting, there are a number of types of evaluations performed by speech-language pathologists (SLPs) that provide valuable information to guide medical management of patients. These assessments include clinical swallowing evaluations and instrumental swallowing exams such as modified barium swallow (MBS) study…

Sleep Study

Backgound There are multiple diagnostic tests to evaluate sleep disorders. Common tests include polysomnograph (PSG), home sleep apnea test (HSAT), multiple sleep latency test (MSLT), oximetry, and actigraphy. PSG, also known as an “in-lab sleep study or sleep test,” is derived from the Greek roots “poly,” meaning many, “somno,” meaning sleep, and “graphy,” meaning to write, and refers to testing performed on patients while they sleep.…

Renal Ultrasound

Background Renal ultrasound is a noninvasive diagnostic test that uses high-frequency sound waves to create real-time images of the kidneys. The images are two-dimensional pictures of the kidneys that evaluate their size, shape, architecture, and location. It can also be used to evaluate the blood flow to and from the kidneys. The underlying complex architecture of the kidneys is represented by the variety of echotextures seen…

Peritoneal Dialysis

Background Peritoneal dialysis (PD) is a modality of renal replacement therapy using a patient’s peritoneal cavity and extensive capillary vasculature as a dialysis membrane. The concept is exactly the same as hemodialysis (HD); both involve the transport of solutes and water across a membrane that separates two fluid-containing compartments. In HD the dialyzer is the membrane, whereas in PD the peritoneal lining is the membrane. This…

Percutaneous Endoscopic Gastrostomy Tubes

Background Gastrostomy tube placement is used in patients who are unable to maintain adequate oral intake yet have an otherwise intact digestive system. This type of enteral tube is used for patients who will need long-term enteral feeding, generally defined as longer than 4 to 6 weeks. Multiple ways to obtain access to the digestive system exist, including radiologic, surgical, and endoscopic. The most commonly used…

Percutaneous Coronary Intervention

Background Percutaneous coronary intervention (PCI) is a mainstay of treatment for coronary artery disease (CAD). There are approximately 18 million Americans with CAD, and one American will have a myocardial infarction (MI) approximately every 40 seconds. A patient will classically present to the emergency department with chest discomfort along with other signs/symptoms that are suggestive of MI, which will prompt an electrocardiogram (EKG). If the EKG…

Patient-Controlled Analgesia

Background Pain management through patient-controlled analgesia (PCA) allows patients to self-administer predetermined doses of analgesic medication, typically through a computerized pump, eliminating the need for administration by a nurse or healthcare practitioner. This facilitates delivery of analgesia at shorter intervals and in smaller doses and reduces burden on nursing staff. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles…

Oxygen Supplementation

Background The practice of oxygen supplementation for hospitalized patients generally does not follow any standardized protocols. It is often a hospital norm that patients are provided supplemental oxygen regardless of their blood oxygen saturations (SaO 2 ). Until recently, many healthcare professionals believed that oxygen had little or no deleterious effects. However, recent publications indicate that supplemental oxygen use in patients with normal SaO 2 increases…

Nephrostomy Tubes

Background Percutaneous nephrostomy tubes (PCNs) are placed through the skin directly into a portion of the kidney, hence the name (percutaneous = pertaining to through the skin; nephrostomy = making an opening in the kidney). This procedure has four broad indications: relief of urinary obstruction, diagnostic testing, access for therapeutic interventions, and urinary diversion. In the hospital setting, the most common scenario related to PCN that…

Nasogastric Tubes

Background Nasogastric (NG) tubes are commonly called Salem sumps TM or abbreviated and called NG tubes. These tubes vary in diameter and length and can serve many purposes. NG tubes are inserted through the nare, down through the oropharynx, to terminate in the stomach. Hieronymus Fabricius ab Aquapendente, a 16th-century Italian professor of anatomy and surgery, is thought to be the first to use a silver…

Magnetic Resonance Cholangiopancreatography

Background Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive special type of magnetic resonance imaging (MRI) that utilizes a powerful magnetic field and radio waves to produce detailed pictures of the hepatobiliary and pancreatic systems, including the liver, gallbladder, bile ducts, pancreas, and pancreatic duct. The word “cholangiopancreatography” is derived from Greek by combining “chole” (bile), “angio” (vessel), “pancreato” (pancreas), and “graphy” (write). MRCP was first described…

Lumbar Puncture

Background Lumbar puncture (LP), also called a “spinal tap,” is an invasive procedure performed to obtain cerebrospinal fluid (CSF) from the subarachnoid space in the spinal column. It requires the percutaneous insertion of a spinal needle between two lumbar vertebrae located in the lower back. LP is performed for two primary purposes: diagnostic and therapeutic. Most commonly, LPs are performed for suspected central nervous system infection…

Lower Extremity Venous Duplex Ultrasound

Background Diagnostic ultrasonography is the use of ultrasound to image anatomical structures. Ultrasound is sound waves that have a frequency above what the human ear can hear, or higher than 20 × 10 4 Hz. Diagnostic ultrasound is usually on the order of MHz, or 10 6 Hz. These sound waves are generated from an ultrasound probe, which houses a piezoelectric element that vibrates in response to electric…

Intravenous Access

Background Venous access is something that is often taken for granted. Establishing reliable venous access will facilitate a wide array of medical therapies and diagnostic exams. Currently, there are numerous types of intravenous (IV) access available, including peripheral IV (PIV), midline catheters, peripherally inserted central catheters (PICCs), non-tunneled and tunneled central venous catheters (CVCs), and completely implantable devices known as “ports.” Selecting the appropriate type of…