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

Publication: 14/03/2016  --
Last review: 29/05/2019  
Next review: 29/05/2022  
Clinical Guideline
CURRENT 
ID: 4535 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2019  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

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

For all enquiries please call radiology theatres on extension:
 23311 (LGI procedures) or 66841 (SJUH procedures) between 08.15 and 17.00 hours

Failure to follow this guidance may result in cancellation of
the procedure

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. Please liaise with radiology theatres if you need assistance with this
    • 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

Novel oral anticoagulants (NOACS: apixaban, dabigatran, edoxaban and rivaroxaban) have variable effects on coagulation screens. A patient on a NOAC may still be anticoagulated despite an INR of 1.

IF
The patient is on warfarin for a high risk indication (see box)
THEN
They may require bridging treatment with sub-cut LMWH heparin.
Follow LHPs perioperative bridging advice:
detail.aspx?ID=3084

NOTE
If LMWH is contraindicated (eg. renal failure, HIT) then seek advice re: bridging therapy from haematology SpR (bleep: 4475)

IF
The patient is on warfarin for a non-high risk indication
THEN
Stop warfarin for 5 days before procedure and recheck INR the morning of the procedure

 

High risk indications for anticoagulation

VTE within 3 months
VTE within 6 months and active cancer
Severe thrombophilia
Recurrent PE / DVT while anticoagulated
Mechanical cardiac valve
AF and...
- CVA, TIA or other arterial thromboembolic event (<3 months)
- rheumatic valvular heart disease

IF
The patient is on a NOAC
THEN
Timing of cessation of anticoagulant drugs depends on the exact drug in use, renal function (eGFR) and risk of haemorrhage
See LHPs perioperative NOAC management advice (consider all IR procedures as high risk for bleeding) detail.aspx?ID=4492

IF
The patient is on IV heparin
THEN
Stop IV heparin infusion 3 hours pre-procedure and recheck APTTR

 

Abnormal clotting parameters unrelated to anticoagulation will require correction with blood products, vitamin K,octoplex or other agents.

Seek senior advice

Any unexplained coagulopathy should prompthaematology review

IF
The patient is on treatment dose LMWH
THEN
If eGFR >30 last LMWH heparin dose should be at least 24hrs pre procedure.
If eGFR <30, contact haematology SpR for advice (bleep: 4475). Earlier cessation or alternative dosage regimens may be necessary

Do not stop prophylactic dose LMWH
Ideally the last dose of prophylactic LMWH should be 4h before the procedure though later dosing woud not necessarily preclude intervention

 

Specific instructions on restarting anticoagulation will be detailled in the operative note

 

 

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Provenance

Record: 4535
Objective:
Clinical condition:
Target patient group:
Target professional group(s): Secondary Care Doctors
Allied Health Professionals
Adapted from:

Evidence base

SIR consensus guidelines for management of coagulation status in IR
NICE acute kidney injury clinical practice guideline CG 169 (1.2.7)
RCR standards for intravascular contrast adminstration (p8)
Renal association prevention of CI-AKI in adult patients (3.2)
LHPs: Oral Anticoagulation In Patients Undergoing Elective Procedures
BSH guidelines for oral anticoagulants (warfarin) 4th edition, 2011
LHPs: Novel Oral Anticoagulation in patients Undergoing Elective procedures
LHPs: Pre-operative fasting in adult patients presenting for elective surgery

SIR = Society of Interventional Radiology
IR = Interventional radiology
NICE = National Institute of Health and Care Excellence
RCR = Royal College of Radiologists
CI-AKI = Contrast induced acute kidney injury
LHPs = Leeds Health Pathways
BSH = British Society for Haematology
NOACS = Novel oral anticoagulants (apixaban, dabigatran, edoxaban and rivaroxaban)

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Approved By

Trust Clinical Guidelines Group

Document history

LHP version 1.0

Related information

Not supplied

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