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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3892_Библиотеки_им_академика_М_И_Перельмана
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38
The off-label use
of what medication
has been shown to
reduce bleeding time
and complications in
uremic patients?
Desmopressin (DDAVP) 0.3mg/kg. It
reaches maximal effect 30–60min after
administration.
When administering
periprocedural
prophylactic
antithrombotics for
peripheral arterial
interventions, what
is the recommended
method of
anticoagulation
measurement?
Activated clotting time (ACT) with a
point-of-care device.
The activated clotting time (ACT) is
an assessment of overall coagulation
and represents the time it takes the
whole blood to clot in the presence of
an activator. For many interventional
procedures, the patient should be
heparinized to maintain an ACT range of
approximately 250–300s.
An initiating dose of full-dose
unfractionated heparin for therapeutic
purposes during interventions can be
either empiric or weight based. An
empiric dose is a 5000-unit IV bolus
followed by a continuous infusion
of 1000units/hour IV.A weight-
based dosing regimen with a bolus
of 70–100units/kg, followed by a
continuous 18-unit/kg/hour infusion,
was found to be more effective in
preventing recurrent thromboembolism
when compared with non-weight-based
regimens.
For heparin reversal at the end of the
procedure, 1mg of protamine will
neutralize approximately 100units of
heparin.
M. C. Taon
https://t.me/med1917
39
In a “dirty” procedure
that involves entering
an infected purulent
site, a clinically
infected biliary or
genitourinary site, or a
perforated viscus, how
long should antibiotics
be administered?
Prophylactic antibiotics should be
administered 1h prior to procedure
and continued for at least 48h post-
procedure.
Consent
The ALARA (as low as
reasonably achievable)
principle focuses on which
three basic radiation protective
measures?
Minimizing time, maximizing
distance, and using shielding.
What is the maximum effective
radiation dose for exposed
radiation workers in a 1-year
and consecutive 5-year period?
Maximum effective dose for
an exposed radiation worker
in any single year is 50mSv.
Maximum effective dose for
an exposed radiation worker in
a consecutive 5-year period is
100mSv.
What is the principle of using
carbon dioxide (CO2) as a
contrast agent for angiography?
CO2 gas displaces the blood
and produces a negative
contrast for digital subtraction
imaging.
What medication can be used
to reverse the sedation effects
of benzodiazepines?
Flumazenil with an initial dose
of 0.2mg IV administered over
15s to 1min. Repeat dosing
may be necessary since the half-
life of flumazenil is shorter than
that of most benzodiazepines.
(continued)
7 Patient Preparation
https://t.me/med1917
40
30-day, 3-month, and 6-month
mortality after transjugular
intrahepatic portosystemic
shunt (TIPS) is significantly
increased after what Model
for End-Stage Liver Disease
(MELD) score?
Patients with MELD > 18 have a
significant increase in mortality
when compared to patients with
MELD less than or equal to 17.
The MELD score was initially
developed to predict short-term
survival after TIPS and was
subsequently found to be useful
for triaging patients for liver
transplantation. Scores ≥ 18 have
been found to be associated with
1-month and 3-month mortality
of 18% and 35%, respectively.
What are the Anesthesia
Society of America (ASA)
requirements for fasting prior
to moderate sedation?
Though variable depending on
institution, 6h fasting for solids
and 2h fasting for liquids.
Contrast Allergy Prophylaxis
What does the
American College of
Radiology recommend
for contrast allergy
prophylaxis?
A combination of 12–13h of steroids
and antihistamine administration.
A common regimen includes 50-mg
prednisone 13, 7, and 1h before contrast
administration and 50-mg Benadryl 1h
prior to contrast administration.
M. C. Taon
https://t.me/med1917
41© Springer Nature Switzerland AG 2022
R. Chand et al. (eds.), Essential Interventional Radiology
Review, https://doi.org/10.1007/978-3-030-84172-0_8
The number of viable
airborne bacteria in a
surgical suite is directly
proportional to what
aspect of the operating
room?
The number of persons present in the
operating room. This underscores the
importance of limiting traffic flow
through the angiography suite only to
necessary tasks.
According to
consensus, what is
the recommended
time frame between
preparation of the sterile
instrument back table
and the use of the back
table?
The recommended time frame is less
than 1h, preferably immediately
before the procedure.
What is considered the
most important step in
reducing the spread of
infection?
Hand hygiene
Chapter 8
Running theTable
MatthewCzarTaon
M. C. Taon (*)
Kaiser Permanente Los Angeles Medical Center,
Los Angeles, CA, USA
(continued)
https://t.me/med1917
42
When performing a
procedure that involves
catheter insertion, how
long should a sterile
drape be?
The Centers for Disease Control and
Prevention (CDC) recommends that
a sterile drape should be large enough
to cover the entire patient and any
hardware attached to the operating
table.
Regarding pre-
procedural skin
preparation, if a
patient is sensitive
to chlorhexidine and
povidone-iodine
solution, what solution
can be used to cleanse
the skin?
70% alcohol
When injecting contents
from a syringe into a
catheter, how should the
syringe be prepared and
what position should the
syringe be held?
Every syringe on the table should be
labeled and, when injecting, should
be held upright to ensure that any air
will travel toward the syringe plunger,
away from the catheter.
When preparing contrast
syringes for a procedure,
what is an effective
method for reducing
iodinated contrast dose?
Diluting contrast into a 1:1 contrast to
saline ratio. In extremities, a 1:3–1:5
contrast to saline dilution ratio can be
enough to provide diagnostic images.
In the abdomen, a 1:2 contrast to
saline dilution ratio can be enough
to provide diagnostic images if the
patient is able to hold respiration
adequately and if they are of the
correct body habitus.
M. C. Taon
https://t.me/med1917
43© Springer Nature Switzerland AG 2022
R. Chand et al. (eds.), Essential Interventional Radiology
Review, https://doi.org/10.1007/978-3-030-84172-0_9
How does real-time
ultrasound-guided vascular
access compare to the use
of anatomic landmarks or
vessel palpation in terms of
success rate, time to access,
and complication rates?
Real-time ultrasound-guided
vascular access provides active
visualization of the target, access
vessel, as well as visualization and
avoidance of surrounding, vital
structures.
What Barbeau test
waveform is considered a
contraindication to radial
artery access?
Type D Barbeau waveform. This
waveform appears as a flat line
on the pulse oximeter and persists
beyond 2min, indicating no
collateral supply from the ulnar
artery to the radial side of the
hand.
Chapter 9
Choice ofAccess
MatthewCzarTaon
M. C. Taon (*)
Kaiser Permanente Los Angeles Medical Center,
Los Angeles, CA, USA
(continued)
https://t.me/med1917
44
Prior to transradial artery
interventions, a combination
of what medications can
be mixed and prepared
to be infused through the
access sheath in an attempt
to prevent radial artery
occlusion and spasm?
Nitroglycerin 200mcg, verapamil
2.5mg, and heparin 2500 units
Where is the optimal access
of the common femoral
artery (CFA)?
The common femoral artery should
be accessed at the level of the
femoral head. Access above the
femoral head risks retroperitoneal
hemorrhage, and access below
the femoral head risks thigh
hematoma/pseudoaneurysm.
What are methods to
differentiate a vein versus
artery on ultrasound?
Arteries demonstrate pulsatility.
Veins demonstrate compressibility.
Veins have valves. The common
carotid artery is located medial
to the internal jugular vein. The
common femoral artery is located
lateral to the common femoral vein.
Assess the direction of Doppler
flow.
What is a proposed benefit
to ipsilateral, antegrade
access of the common
femoral artery (CFA) to
treat infrainguinal arterial
disease?
Ipsilateral, antegrade access
provides a short working length,
which can improve steerability and
pushability of wires and catheters.
Also, this technique avoids
aortoiliac crossover, which can be
challenging if there is a steep iliac
bifurcation, tortuous or stenotic
iliac arteries, or presence of an
aortoiliac endoprosthesis.
M. C. Taon
https://t.me/med1917
45
When accessing a
thrombosed hemodialysis
fistula or graft, why is it
important to ensure that the
antegrade and retrograde
sheaths face each other but
do not overlap?
Thrombus within the segment of
overlapping sheath tips would
be inaccessible to catheter
thrombectomy.
In patients with underlying
left bundle branch
block, central venous
catheterization may result
in what lethal dysrhythmia?
Central venous catheterization
may result in transient right bundle
branch block. In a patient with pre-
existing left bundle branch block,
this may result in life-threatening
complete heart block. Techniques
to mitigate risks include using a
guidewire marked at every 10cm,
to facilitate more careful guidewire
manipulation and preparing
a noninvasive transcutaneous
pacemaker at bedside for patients
with known left bundle branch
block. If transcutaneous pacing
is not successful, a transvenous
pacemaker may be necessary. If
the iatrogenic injury leads to a
persistent third-degree AV block,
permanent pacemaker placement
should be considered.
What are the three
endovascular methods to
access and treat type II
endoleaks?
Transarterial embolization of
the inflow and outflow arteries
supplying and draining the
endoleak, translumbar direct
percutaneous puncture of the
aneurysm sac with embolization,
and transcaval puncture of the
aneurysm sac with embolization
(continued)
9 Choice ofAccess
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46
Pedal access should be
avoided in which type of
patients?
Claudicants with single vessel
runoff, since pedal access can
compromise the only remaining
arterial supply to the foot
What are the relative
contraindications to using
vascular access closure
devices?
Vascular access above the inguinal
ligament, small (<5mm) vessel
size, large arteriotomy size unless a
pre-close technique is performed,
severe atherosclerosis, need for
repeat arterial access, and allergy to
a device component
M. C. Taon
https://t.me/med1917
47© Springer Nature Switzerland AG 2022
R. Chand et al. (eds.), Essential Interventional Radiology
Review, https://doi.org/10.1007/978-3-030-84172-0_10
Describe the
Seldinger
technique.
Obtain vascular access with a trocar needle,
insert soft curved tip guidewire, secure
guidewire and remove trocar needle,
exchange a sheath/cannula/catheter over
the guidewire into the lumen or cavity, and
withdraw guidewire. Seldinger described
this technique as “needle in, wire in, needle
off, catheter on wire, catheter in, catheter
advance, wire off.”
What are potential
complications
associated with
the Seldinger
technique?
Failed access, hemorrhage, infection, air
embolus, guidewire embolus, injury to
adjacent tissue, and pseudoaneurysm
formation
What units are
percutaneous
needle diameters
measured in?
Gauge; increasing gauge numbers denote
decreasing wire diameters. In general, an
18-gauge needle accepts a 0.035–0.038-inch
guidewire, and a 21-gauge needle accepts a
0.018–0.021-inch guidewire.
Chapter 10
Seldinger Technique
MatthewCzarTaon
M. C. Taon (*)
Kaiser Permanente Los Angeles Medical Center,
Los Angeles, CA, USA
(continued)
https://t.me/med1917
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