Consults for Radiology Procedures

  • Radiology Procedures are performed by three separate consult services depending on the clinical indication or procedure requested
  • Knowing the correct service will save you time when placing consults to reach the right service on first attempt
  • Contacting the pager for the appropriate service is the best way to speak directly with one of the physicians covering these services (MD’s are most often performing procedures or seeing patients, not located at the service desks)
  • These pagers are covered 24/7, often by the same person for up to a week at a time (not a nightfloat), so kindly reserve overnight pages for true urgent / emergent indications, and delay other non-emergent communications until the morning

 

 

Consult Service

Vascular IR

 

Body Procedures

 (CT or US guided)

Body/Neuro/MSK fluoroscopy

EPIC Order

“Inpatient Consult to Interventional Radiology”

“Inpatient Consult for Adult Image-Guided Procedures (CT/US)”

Call 20878 (Fluoroscopy) for scheduling & orders.

Contact Number (week days)

#20840

(MD desk)

#20120

(MD desk)

#20878

(Fluoro techs)

Contact Number (nights & weekends)

Pager only

Pager only

#3-7185

(ER reading room)

Service Pager

835-5105

835-0770

N/A

Procedure Requested

Active bleeding; Embolization’s

 

Cholecystostomy

 

PTC (biliary drains)

 

Nephrostomy

 

Tunneled lines

 

Dialysis interventions

 

G-tube placement

 

IVC Filter

 

Drain repositioning

Abscess drainage

 

Biopsy requests

 

Paracentesis**

 

Thoracentesis**

 

 

 

 

 

 

 

 

 

 

Dobhoff tube placements**

 

Lumbar punctures**

 

Joint injections / aspirations

 

Esophograms

 

Upper GI Series

 

Small bowel follow-through

 

Contrast enemas

 

    **Typically requires prior attempt by medicine or procedure service on the floor

 

Specific Procedural Questions:

Pre-Procedure (contact consult services for case-specific requirements, guidelines below):

  • NPO @ MN prior to procedure if sedation is to be used (majority of cases)
  • Labs required morning of procedure:
    • INR (<1.5 for most procedures)
    • Plts (>50K)
  • Anticoagulation
    • Hold Lovenox for 12h prior to procedure
    • Hold AM dose of SQH prior to procedure
    • Search “SIR anticoagulation guidelines 2019” for hold times for other AC
  • Para/thora/LP: typically requires prior failure by floor team or procedure services. Please describe why initial procedure failed so that radiology can avoid that issue.
  • Inpatient biopsies for malignancy: due to schedule and resource availability, it is rare that this is approved as an inpatient.
    • Consider placing outpatient consult for “adult image-guided procedures” team.
    • The pt will get an outpatient slot, and if they happen to still be inpatient, they will receive the biopsy at that time regardless to prevent keeping patient hospitalized only for biopsy

Drain management: Best to discuss directly with service that placed the drain

  • Flush with 10mL NS BID (flush into drain, then put back to gravity or accordian suction)
  • If drain output decreases, either:
    • The drained area (e.g. abscess) is empty
    • The drain is clogged/malfunctioning /malpositioned
  • Start with ensuring the drain is adequately flushed/flushing. If still no output, CT w/ IV contrast to re-evaluate area of the drain, then page 835-0770 (Body Procedures) for abscess drains or page 835-5105 (Vascular IR) for rec’s regarding PCNs, PTCs, or G-tubes.
    • If an abscess drain is malfunctioning, first ensure proper suction/3-way direction. Next instill tPA into the catheter for 2 hours. Epic order: “Alteplase (TPA) injection/infusion options” -> Percutaneous drainage -> 2mg or 4mg (20mL or 40mL, 1mg/10mL concentration). Reach out to Body Procedures service (835-0770) with any questions.
    • If drain is at an operative site, confirm drain tPA is acceptable by surgery team.
    • If this doesn’t improve output in 48 hours, consider repositioning drain (VIR consult).