Hospital-Based Procedures
Vascular Access Procedures:
PICC Line Placement
Many patients are given temporary PICC lines to reduce the number of needle punctures during chemotherapy or antibiotic treatment or diagnostic blood draws. A vascular access procedure is designed for patients who need intravenous (IV) access for a considerable time, longer than 7 to 10 days. A simple IV set-up is effective in the short term, but is far from ideal when, for instance, a patient needs a course of chemotherapy, several weeks of IV antibiotic treatment, or long-term IV feeding.
Planning for your PICC Line Placement procedure
You may be instructed to not to eat or drink anything several hours prior to your procedure. Leave jewelry at home and wear loose, comfortable clothing. This procedure can be performed on an in-patient or out-patient basis, but if you receive conscious sedation, you should still arrange for a designated driver to drive you home afterward.
You will be positioned on your back on an angio/fluoroscopy table. A technologist may insert an intravenous (IV) line into a vein in your hand or arm so that sedative medication can be given intravenously prior to the start of or during the procedure, as needed. Your physician will numb the area with a local anesthetic. A tiny incision is made at the site. To place the PICC line and with the aid of fluoroscopy, the physician will identify the vein using ultrasound or x-ray guidance and insert a small needle into the arm vein and advance a small guide wire into the large central vein, called the superior vena cava. The catheter is then advanced over the guide wire and moved into position. The guide wire is then removed.
It is especially important to keep the catheter site clean and dry. You may be allowed to shower by wrapping a piece of watertight plastic seal wrap over the site where the catheter was inserted. You should not allow the incision to be held under water such as by swimming or soaking in a tub.
Port Placement
Ports are often requested for chemotherapy or antibiotic infusions in order to prevent venous injury. They provide a relatively safe and easy access by the healthcare providers. After the initial healing process (when the port is not accessed), you can take showers or immerse the site in a pool of water without being concerned about infection. Ports can be kept even after the initial chemotherapy has been completed. The port needs to be flushed occasionally in order to maintain the patency of the port and its catheter. You can always request a consultation with your interventional radiologist before having a port placed.
Planning for your Port Placement procedure
You may be asked to stop taking certain blood thinners for a short time before and after the port placement, in order to prevent bleeding as a result of the procedure. Continue to take your other medications, if required. You may require a blood draw in order to assess your coagulation factors.
Leave jewelry at home on the day of your procedure. You will receive an IV access and be administered intravenous antibiotics, after which time you will be escorted into a fluoroscopy suite and sterile procedure room where you will be sedated. After sterile prep and use of local anesthetic, a 4 to 5 cm incision will be made on your upper left or right chest as well as a 1 cm incision for access into your jugular vein on the same side. The port will be placed under your skin and the catheter from the port will go into your jugular vein. Incisions will be closed and dressings placed on the incision sites. You will be able to go home one or two hours after the procedure. Arrange for a designated driver to drive you home, since you will receive conscious sedation during the procedure.
You may shower, but until the incisions are healed, no baths or immersion of the incision sites into a pool of water are allowed. You may remove the clear and gauze dressings after two days, but allow the white strips of paper tape (Steristrips) to fall off on their own. The port can be accessed immediately after placement. Do not immerse the port site in a pool of water while the port is accessed with a needle.
A catheter approximately the size of a pen tip is guided under fluoroscopy into the desired vessels in your liver. Ionizing radiation via millions of tiny glass beads is then delivered into the tumor.
Transjugular Intrahepatic Portosystemic Shunt (TIPS)
When the liver encounters any of the diseases that cause cirrhosis, scar tissue can form and interrupt normal blood flow through the liver, compromising or disabling the liver’s ability to clean the blood of toxins.
In addition, with cirrhosis, there is progressive resistance of blood flow through the liver. Increased resistance of blood flow causes increased pressure on the veins from the bowels to the liver, known as portal hypertension. Portal hypertension results in venous blood backing up into the bowel wall veins and spleen. The enlarged veins (varices) — especially in the esophagus and stomach — can become so large and fragile that they can perforate and cause significant bleeding into the bowels.
Transjugular Intrahepatic Portosystemic Shunt, or TIPS, is an effective life-saving treatment to help bypass the liver. This relieves the pressure off of the varices. TIPS is a minimally invasive procedure in which a shunt is inserted to create a new passage to assist blood flow through the liver. The blood is diverted from the bowels to the right side of the heart. As a result, the blood is no longer filtered through the liver. In patients with cirrhosis, TIPS can also be utilized for recurrent ascites.
Planning for your Transjugular Intrahepatic Portosystemic Shunt (TIPS) procedure
You will have a consultation with your interventional radiologist to discuss the pros and cons of the procedure. If you are taking anticoagulants, you may be asked to check with your primary physician to confirm if you are required to stop taking them for a designated time before and after your procedure. Your doctor will instruct you on the appropriate medication to take the morning of your procedure.
Leave jewelry at home and wear loose, comfortable clothing. Plan to stay overnight at the hospital for one or more days.
The procedure is performed with conscious sedation. In special circumstances, general anesthesia may be utilized. You may or may not remain awake, depending on how deeply you are sedated. As the contrast material passes through your body, you may feel warm. This will quickly pass.
After the procedure, you will be monitored and your head will be kept elevated for a few hours after you return to your room. Often, symptoms are mild or controlled enough that patients may go home the next day. You should be able to resume your normal activities in seven to 10 days.
The liver has limited filtering activity after the TIPS procedure. In order for your body to eliminate the toxins typically removed by the liver, you will be required to take laxative medication to have three to four loose stools per day. Accumulation of these toxins could lead to serious complications.
For more information, visit: Society of Interventional Radiology/Liver Disease
Catheter Embolization
Embolization is a way of occluding (closing) or, at least, drastically reducing blood flow to one or more blood vessels that are causing excessive harm. One of a variety of materials, depending on whether vessel occlusion is to be temporary or permanent, is passed through a catheter; its tip lying in or near the vessel to be closed. This approach can be used to control or prevent abnormal bleeding as well as shut down the vessels that support a growing tumor. Therapeutic embolization may also serve to eliminate an arteriovenous malformation (AVM): an abnormal communication between an artery and a vein.
Planning for your Catheter Embolization procedure
You will be advised to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) or blood thinners several days prior to your procedure and instructed to not eat nor drink anything after midnight the night before. Your doctor will inform you as to which medications you may take in the morning. Leave jewelry at home and wear loose, comfortable clothing. Plan to stay overnight at the hospital for one or more days.
Using x-ray imaging and a contrast material to visualize the blood vessel, the interventional radiologist inserts a catheter through the skin into a blood vessel and advances it to the treatment site. A synthetic material or medication called an embolic agent is then inserted through the catheter and positioned within the blood vessel or malformation, where it will remain permanently.
Most patients leave the hospital within 24 hours of the procedure. You should be able to resume your normal activities within a week. Until then, minimal activity is recommended.
For more information, visit: Radiologyinfo.org Catheter Embolization
Inferior Vena Cava Filter Placement/DVT
The inferior vena cava is a large vein that connects your leg veins with your heart. Occasionally, clots develop in the leg veins called deep vein thrombosis. A clot, or a piece of it, can move out of your leg and flow towards your heart and lungs, which could be life-threatening.
An inferior vena cava (IVC) filter, which is placed in the inferior vena cava by an interventional radiologist, traps blood clots and protects the lungs from these life-threatening clots.
Planning for your Inferior Vena Cava Filter Placement/DVT procedure
You will be advised to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) or blood thinners several days prior to your procedure and instructed to not eat nor drink anything after midnight the night before. Your doctor will inform you as to which medications you may take in the morning. Leave jewelry at home and wear loose, comfortable clothing. Arrange for a designated driver to drive you home post-procedure.
After the insertion area is numbed, you will feel a slight pinch when the needle is inserted into your vein for the IV line and the local anesthetic is injected. You may feel pressure when the catheter is inserted into the vein or artery. However, you will not experience severe discomfort. If the procedure is performed with sedation, the intravenous (IV) sedative will make you feel relaxed, drowsy and comfortable for the procedure. As the contrast material passes through your body, you may feel warm. This will quickly pass.
If your IVC filter was inserted through a vein in your neck, you should be able to resume your normal activities within 24 hours. If your filter was inserted through a vein in your groin, you should avoid driving for 24 hours as well as lifting heavy objects and climbing stairs for 48 hours. You will be provided with additional post-procedure instructions.
For more information, visit: Radiologyinfo.org Inferior Vena Cava Filter Replacement and Removal
Thrombolytic Therapy
Thrombolysis is the treatment to break up abnormal blood clots that are restricting blood flow. Thrombolytic therapy dissolves these blood clots using various medications administered directly into the clot through a catheter.
Thrombectomy is the disruption of a blood clot using one of several mechanical devices. Our interventional radiologists can use either or both methods to dissolve and remove blood clots. Radiological thrombolysis can greatly improve blood flow and reduce or eliminate the related symptoms and effects without the need for more invasive surgery.
Planning for your Thrombolytic Therapy procedure
You will be advised to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) or blood thinners several days prior to your procedure and instructed to not eat nor drink anything after midnight the night before. You will be informed as to which medications you may take in the morning. Leave jewelry at home and wear loose, comfortable clothing. Arrange for a designated driver to drive you home post-procedure.
During a catheter-based thrombectomy, an incision is made in the groin and a catheter is advanced through an artery to the clot. In order to maneuver the catheter to the exact location, the surgeon will use a specialized x-ray to monitor placement of the catheter.
You may need to take medicine for a limited time to help prevent blood clots. You will likely be advised to resume mobility soon after the treatment. You may need to wear compression stockings in order to help prevent the clot from forming again and a new one from developing.
For more information, visit: Radiologyinfo.org Catheter-Directed Thrombolysis
Balloon Angioplasty (Percutaneous Transluminal Angioplasty) and Vascular Stenting
Angioplasty is a way of opening a narrowed or closed blood vessel without having to perform major surgery. Instead, a catheter with a tiny balloon at its tip is inserted into the vessel – usually in one of the coronary arteries supplying the heart wall or a major artery bringing blood to an arm or a leg. After advancing the catheter until its tip is at the site of the blockage, the balloon is inflated and then deflated, and removed. Ordinarily, the narrowing or blockage is caused by arteriosclerosis – or hardening of the arteries – when fatty plaque forms on the inner wall of the artery and it enlarges, gradually decreasing circulating blood flow. Expanding the balloon stretches the arterial wall and disrupts the fatty plaque, helping to restore blood flow.
Most angioplasty procedures utilize a stent – a hollow thin-walled wire mesh tube – to keep the vessel open after widening it. Otherwise, and because arteriosclerosis is an ongoing disease, more plaque might form and again limit blood flow. The stent is placed onto the balloon and pressed firmly against the artery wall when inflating it. The balloon is then deflated, leaving the stent in place to act as a scaffold.
Planning for your Balloon Angioplasty and Vascular Stenting procedure
You will be advised to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) or blood thinners several days prior to your procedure and instructed to not eat nor drink anything for several hours beforehand. Leave jewelry at home and wear loose, comfortable clothing. Arrange for a designated driver to drive you home post-procedure.
You will feel a slight pinch when the needle is inserted into your vein for the IV line and when the local anesthetic is injected. Most of the sensation is at the skin incision site. This is numbed using local anesthetic. You may feel pressure when the catheter is inserted into the vein or artery; however, you will not experience severe discomfort.
If the procedure is performed with sedation, the intravenous (IV) sedative will make you feel relaxed, drowsy and comfortable for the procedure. As the contrast material passes through your body, you may feel warm. This will quickly pass. It is common for some patients to feel mild discomfort when the balloon is inflated. This is because the artery is being stretched.
At home, you should rest and drink plenty of liquids. Avoid lifting heavy objects and engaging in strenuous exercise for at least 24 hours. If bleeding begins where the catheter was inserted, you should lie down, apply pressure to the site and call your doctor. If your leg changes color or if you feel pain or warmth where the catheter was inserted, call your doctor immediately.
For more information, visit: Radiologyinfo.org Angioplasty and Vascular Stenting
Diagnostic Biopsies
These procedures are typically requested by referring physicians. The interventional radiologist then reviews the previously obtained imaging study and determines the need and feasibility of a minimally invasive biopsy. We perform these procedures under imaging guidance (US, CT, fluoroscopy, or MRI).
Lung Biopsy
These procedures are typically requested by referring physicians. The interventional radiologist then reviews the previously obtained imaging study and determines the need and feasibility of a minimally invasive biopsy. You will be advised to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) or blood thinners several days prior to your procedure. We perform these procedures under CT guidance.
The interventional radiologist will clean the area of skin the needle will go through, place a sterile drape around the area and numb the area. Using CT guidance, a needle will then be inserted through the skin and into the lung to the nodule and multiple samples will be taken with the samples sent to pathology for evaluation. After the procedure, you will be observed by nurses for routine monitoring. You may experience pressure during tissue sampling as well as an urge to cough. You may experience the urge to cough including coughing a small amount of blood during the procedure.
You will be observed/monitored over a timeframe of one hour and will then be permitted to go home. If you receive conscious sedation, you must arrange for a designated driver to drive you home post-procedure. Your referring physician will receive the results in a few days. Very few patients may experience an air leak due to the needle causing a hole in the lung (pneumothorax). This usually heals on its own and will not require further procedures. But if the air leak is big enough, or you experience symptoms due to the air leak, a tube may need to be inserted through the skin and chest wall to drain the air from your chest cavity.
Thyroid Nodule Fine Needle Aspiration (FNA)
These procedures are typically requested by referring physicians. The interventional radiologist then reviews the previously obtained imaging study and determines the need and feasibility of a minimally invasive biopsy. You will be advised to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) or blood thinners several days prior to your procedure. We perform these procedures under ultrasound guidance.
The interventional radiologist will clean the area of skin the needle will go through, place a sterile drape around the area and numb the area. Under ultrasound guidance, the small needle will be advanced through the skin and into the nodule. Aspiration is performed with this needle attached to a syringe with gentle aspiration technique. 3-4 separate samples are typically obtained and the sample is sent to pathology for evaluation.
You will be given an ice pack to decrease any potential swelling. Patients typically experience little to no pain but may have a small amount of bruising at the biopsy site. You can resume normal activities after thyroid aspiration.
Liver Biopsy
These procedures are typically requested by referring physicians. You will be advised to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) or blood thinners several days prior to your procedure. We perform these procedures under ultrasound or CT guidance.
These procedures are typically requested by referring physicians. You may be advised to stop blood thinners several days prior to your procedure. We perform these procedures under fluoroscopic (X-ray) or CT guidance, targeting a mass or obtaining tissue anywhere from the liver to evaluate overall liver function (random liver biopsy).
You will be observed/monitored over a timeframe of one hour and will then be permitted to go home. If you receive conscious sedation, you must arrange for a designated driver to drive you home post-procedure. Your referring physician will receive the results in a few days. You may have some pain where the needle entered your skin. You may also have pain in your shoulder. It's caused by pain travelling along a nerve that goes to the liver. This pain usually lasts less than 8-12 hours.
Kidney Biopsy
These procedures are typically requested by referring physicians. You will be advised to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) or blood thinners several days prior to your procedure. We perform these procedures under ultrasound or CT guidance.
The interventional radiologist will clean the area of skin the needle will go through, place a sterile drape around the area and numb the area. Under ultrasound or CT guidance, the small needle will be advanced through the skin and into the kidney, targeting a mass or obtaining tissue from the outer portion of the kidney (cortex) to evaluate overall kidney function (random kidney biopsy).
You will be observed/monitored over a timeframe of one hour and will then be permitted to go home. If you receive conscious sedation, you must arrange for a designated driver to drive you home post-procedure. Your referring physician will receive the results in a few days. You may have some pain in the flank region where the biopsy is performed. The pain usually lasts less than 8-12 hours.
Bone Marrow Biopsy
These procedures are typically requested by referring physicians. You may be advised to stop blood thinners several days prior to your procedure. We perform these procedures under fluoroscopic (X-ray) or CT guidance.
The interventional radiologist will clean the area of skin the needle will go through, place a sterile drape around the area and numb the area. The bone biopsy needle is advanced through the outer part of the bone (cortex) to obtain marrow. Bone marrow fluid (aspirate) and tissue sample (biopsy) are usually collected from the top ridge of the back of a hipbone (posterior iliac crest).
Depending on the pain medicine required to perform the procedure (local anesthetic or local anesthetic with IV sedation), you will be monitored for a short time period and then discharged home. Make arrangements to have a ride home and plan for light activity for the remainder of day. You may experience pain in the bony pelvic region where the biopsy was performed. The pain usually lasts less than 8-12 hours.
Soft Tissue/Lymph Node Biopsy
These procedures are typically requested by referring physicians. You may be advised to stop blood thinners several days prior to your procedure. We perform these procedures under ultrasound or CT guidance depending on the location of the lesion of concern.
Your biopsy experience will depend on the location of the lesion. You may be lying on your back or stomach and you may/may not require IV sedation in addition to local anesthetic. In all cases, the interventional radiologist will clean the area of skin the needle will go through, place a sterile drape around the area and numb the area. Under ultrasound or CT guidance, the small needle will be advanced through the skin and into the lesion of concern. Tissue sampling will be performed and the samples will be sent to pathology for evaluation.
Depending on the pain medicine required to perform the procedure (local anesthetic or local anesthetic with IV sedation), you will be monitored for a short time period and then discharged home. Make arrangements to have a ride home and plan for light activity for the remainder of day.
Planning for your Diagnostic Biopsy procedure
You may be asked to stop taking blood thinning medication.
You are escorted into an imaging suite, where local anesthetic is administered. Using imaging guidance, a needle is inserted into the lesion of concern and several tissue samples are obtained.
The specimens are submitted to a lab or pathologist for diagnosis.
In some cases, an IV sedative may be administered for additional comfort.
You will be observed/monitored over a timeframe of a few minutes to a couple of hours and will then be permitted to go home. If you receive conscious sedation, you must arrange for a designated driver to drive you home post-procedure. Your referring physician will receive the results in two to three days. If the biopsy is requested by your interventional radiologist, we will contact you directly with the results.
Venous Intervention
The interventional radiologists at Lake Medical Imaging are the original physicians in this geographic area to perform venous interventions. These continue to include opening blocked veins; placing filters in the Inferior Vena Cava in order to prevent migration of lower extremity blood clots to the lungs; and treatment of varicose veins, superficial venous reflux and spider veins.
Arterial Intervention
In some cases, ultrasound, CT or MRI may be needed to best evaluate the vascular problem. Please see the list of arterial interventions performed.
Biliary Intervention
There are a variety of reasons for the liver bile duct pathology and gallbladder disease. Treatment of these diseases is typically an in-patient procedure performed by interventional radiologists. However, after the initial procedure, some of the follow-up procedures can be performed on an outpatient basis.
PTC (Cholangiogram with Catheter Placement)
Blocked bile ducts in the liver will sometimes require drainage by the Interventional Radiologist by placing a small drainage catheter through the skin and right upper abdomen into the bile ducts.
You will be advised to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) or blood thinners several days prior to your procedure and instructed to not eat nor drink anything for several hours beforehand.
In addition to local anesthetic numbing the skin, an intravenous (IV) sedative will make you feel relaxed, drowsy and comfortable for the procedure.
You may have a catheter (small drainage tube) in place that's connected to a collection bag or capped. How long the drain stays in place depends on what caused the problem with your bile duct. If the drain is to stay in place when you go home, your doctor will talk to you about this. You'll also get instructions about how to take care of the tube including tube flushing to minimize clogging over time. You may have some pain where the needle entered your skin. You may also have pain in your shoulder. It's caused by pain travelling along a nerve that goes to the liver. This pain usually lasts less than 12 hours. You may have a small amount of bleeding from the puncture site. Depending on how long the tube is required, periodic tube exchanges may be required as these tubes can breakdown or get clogged over time.
Gastrointestinal Intervention
Interventional Radiologists will place feeding tubes into the stomach with an approach through the skin in the upper abdomen. This is usually performed in patients with difficulty swallowing related to numerous conditions including stroke, obstructive cancer of the head and neck or chronic illnesses creating an inability to maintain adequate nutrition by mouth.
You will be advised to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) or blood thinners several days prior to your procedure and instructed to not eat nor drink anything for several hours beforehand. Leave jewelry at home and wear loose, comfortable clothing. Arrange for a designated driver to drive you home post-procedure or these arrangements will be made between our nurses and your caretaker ahead of time.
In addition to local anesthetic numbing the skin, an intravenous (IV) sedative will make you feel relaxed, drowsy and comfortable for the procedure. Oftentimes, a small catheter will be placed into your stomach through your mouth in order to expand the stomach with air to allow needle passage into the stomach through your skin in the upper abdomen.
- You’ll feel some pain around the tube entry site after a percutaneous endoscopic gastrostomy. Or you might have cramping from gas buildup in your digestive system. This pain should decrease within 24 to 48 hours. You may see some drainage around the catheter entry site for up to 48 hours. Your doctor will arrange a dietician, a specialist to explain how to use the tube and start you on required nutritional regimen.
Genitourinary Intervention
Interventional Radiologists often place drainage tubes through the skin to alleviate blockages in the kidney (nephrostomy tube) or urinary bladder (suprapubic tube). Nephrostomy tubes are also placed prior to the treatment of kidney stones performed by the Urologist.
Percutaneous Nephrostomy Tube Placement (PCN)
You will be advised to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) or blood thinners several days prior to your procedure and instructed to not eat nor drink anything for several hours beforehand. Leave jewelry at home and wear loose, comfortable clothing. Arrange for a designated driver to drive you home post-procedure.
In addition to local anesthetic numbing the skin, an intravenous (IV) sedative will make you feel relaxed, drowsy and comfortable for the procedure.
You may have a catheter (small drainage tube) in place that's connected to a collection bag or capped. How long the kidney drain stays in place depends on what the nature of the problem is. If the drain is to stay in place when you go home, your doctor will talk to you about this. You'll also get instructions about how to take care of the tube including tube flushing to minimize clogging over time. You may have some pain in the flank region where the tube was placed. This pain usually lasts less than 12 hours. You may have a small amount of bleeding from the puncture site. Depending on how long the tube is required, periodic tube exchanges may be required as these tubes can breakdown or get clogged over time.
Suprapubic Tube Placement (SP tube)
You will be advised to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) or blood thinners several days prior to your procedure and instructed to not eat nor drink anything for several hours beforehand. Leave jewelry at home and wear loose, comfortable clothing. Arrange for a designated driver to drive you home post-procedure.
In addition to local anesthetic numbing the skin, an intravenous (IV) sedative will make you feel relaxed, drowsy and comfortable for the procedure.
You will have a catheter in place in the lower abdomen that's connected to a collection bag or capped. How long the bladder drain stays in place depends on what the nature of the problem is. If the drain is to stay in place when you go home, your doctor will talk to you about this. You'll also get instructions about how to take care of the tube including tube flushing to minimize clogging over time. You may have some pain in the lower abdomen and pelvic region where the tube was placed. This pain usually lasts less than 12 hours. You may have a small amount of bleeding from the puncture site. Depending on how long the tube is required, periodic tube exchanges may be required as these tubes can breakdown or get clogged over time.
