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LSUHSC Shreveport Radiology Department Proc 15.22

CATHETER MANIPULATION and REMOVAL Purpose: Procedure: Catheter Manipulation: In catheters with side holes, the proper way to flush is a forceful aspiration until blood appears into the syringe, which is followed by a forceful injection of saline into a towel to avoid spray so that the entire catheter and side holes are cleared. Gentle aspiration and injection clean only the proximal holes. Catheters must be flushed every two to three minutes. Prior to the pressure injection and filming, the following items should be checked: 1. Catheter tip position is correct. 2. Extension tube is firmly attached to the catheter and the injector with the absence of any air visible. 3. Catheter is secured at the entry site and towel placed over catheter. 4. All stop cocks are appropriately opened. 5. Patient is properly centered and the technicians are ready to proceed. The injector is on and the settings on the injector are correct. 6. Inform the patient that he will experience a slight burning sensation in the abdomen, back, thighs, etc. as appropriate. Also inform him that the heat lasts for several seconds and then fades. He/she should also be informed of the length of time that he/she has to hold their breath. 7. Arteriography of the chest is performed in full inspiration. Arteriography of the abdomen is generally performed in expiration. The following injections are most painful in ascending order: renal, aortogram, celiac, superior mesenteric and peripheral arteriography. With new contrast on the market with lower osmalarity the painful sensation is not as much a factor. 8. Always check fluoroscopy before proceeding with the arterial puncture. Before fluoroscoping, make sure that the patient distance is minimal, so that you do not receive any unnecessary radiation. Avoid fluoroscoping continuously for long durations. Table top manipulations should be done using the table side controls located on either side of the table top. During a procedure, the sterility of the angio tray, drapes, and puncture site should be maintained. To provide guidelines for the safe manipulation and removal of catheters.

LSUHSC Shreveport Radiology Department Proc 15.22

9. While searching for a specific vessel, the catheter tip may frequently fall into the origin of a lumbar or intercostals artery. Due to the small orifice of these vessels, the catheter tip usually occludes it (especially if there is no back flow). If contrast injection is used to verify location, only a very small amount should be used. Not only because it is painful but also because injection of contrast media into the artery of Adamkiewitz, which may originate from an intercostals or lumbar artery between T3 and L4 usually on the left side, may result in transverse myelitis. Lack of back flow when the tip of the catheter is in the small artery usually means the catheter is occluding the vessel. Catheter Removal 1. Prior to catheter removal, the distal pulse should be checked for its presence. If it is absent, the catheter should be pulled down to near the arterial puncture site and a pull-out arteriogram should be obtained to determine the etiology. 2. A pigtail catheter should always be straightened by a guide wire prior to removal. This procedure should be carried out in the abdominal aorta. If an aneurysm is present, this should be performed superior to the aneurysm. 3. If a loop is present, the catheter may be withdrawn gently under fluoroscopy until the loop gets undone. 4. If any resistance is encountered stop and evaluate. 5. If there is not resistance, you may gently remove the catheter. 6. If the distal pulse is present and the catheter is withdrawn slowly and atraumatically and the artery is compressed over the arterial puncture site with sufficient pressure to obtain hemostasis with one or two fingers for 10 to 15 minutes. 7. If a closure device is used pressure should still be maintained for approximately 5 minutes. 8. It is not always necessary or desirable to obliterate the arterial pulse. 9. After 5 minutes of constant moderate compression, the pressure is gradually released and at the end of 15 minutes, you are merely supporting the subcutaneous tissue. Do not release abruptly. 10. When you check at the end of the compression, release gently. 11. All arterial punctures should be compressed for 15 minutes (or more). 12. All venous punctures should be compressed for 10 minutes. 13. Patients with hypertension bleeding tendency will require a longer compression time. Written: 7/1/2003 Reviewed: 1/15/07 Revised: 01/09 Revised 11/9/2012

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