Difference between revisions of "I need a procedure"

Revision as of 05:42, 5 August 2022

Who to call

• Imaging-guided interventions are provided by several sections in radiology (VIR, Body, GI/GU, Peds, Neuro, MSK, Chest) the details and appropriate contacts for which are below (and also on this spreadsheet). Consider using the search function to find the procedure (and associated team) below.

• Please note that while placing an imaging-guided procedure order will be needed (the most common of which are here), this procedure order alone will NOT generate a page to the appropriate radiology section; you'll need to follow the section-specific steps below to make sure the appropriate team is aware of the request

VIR (Vascular and Interventional Radiology)

You can contact VIR via the Vascular Radiology pager (970-7930) or by placing a 'Consult to Interventional Radiology' order to generate a page. VIR uses a home-call system and is available for emergent procedures 24/7; for non-emergent procedure requests, non-urgent questions, and FYI pages, please contact us between 6:30am and 9:30pm, as the home-call fellow will otherwise be asleep overnight. VIR procedures include:

• Tunneled central line placement and bedside removals
• Arteriograms +/- intervention (e.g., arterially extravasating GI bleed requiring embolization)
• Pulmonary arteriograms and PE suction thrombectomy
• IVC filter placements and removals
• AVF / AVG fistulagrams +/- intervention
• Percutaneous GTube / GJ Tube / J Tube placements, replacements, and checks in adults
• Percutaneous nephrostomy / biliary / cholecystostomy tube placements, replacements, and checks (PCNs, PBDs, PercCholes)
• Intravascular solid organ biopsies (e.g, transjugular liver biopsies, transcaval biopsies)
• Solid organ tumor ablations and embolizations (e.g., hepatic Y-90 treatment, hepatic bland embolization and microwave ablation, renal cryoablation, etc)
• Vertebral kyphoplasty and sacroplasty
• Venous and arterial malformation percutaneous treatment
• Additional procedures not covered below

Of note, VIR does not place PICC lines (contact PICC team), and generally does not place or pull inpatient non-tunneled central lines (contact medical procedure team), though is available in complicated cases.

Body Interventions

The Body Interventions pager (206-3465) is held from 7:30 am to 5:00 pm Monday-Friday. If urgent or emergent intervention is required between 5:00 pm and 10:00 pm Monday-Friday, or 7:30 am to 12:00 pm on weekends/holidays, please call the Body reading room (684-7224). If emergent intervention is required outside of these hours (ie, overnight), please call the Radiology Senior Call phone (681-4422). Body intervention procedures include:

• Intraabdominal collection drain placement and aspiration (U/S and CT-guided)
• Superficial soft-tissue collection aspiration and drains (U/S and CT-guided)
• Percutaneous solid organ and other intraabdominal biopsies, both targeted and random (U/S and CT-guided)
• See 'GI / GU Fluoroscopy' for information on Dobhoff tubes, esophograms, upper GI exams, contrast enemas, etc

GI / GU Fluoroscopic Studies

GI / GU fluoroscopic studies are available from 7:30 am to 5:00 pm Monday-Friday, which can be scheduled by calling the GI/GU reading room (684-7257). Urgent procedures are available from 7:30 am to 12:00 pm on the weekend / holidays, which can be scheduled by calling the Body reading room (684-7224). If emergent evaluation is required between 5:00 pm and 10:00 pm Monday-Friday, please call the Body reading room (684-7224). If emergent evaluation is required outside of these hours (overnight), please call the Radiology Junior Call phone (681-4475). GI / GU fluoroscopic evaluations include:

• Imaging-guided Dobhoff tube placements (we ask that an attempt is first made on the floor)
• Esophagrams, Upper GI studies (evaluate through the ligament of Trietz), and small bowel follow throughs (for intestinal motility)
• Contrast enemas (water-soluble contrast for leaks, barium for pre G-tube placement)
• Fluoroscopic cystograms and retrograde urethragrams (RUGs)
• For similar exams but in the pediatric patients, please see 'Pediatric Fluoroscopic Studies' for more information

Pediatric Fluoroscopic Studies

Pediatric fluoroscopic studies are available from 7:30 am to 5:00 pm Monday-Friday, and urgent studies available from 7:30 am to 12:00 pm on the weekend. These can be scheduled by calling the Peds reading room (684-7288). If emergent evaluation is required outside of these hours (overnight), please call the Radiology Junior Call phone (681-4475). Pediatric fluoroscopic evaluations include:

• Fluorscopic upper GI exams (evaluate for malrotation, upper GI pathology) and contrasted enemas
• Fluoroscopic Dobhoff tube placement
• Fluoroscopic percutaneous GTube / GJ tube checks
• Intussusception reductions

Neuroradiology Interventions

The Neuroradiology Interventions pager (206-9959) is held from 7:30 am to 5:00 pm Monday - Friday. If emergent intervention is required between 5:00 pm and 10:00 pm Monday-Friday, or 7:30 am - 12:00 pm on the weekend, please call the Neuroradiology reading room (684-7213). If emergent intervention is required outside of these hours (overnight), please call the Radiology Senior Call phone (681-4422). Neuroradiology procedures include:

• Fluoroscopic guided lumbar punctures (following failed bedside LP attempts)
• Myelograms
• Vertebral body / disc aspiration for evaluation of osteomyelitis
• CSF-leak related interventions

Musculoskeletal Interventions

MSK interventions can be requested between 7:30 am to 5:00 pm Monday-Friday by calling the MSK reading room (684-7465). If emergent intervention is required between 5:00 pm and 7:30 am or on the weekend, please call the Radiology Senior Call phone (681-4422). MSK procedures include:

• Fluoroscopic guided bone biopsies, marrow aspiration
• Shoulder and hip arthrograms and aspirations

Thoracic Interventions

Chest interventions can be requested between 7:30 am to 10:00 pm Monday-Friday by calling the CTI reading room (684-7419). If emergent intervention is required outside of these hours, please call the Radiology Senior Call phone (681-4422). Chest procedures include:

• Lung / mediastinal / pleural biopsy not accessible by interventional pulmonology
• CT guided thoracentesis / chest tube placement if not successful by ultrasound approach with interventional pulmonology

Procedure Request Checklist

For all procedures,, please have the following information readily available:

• Patient last name and MRN (room number is not terribly helpful)
• Consentability, NPO, and anticoagulation status
• Relevant allergies (contrast, sedating medications)
• A direct call-back number that you will be available at for 60 minutes following your page.