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Peripheral Intervention: Ardhiana Kasaba

The document discusses various peripheral interventions including diagnostic angiography and venography as well as therapeutic procedures like inserting central venous access devices, angioplasty, and embolization/sclerotherapy. It provides details on different diagnostic modalities for arterial imaging of the lower limbs and indications for CVADs. Angioplasty and sclerotherapy procedures are also described.

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Fitri Shabrina
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154 views36 pages

Peripheral Intervention: Ardhiana Kasaba

The document discusses various peripheral interventions including diagnostic angiography and venography as well as therapeutic procedures like inserting central venous access devices, angioplasty, and embolization/sclerotherapy. It provides details on different diagnostic modalities for arterial imaging of the lower limbs and indications for CVADs. Angioplasty and sclerotherapy procedures are also described.

Uploaded by

Fitri Shabrina
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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Peripheral intervention

Ardhiana Kasaba
What we can do to help?
Peripheral intervention
Diagnostic
- Arteriogram.
- Venogram.
Theraupetic
- Inserting CVAD (Central Vein Acces
Devices).
- Angioplasty
- Embolisation/ scleroteraphy.
DIAGNOSTIC
Diagnostic
SCENARIO FOR LOWER LIMB MODALITY
ARTERIAL IMAGING
ELECTIVE

Intermitten claudication MRA/CTA>DSA


Chronic critical limb ischaemia MRA/CTA>DSA
Assesment of bypass graft US then DSA
Popliteal aneurysm US initial diagnosis and size then
DSA/MRA
Politeal entrapment US initial diagnosis,MR/MRA
Tumor/vascular malformation MR/MRA, DSA for intervention
ACUTE

Acute limb ischaemia DSA > MRA


Trauma CTA , except un usual condition.
DIAGNOS
TIC DSA superior for
end peripheral
arteries and vessel
detailing
DIAGNOSTIC
CVADs
Central Vein Acces Devices

DEFINITION
A short or long term intravenous
catheter inserted into a centrally
located vein with the tip residing in
the lower 1/3rd of the Superior Vena
Cava (SVC)

(Infusion Nurses Society (INS) Standards of


Practice, 2006).
The superior vena cava is on
average 20 mm in diameter and has
a high blood flow of approximately
2000 mL/min, far greater than in a
peripheral vein.

This means that irritant drugs and


fluids, those with concentrations of
solutions with extremes of pH or
osmolality can be infused without
damaging the SVC vein wall due to
this increased haemodilution.
CVADs usually used
Peripherally Inserted Central Catheter (PICC)
Hickman skin tunneled catheter
Central Venous Catheter
(short term non-tunneled referred to as CVC)
Port-a-cath implanted port and Power
Port(power injectable)
Dialysis & Apheresis catheters which are
procedure specific
Antibiotic and antimicrobial coated
catheters.
CHOOSING THE ACCESS
DEVICE
Patients disease and status
Number and type of solutions,
osmolality
Flow required
Frequency accessed
Duration of use- days vs months
Preferences - Dr. / Patient
DURATION
> 7 days - PICC Line
1- 12 Weeks - PICC line / tunneled
catheter
12 weeks - 6 months or greater
tunneled catheter
> 6 months - Port
Commonly used catheter
insertion sites
CENTRAL VENOUS ACCESS:
INDICATIONS

1. Long term IV therapy:


-Chemo
-Antibiotics
-TPN
-Blood products
2. Recurrent blood draws
3. Dialysis
Dialysis catheter
PICC
Implanted Venous Ports
Placed in IR or OR.
May be used for chemo same day
it is inserted.
Need huber needle to access.
Sterile procedure for access.
2,000 punctures.
Nice VAD for patients; low care
and maintenance, low infection
rate.
Needs a flush once a month when
not in use.
Newer power ports, regular and
low profile.
Image Guided minimally
invasive procedure.

Ultrasound guiding image for


vein acces.
X ray fluoroscopy guiding image
(cath lab) to make sure the
catheter tip at SVC.
Angioplasty
Angioplasty (PTA)
Angiosome concept
Stenosis post AV
fistula

Ballon
inflate
Scleroteraphy
Scleroteraphy

Procedure to treat blood vessel


malformation
A medicine injected into the vessel ,
which make them shrink.
In adults often to use to treat spider
veins and small varicose vein
Terima Kasih

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