Primer For New Trainees In Neurointerventional Radiology

OVERVIEW

This page is dedicated to serving as a primer for trainees that are new to the field of neurointerventional radiology (NIR). The content on this page can be found throughout the neurointerventional radiology section of this website, however it is also organized here for the sake of convenience. While this page aims to serve as a good primer there are other established resources for NIR that complement the content of stepwards.com.

FUNDAMENTAL PERI-PROCEDURAL TASKS

There are fundamental peri-procedural tasks that are universal and apply to many different types of radiology procedures which are organized and discussed further on this page. A good example of such a task is how to perform a chart review (and write a H/P note).

READING DIAGNOSTIC IMAGING

A big component of neurointerventional radiology is being able to interpret diagnostic imaging studies. Every study in radiology can have a “search pattern” which refers to a guide on how to read through the study in question. The search patterns for various imaging studies are organized here.

The search patterns for various CT studies are organized here:

• CT Head (Non-Contrast)

BIPLANAR PROJECTIONS

Angiographic projections change the visualization of cerebral vasculature, and it is important to understand the relationship between biplanar projections and the appearance of key vascular anatomy. Here is a guide to angiographic projections commonly utilized in NIR.

BASIC CONVERSIONS AND MEASUREMENTS IN NEUROINTERVENTIONAL RADIOLOGY

Measurements in neurointerventional radiology can get confusing because needles are measured in GAUGES, wires diameters are measured in INCHES, and other equipment (such as catheters, sheaths, etc) are measured in FRENCH. This page is decanted to discussing this topic in greater detail to provide some clarification on this quirky aspect of interventional radiology.

UNDERSTANDING AND UTILIZING ROOM EQUIPMENT IN THE NEUROINTERVENTIONAL RADIOLOGY SUITE

Many different types of technical equipment are utilized in the neurointerventional radiology procedure room. It is important to try and become familiar with these pieces of equipment because they are often times relied upon heavily during a case. Some examples are listed below:

• Using Ultrasound For Interventional Radiology Procedures: this is a very large topic however a video series that introduces how to use ultrasound for interventional radiology procedures is linked here.

BASIC TECHNICAL SKILLS RELEVANT TO NEUROINTERVENTIONAL RADIOLOGY

Trainees may have been exposed to some of these technical skills from other specialties, however they are also very useful to the field of NIR.

• Suturing Basics: while this guide was initially made for those interested in surgery, the skills and techniques discussed are very useful for those in NIR as well.
• Performing a Pulse Exam: an important step before any trans-arterial intervention.

START UP  KITS/TRAYS

These refer to the start up kits/trays that the technicians will use to prepare for each neurointerventional radiology case. They contain stock items (such as syringes, waste management systems, bowls, towels, etc) that are routinely used during various cases.

• Neuro Angiography Pack: this is a very typical start up kit/tray/pack that is used for many different types of neurointerventional procedures. The linked page and video goes over what is included in this pack.

SCRUBBING INTO CASES

As a new trainee it is important to understand that the manner in which people “scrub into” cases is different for most NIR procedures. Unlike most surgical specialties for NIR cases it is important to be familiar with how to scrub yourself into the case (this essentially involves putting on your gown and gloves by yourself in a sterile fashion). The general workflow for scrubbing into a case involves acquiring your gown/gloves, opening them up, washing your hands, and then carefully putting on your gown, and then using your gown to put on your gloves in a sterile fashion.

For more detailed reference please reference the dedicated page on how to scrub yourself into interventional radiology cases which provides instructional videos as well.

BASIC TASKS PRIOR TO THE START OF A CASE

After scrubbing into a case there are often certain tasks that need to be done to prepare the equipment that is routinely used at the start of the case. This includes the following:

• Organizing Sharps on the Back Table: an organized back table is important preparation prior to the start of a case. The linked page shows how to organize the table, and specifically the sharps, to help minimize the risk of an adverse event.
• Flushing Arterial (Drip) Lines: most all neurointerventional radiology procedures will require at least one arterial drip line to run during the case (to protect against thromboembolic events). These arterial lines will need to be flushed and prepared prior to usage to prevent the introduction of air into the patient. The linked page shows how to flush these lines prior to use.

BASIC TECHNIQUES AT THE START OF THE CASE

Once the case has begun here are some basic fundamental techniques to be aware of:

• Filling Syringes: there is a specific technique employed when filling syringes (with saline, contrast, etc) for neurointerventional cases designed to prevent the injection of air. This linked page and video shows this technique.
• Handling Sharps: proper handling of sharp objects during a case is essential for provider and patient safety.
• Double Flushing: this is how to properly flush equipment that has been exposed to patient blood (to prevent showering the brain with thromboemboli)

CLOSING ACCESS SITES/SECURING DEVICES/APPLYING DRESSINGS AT THE END OF A CASE

At the end of cases it is important to make sure that access sites are closed, devices are properly secured, and that dressings are applied neatly and properly to the patient as needed. Not only is this what the patient and other providers will see, however these dressings also serve a medical purpose (limiting oozing/bleeding, preventing infection, allowing for proper wound healing, etc). It is important to be comfortable and capable with dressing types listed below:

• Closing Femoral Artery Access Sites (Angio-Seal Vascular Closure Device): the linked device is one used very commonly to close femoral artery access sites. The linked page explains how the kit works and how to use it properly during a case.
• Closing Radial Artery Access Sites (TR Band Radial Artery Compression Device): this is a device that is used to apply compression to a radial artery access site at the end of a case. The linked page shows what is included in the kit, how to use it, and then how to remove the device when it is no longer needed.
• Dressing Puncture Sites (2×2 Gauze With Tegaderm): this is perhaps the most commonly applied dressing given that most all NIR cases will have some type of puncture site (which are commonly covered in the fashion shown on the linked page/video).