Subject(s)
Clinical Competence , Nurse Practitioners , Nurse's Role , Radiography, Interventional/nursing , Radiology, Interventional , Certification , Clinical Competence/economics , Clinical Competence/standards , Cooperative Behavior , Drug Prescriptions/nursing , Fees and Charges , Health Care Costs , Humans , Insurance, Health, Reimbursement , Nurse Practitioners/economics , Nurse Practitioners/standards , Practice Guidelines as Topic , Practice Management, Medical , Radiography, Interventional/economics , Radiography, Interventional/standards , Radiology, Interventional/economics , Radiology, Interventional/standards , WorkloadABSTRACT
OBJECTIVE: To review venous anatomy and physiology, discuss assessment parameters before vascular access device (VAD) placement, and review VAD options. DATA SOURCES: Journal articles, personal experience. CONCLUSION: A number of VAD options are available in clinical practice. Access planning should include comprehensive assessment, with attention to patient participation in the planning and selection process. Careful consideration should be given to long-term access needs and preservation of access sites. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses are uniquely suited to perform a key role in VAD planning and placement. With knowledge of infusion therapy, anatomy and physiology, device options, and community resources, nurses can be key leaders in preserving vascular access and improving the safety and comfort of infusion therapy.
Subject(s)
Catheterization, Central Venous/instrumentation , Catheterization, Peripheral/instrumentation , Catheters, Indwelling/supply & distribution , Nursing Assessment/methods , Oncology Nursing/methods , Patient Selection , Age Factors , Catheterization, Central Venous/nursing , Catheterization, Peripheral/nursing , Comorbidity , Equipment Design , Humans , Infusions, Intravenous/instrumentation , Infusions, Intravenous/nursing , Medical History Taking , Nurse's Role , Patient Care Planning , Patient Participation , Physical Examination , Safety , Veins/anatomy & histology , Veins/physiologyABSTRACT
It is increasingly recognized that clinical management in interventional radiology is necessary. To effectively participate in such management requires patient management infrastructure. The cornerstone of this effort is the clinical office.
ABSTRACT
During the past two decades, the practice of interventional radiology has evolved into one that mandates longitudinal patient care taking place before, during, and after interventional procedures. This requires the establishment of relationships between physicians and patients that often must be fostered in an outpatient clinic setting. Recognition of this practice shift was formally made by the American College of Radiology with the publication of a document concerning the importance of clinical patient management within the practice of interventional radiology. This article will review the clinical patient management as it relates to the practice of interventional radiology, with a focus on the physician-patient relationship and the components of a successful outpatient clinic.
Subject(s)
Ambulatory Care Facilities/organization & administration , Physician-Patient Relations , Practice Management, Medical/organization & administration , Radiology, Interventional/organization & administration , Appointments and Schedules , Facility Design and Construction , Forms and Records Control , Humans , Patient Credit and CollectionABSTRACT
PURPOSE: To evaluate the safety and efficacy of the recombinant tissue plasminogen activator alteplase in the clearance of poorly functioning tunneled hemodialysis catheters. METHODS: We retrospectively reviewed the outcomes of 25 patients who presented with poorly functioning hemodialysis catheters and were treated with alteplase. After confirming fluoroscopically the need for thrombolytic therapy, alteplase was administered over 2 hours as a 2.5-mg/hour/catheter lumen infusion (total 10 mg). Treatment was considered a clinical success if a flow rate of 250 mL or more per minute was established. RESULTS: Clinical success was achieved in each of 25 patients (100%). There were no thrombolytic-related complications. Catheter survival was extended 30 days in 54% of patients and 45 days in 33% of patients. CONCLUSION: Alteplase is a safe and effective means of producing clearance of blocked tunneled catheters.
Subject(s)
Catheters, Indwelling , Fibrinolytic Agents/therapeutic use , Renal Dialysis/instrumentation , Tissue Plasminogen Activator/therapeutic use , Adolescent , Adult , Aged , Aged, 80 and over , Equipment Failure , Female , Humans , Male , Middle Aged , Retrospective Studies , SafetyABSTRACT
PURPOSE: To assess the feasibility and safety of early ambulation in patients undergoing transfemoral diagnostic angiography using 4-F catheters or sheaths. METHODS: In this prospective study approved by the institutional review board, patients undergoing diagnostic angiography were randomized to ambulate 3 or 6 hours after catheter or sheath removal. All patients were assessed for hematoma formation, pseudoaneurysm development, and other groin complications during the in-hospital recovery period and after 30 days. Patient satisfaction and comfort level were also assessed by survey. RESULTS: Of 110 patients (66 men; mean age 64.9 +/- 12.8 years) who participated in this study, 47 were randomized to the 6-hour (6-H) group and 63 to the 3-hour (3-H) group. In the 3-H and 6-H groups, respectively, a 4-F catheter was used in 45 (71%) and 35 (74%) patients and a 4-F sheath in 18 (29%) and 12 (26%). No clinically significant groin complications were encountered in either group. Moderate to severe discomfort was reported in 9 (16%) of the 56 patients responding to the discomfort survey in the 3-H group compared to 10 (26%) of the 38 in the 6-H survey respondents. CONCLUSIONS: It is feasible and safe to ambulate patients 3 hours after diagnostic angiography performed with a 4-F catheter with or without a 4-F sheath. Early ambulation of patients after angiography has the additional benefits of increasing patient satisfaction and resource utilization.
