Fletcher Allen, a Vermont university hospital and medical center, serves all of
Vermont and the northern New York region. Located in Burlington, Fletcher Allen is a regional, academic healthcare center and teaching hospital in alliance with the University of Vermont.
What should I do to prepare for my procedure?
Prior to the examination, the physician requesting the procedure will order blood tests to assess your kidney function (if you will receive contrast) and to check your blood's ability to form a clot. Those results must be available at least 3 days prior to the procedure.
You may have fat free liquids (water, black coffee or tea, white grape juice, or ginger ale) until four hours before your procedure
Do not eat any solid foods after midnight before your procedure. Unless your doctor has instructed you to restrict fluids, drink extra fluids the day before and the day after your procedure. Our bodies respond better to contrast dye when we are well hydrated.
You may take all of your routine medications with a sip of water. Inform your doctor if you take any blood thinning medication (e.g. Coumadin (Warfarin), Plavix, aspirin, NSAIDS). He will advise you whether to stop taking this medicine for a certain time period prior to your procedure.
Do not stop a medication on your own!
Your doctor needs to know if you have had an allergic reaction to contrast (X-ray Dye or IVP Dye) or iodine. If you have, you may need to take special medications, (prednisone and benadryl), 24 hours prior to your scheduled exam.
You must have a responsible adult available to drive/escort you home from the hospital.
Patients with Diabetes:
If you have diabetes and are on insulin you should check with your doctor about adjusting your insulin dose the morning/day of the exam. You will not be eating your regular diet that morning and may need to alter your medication regime.
If you are on Glucophage/Glucovance, you should take it the day of the procedure, but you may be instructed not to take it for 2 days following the exam. You will be asked to get a blood test, (creatinine level) a few days after the test. After your physician has seen these results he/she will inform you as whether to resume your medication.
You will be directed to the cardiovascular waiting room. You will be escorted to the cardiovascular unit. You will change into a hospital gown and an intravenous (IV) line will be started. This will be used to give you fluids and medications during the procedure. The IV will stay in place until you are ready to be discharged home.
A staff member will take a brief medical history that includes any past medical problems/surgeries and a list of current medications. A member of the interventional team, (Physician, Physician Assistant or Nurse Practitioner) will tell you about the procedure, explaining the benefits and risks and give you the opportunity to ask questions.
If you are a patient with chronic renal failure and on dialysis, you will need to have your blood drawn 1-4 hours prior to the procedure to check your BUN and potassium levels. You may also need to have your PT/INR checked.
What is conscious sedation?
Conscious sedation or moderate sedation is a type of anesthesia in which the patient is given medication to produce a sleepy and relaxed state. It is safer than general anesthesia. The most frequently used drugs are Valium-like medication: “Midazolam (Versed®)” and Morphine-like medication: “Fentanyl.”
This conscious sedation will be administered through an intravenous (IV) line by a specially trained radiology nurse. Its purpose is to relax you during your procedure and to reduce perception of any discomfort that you may experience. If you have an allergy to either of these medications, please let your doctor know.
You will be drowsy, but will remain conscious and able to speak and follow directions throughout your procedure. Your blood pressure, blood oxygen level, heart rhythm and breathing rate will be continuously monitored throughout the procedure.
Any medical procedure has inherent risks. The decision to perform a given procedure is based upon consideration of the risks and the benefits. In almost all instances and certainly for all elective procedures, the potential benefits should far outweigh the risks. The relative risks may vary between patients depending on general health, underlying diseases and medications taken.
- Most common general risks include:
- Any procedure which breaks the skin carries the risk of infection. This may manifest as local wound infection to severe life-threatening internal infection. Great care is taken to avoid infections as procedures are performed under sterile conditions.
- In general the pain experienced varies with the type of procedure. Individual patients may also have different expectations and responses to pain. Nearly all procedures utilize local anesthetic which, once injected, blocks perception of sharp pain and temperature. Patients can expect to continue to feel pressure such as pulling and pushing.
- Inherent in any procedure which breaks the skin is the potential to cause bleeding. Bleeding can range from oozing of the incision or under the skin, (hematoma), to massive life-threatening hemorrhage. Again, relative risks vary with the type of procedure and underlying medical conditions and medications being taken
The doctor will give you local anesthesia in the skin at the site of the procedure. The radiology nurse will also give you medication, through your IV to help you relax (Conscious Sedation). You will not be put to sleep, but we will make you comfortable and relaxed while you maintain breathing on your own.
What is my expected recovery time and will I have any activity restrictions?
Recovery will vary with the type of procedure. Following an arteriogram, patients will be on bed rest for at least 4-6 hours while keeping the extremity that was punctured straight and their head flat on the pillow for the first 2 hours. If there are no signs of bleeding at that time, you would be discharged home. For the next 48 hours you should not lift more than 5-10 lbs., minimize use of stairs, bending at the hip, and picking things up from the floor. Any straining such as vomiting, coughing, or forced bowel movements could dislodge the clot that forms to seal the artery and cause bleeding, therefore, it is wise to support the arterial access site , holding moderate pressure if that occurs.
It is usually safe to resume any blood-thinning medications within 24 hours however you should ask the physician performing the procedure.
The amount of discomfort will vary with the type of procedure you have. In most cases, it is normal to have soreness at the point of entry into the body. Often this is relieved by non-prescription medication such as Tylenol. Discomfort is usually worst within the first 48 hours following the procedure.
Some signs to watch for include progressively worsening pain, bleeding at the point of entry or fever/chills.
You will receive a set of after-care instructions that will be specific to the procedure performed. These will also include a phone number for you to call should you have specific problems or questions once you leave the hospital.