Pulmonary Angiography Technique Periprocedural Care

Updated: Feb 05, 2021
  • Author: Amanda M Wiant, MD; Chief Editor: Caroline R Taylor, MD  more...
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Periprocedural Care

Pre-Procedure Planning

Before the procedure, the interventionalist should review the following patient information in addition to a complete history and physical examination:

  • Vital signs and hemodynamic parameters

  • Allergies, particularly to intravenous contrast material or other procedural medications such as sedatives

  • Medications, including anticoagulants, antiplatelet agents, and metformin

  • ECG abnormalities: Look specifically for LBBB [32] ; potentially fatal complete heart block is a risk during manipulation of the catheter through the right heart by induction of a right bundle branch block; if LBBB is present, a transvenous pacemaker or external pacing leads should be in place prior to starting the procedure possibly in consultation with the cardiology service

  • Laboratory studies: Blood urea nitrogen/creatinine, coagulation parameters (PT, PTT, INR, platelets), pregnancy test (if appropriate)

  • Imaging: CT scanning (to evaluate anatomic abnormalities and to plan approach), ultrasonography (to check for location of deep venous thrombosis, if present), echocardiography (may show right heart dysfunction in a patient with PE; PFO increases the risk of periprocedural stroke in rare circumstances)


Patient Preparation

The patient is placed on nothing by mouth (NPO) status according to the institution’s requirements for patients undergoing monitored moderate conscious sedation.

Anesthetize the skin using appropriate anesthetic agent. Conscious sedation may be used depending on the clinical status of the patient.

Be alert for airway issues when giving respiratory depressants. Avoid excessive sedation, since breath-holding during imaging is crucial in obtaining diagnostic-quality imaging.

The patient is placed in the supine position on the angiographic table.

Periprocedural observation includes puncture site checks to evaluate for hematoma, in addition to frequent vital sign monitoring for the first 4 hours postprocedure.