Primer For New Trainees In Interventional Radiology

OVERVIEW

This page is dedicated to serving as a primer for trainees that are new to the field of interventional radiology (IR). The content on this page can be found throughout the interventional 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 IR that complement the content of stepwards.com.

The field of Interventional radiology one can be daunting for new trainees given its nuanced nature. This page strives to try and clarify some of the basics (image source).
BASIC CONVERSIONS AND MEASUREMENTS IN INTERVENTIONAL RADIOLOGY

Measurements in interventional 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 INTERVENTIONAL RADIOLOGY SUITE

Many different types of technical equipment are utilized in the interventional 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:

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 IR procedures. Unlike most surgical specialties for IR 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 PREP AT THE START OF A CASE

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

  • Filling syringes (saline/contrast)very routinely at the start of the case the empty syringes used for contrast and saline injections will need to be filled. It is important to be familiar with the apparatus used to fill these syringes as it is often times the role of more junior trainees to make sure these syringes stay filled. Please refer to the linked page for a detailed video on how to use the apparatus for filling these syringes as it is a bit nuanced. It involves lines for saline, contrast, and then also a line for flushing syringe contents into a waste collection bag.
  • Flushing wiresand most any device that has a leur lock compatible port (needles, catheters, dilators, sheaths, etc) will generally be flushed at the start of a case. This includes wires which are packaged in casings that allow for the to be flushed easily. The linked page shows how this can be performed. It is important to realize that there are exceptions to this flushing rule (such as NOT flushing balloon ports on devices such as balloon dilators, drainage tubes with balloon retention devices, etc). 
COMMONLY USED EQUIPMENT DURING CASES

There are many different types of equipment that are used in the field of interventional radiology (an overview of equipment can be found here) however the list below identifies some of the most commonly used things and provides linked pages with more information:

  • Micropuncutre Kitthis kit is used very commonly at the start of the case to gain access. The linked page shows the kit components, how to prepare/flush each item, and then also includes a video on how to actually use the kit itself.
  • Vascular Access Sheath (Percutaneous Sheath Introducer Set)this set is used very commonly at the bringing of a case to establish long term access. The linked page shows the kit components, how to prepare/flush each item, and then also includes a video on how to actually use the kit itself.
  • 3-Way Stopcockwhile a simple device, its usage can be tricky for new trainees. The linked page provides a video which shows clearly how to use the 3-way stopcock to avoid unnecessary spills.
WIRE MANAGEMENT

A core component of working in interventional radiology involves working with wires. While not necessarily the most complicated topic, handling wires effectively and being able to manage organizing multiple wires on the table is a useful skill. Some specific points on this subject include:

  • How to gather a wireit may not seem like such a huge topic, however as things speed up during a case it is important to be skilled in how to gather a wire quickly and effectively without compromising the integrity of the wire or its sterility. Observe the linked page which includes a video on this topic.
  • Re-sheathing wires (placing them back in their packaging/casing)it will depend on the situation however sometimes it is advantageous to put a wire back in the casing it was packaged in. The linked page offers more on this topic.
  • Loading equipment onto the wireit can be tricky loading small devices onto thin wires given that the wire will need to be threaded through very small holes. Small technical considerations discussed in the linked page/video can help make this skill second nature. Mainly using ones finger on the back end of the wire as a scaffold for loading things onto the wire is useful.
  • Advancing equipment over the wire (pinch/push technique)it is very critical to avoid moving the wire when advancing equipment over the wire. It is dangerous for the wire to move forward without knowledge of the interventional radiologist. Similarity if the wire moves back access into a specific anatomical space may be lost unnecessarily. It is for this reason that a pinch/push technique is implemented which involves pinching the wire and pushing the device that is being advanced to ensure that the wire does not move. The linked page/video helps demonstrate this technique.
  • Removing equipment off the wire (pinch/pull technique): it is very critical to avoid moving the wire when removing equipment off the wire. It is dangerous for the wire to move forward without knowledge of the interventional radiologist. Similarity if the wire moves back access into a specific anatomical space may be lost unnecessarily. It is for this reason that a pinch/pull technique is implemented which involves pinching the wire and pulling the device that is being removed to ensure that the wire does not move. The linked page/video helps demonstrate this technique.
  • Securing the back end of the wire (anchoring the wire)often times it is useful to secure the back end of the wire to make sure that it does not move. The wire is pinched and then ideally the anchoring hand is rested on stable surface. The linked page/video demonstrates this technique.
APPLYING DRESSINGS AT THE END OF A CASE

At the end of cases it is important to make sure 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:

 

Page Updated: 03.03.2019