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Malone Complications and Troubleshooting
Published in Marc A. Levitt, Pediatric Colorectal Surgery, 2023
Be aware that the flush can reflux into the terminal ileum in some patients, instead of flowing through the large intestine (Figure 18.3). As a result, the flush will not work well for these patients, and they will often experience side effects of nausea and abdominal discomfort. Of course, a large volume of the flush does not therefore enter the colon, so the flush is ineffective. The problem, if identified, can be resolved by placing a longer catheter into the Malone, which will direct the flush to the colon. This is a procedure performed by interventional radiology. Or, if the patient is cathing the Malone, they should put the catheter in deeper. Correct passage of the catheter into the deep right colon can be confirmed in the radiology suite.
Hospital Resources
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
When PICC (peripherally inserted central catheter) lines became available it was common practice for me to insert them at the bedside. This could easily be done under strict sterile conditions with the assistance of a floor nurse. As with the central lines, this is now commonly done under ultrasound guidance. It can still be at the bedside by a physician or IV team, but many hospitals (including ours) utilize interventional radiology for this procedure.
Vascular Trauma
Published in James Michael Forsyth, How to Be a Safe Consultant Vascular Surgeon from Day One, 2023
You contact the vascular interventional radiologist on-call and explain the situation. You both agree the patient needs an emergency thoracic aortic stent. The patient is counselled for this and goes immediately from A&E to interventional radiology for the procedure.
Peptide receptor radionuclide therapy in neuroendocrine neoplasms and related tumors: from fundamentals to personalization and the newer experimental approaches
Published in Expert Review of Precision Medicine and Drug Development, 2023
Currently, multiple therapeutic options are available for the management arsenal of NETs, including surgery, liver-directed therapies (like RFA, TACE, TARE, SIRT), somatostatin analogues (SSA), radiolabelled SSTR-based therapy (PRRT), chemotherapeutic agents, molecular targeted agents, and immunotherapy. The choice of the most appropriate option depends upon multiple factors like local tumor invasion, metastatic status, functional status, histopathological subtype and grade, SSTR, and metabolic status on dual tracer PET imaging and the patient’s clinical condition. For limited early disease- only local tumor invasion surgery is the best curative option but most of the tumors remain asymptomatic and get diagnosed when it has already metastasized or progressed to inoperable stages. The locoregional cytoreductive strategies, e.g. trans-arterial chemo-embolization (TACE), trans-arterial embolization (TAE), radiofrequency ablation(RFA), and other techniques such as selective internal radiation therapy (SIRT), are helpful in palliative and symptom control. These local embolization techniques are particularly useful when treating patients with functionally active liver metastases. TACE has shown symptomatic response rates of 60–95% and the radiological response of 33–80% with response duration of 18 and 24 months [67,68]. The procedure may require more than one treatment session and interventional radiology assistance.
Radiation exposure during angiographic interventions in interventional radiology – risk and fate of advanced procedures
Published in International Journal of Radiation Biology, 2022
Hanns Leonhard Kaatsch, Julian Schneider, Carolin Brockmann, Marc A. Brockmann, Daniel Overhoff, Benjamin Valentin Becker, Stephan Waldeck
In recent years, angiographic procedures in interventional radiology (IR) have been used more widely and embrace new and often advanced therapy options for several diseases. In the treatment of acute ischemic stroke and ruptured cerebral aneurysms, for example, interventional procedures represent valuable and often superior therapeutic approaches compared to surgical treatment (Fransen et al. 2014; Ellis et al. 2018). Furthermore, in the care of trauma patients, e.g. suffering from spleen laceration or aortic dissection, interventional procedures are meanwhile recommended as standard in many cases (Gould and Vedantham 2006). It is therefore not surprising that numbers of performed interventions have continuously risen during recent years in Germany, the US and other countries, respectively (Tsapaki et al. 2009; Schegerer et al. 2019; Mettler et al. 2020). More complex interventions often result in higher dose burdens for patients (Miller et al. 2003) and especially fluoroscopically guided interventions affect patients (Vano et al. 2008) as well as attending medical staff alike (Chida et al. 2013). The administered doses applied in angiographic procedures range from very low doses (e.g. peripheral artery occlusion therapy) to high doses for special treatments (e.g. endovascular aortic repair (EVAR)) and may even reach exorbitant levels under special circumstances (Jaschke et al. 2020). Hence, deterministic effects, such as cutaneous radiation injuries and cataracts have been repeatedly reported (Balter et al. 2010; Rehani and Srimahachota 2011; Vano et al. 2013; Balter and Miller 2014).
Implementation of an academic hospital medicine procedure service: 5-year experience
Published in Hospital Practice, 2021
Hillary Spangler, John R. Stephens, Emily Sturkie, Ria Dancel
Prior studies have demonstrated that an MPS presents academic hospitals with a cost-effective and safe way to provide procedural support, as there is less need for referrals [25]. While Tukey et al. did not find an MPS revenue positive [10], our MPS implementation correlated with a dramatic increase in procedural revenue for our department, suggesting that prior to the use of the MPS service, procedures were being referred or were not being billed due to lack of supervising physician presence. Additionally, the MPS increases efficiency by performing procedures at bedside, obviating the need for patient transport, and allowing for fast turnaround between request and completion. Using paracentesis – our most common procedure – as an example, we can calculate the cost savings of having an MPS to perform this single procedure. Barsuk et al. found that referral for paracentesis to interventional radiology resulted in an increased length of stay by 1.86 hospital days per case even though there was no difference in patient complexity in study patients referred to interventional radiology [25]. Extrapolating these data to our series, the 2,022 MPS performed paracenteses avoided 3,757 hospital days over a 5-year period. Using the 2009 Healthcare Cost and Utilization Project estimate of 2000 USD per day of hospitalization [26], our MPS may thus have saved more than 7,500,000 USD over 5 years for paracentesis cases alone.