1. Before You Start: Evaluation of the Patient and the Procedure
Krishna Jain MD, FACS
Clinical professor of Surgery
Western Michigan University Homer Stryker MD School of Medicine
Society for Vascular Surgery, 2019

3. Disclosures President and CEO National Office Endovascular Labs LLC
CEO National Surgical Ventures

4. Not Suitable for Office Intervention
Morbid Obesity
Severe dye allergy
Inability to lay flat
Pain control and anxiety
Sever seizure disorder
ASA 4
Poor airway
Severe sleep apnea
MI < 3 months
Stroke < 3 months
Previous anesthetic complications ( If conscious sedation planned )

6. Pre procedure Checklist
Name,
Date of Birth
Sex
Age
Weight
Medical record number
Informed Consent
Procedure
Type
Site marked

7. Pre Procedure Checklist
Anticoagulants
Not applicable
Stopped
Pt, PTT checked
Blood sugar
Checked before procedure
GFR
Checked
Normal
Abnormal: hydration protocol

8. Pre Procedure Checklist
Allergies
Drugs
Antibiotics
Contrast Agent
Allergy Prevention
Not Applicable
Medicines administered
Administered
Not indicated

9. Pre Procedure Checklist
Special Equipment
Available
Not needed
Cardiopulmonary status
Abnormal, unchanged from baseline
Blood pressure
Radiation Precautions
All personnel adequately protected

10. Patient With Renal Insufficient But Not On Dialyses
Less than 5 CC of dye
Use of intravascular ultrasound
Ultrasound guided intervention

11. Patients for Port Insertion
Platelet count
White blood cell count
PT,PTT

12. PAD Intervention Hostile groin Retrograde tibial approach
If diseased one vessel run off, may be contraindicated
Obesity
Indication for procedure ( Poor outcome in Rutherford 6)

13. Anesthesia Local anesthesia Does not need to be NPO
Can receive narcotics
Conscious sedation
Needs to be NPO

14. Procedure Is it appropriate Is indication well documented?
Procedures scheduled on regular intervals are not indicated and may result in fines.
No difference in indications based on geographical location of the procedure
Should not be driven by financial incentive