Difference between revisions of "Quick Reference"

Line 26: Line 26:
|ASA 1
|ASA 1

Latest revision as of 13:20, 19 February 2019

Pre-procedural evaluation

Non-per-oral (NPO) time

NPO Time:[1]
Minimum fasting period
Clear liquids 2h
Breast milk 4h
Infant formula, nonhuman milk, light meal 6h
Fried foods, fatty foods, or meat Potentially 8+hours needed

Physical status classification

American Society of Anesthesiologists Classification (ASA Class)[2]
ASA Class Definition Example Corrolary
ASA 1 A normal healthy patient. Fit, nonobese (BMI under 30), a nonsmoking patient with good exercise tolerance. Conscious sedation
ASA 2 A patient with a mild systemic disease. No functional limitations and a well-controlled disease (e.g., treated hypertension, obesity with BMI under 35, frequent social drinker or is a cigarette smoker). Conscious sedation
ASA 3 A patient with a severe systemic disease that is not life-threatening. Some functional limitation as a result of disease (e.g., poorly treated hypertension or diabetes, morbid obesity, chronic renal failure, a bronchospastic disease with intermittent exacerbation, stable angina, implanted pacemaker). Conscious sedation
ASA 4 A patient with a severe systemic disease that is a constant threat to life. Patient with functional limitation from severe, life-threatening disease (e.g., unstable angina, poorly controlled COPD, symptomatic CHF, recent (less than three months ago) myocardial infarction or stroke. Anesthesia consult
ASA 5 A moribund patient who is not expected to survive without the operation. Ruptured abdominal aortic aneurysm, massive trauma, and extensive intracranial hemorrhage with mass effect.   Anesthesia consult
ASA 6 A brain-dead patient whose organs are being removed with the intention of transplanting them into another patient.

Periprocedural management of coagulation status

Periprocedural management of coagulation status[3][4]
Category 1:

Low risk of bleeding, easily detected and controlled

Category 2:

Moderate risk of bleeding

Category 3:

Significant bleeding risk, difficult to detect or control

PT-INR >2.0 threshold for treatment Correct to <1.5 Correct to <1.5
PTT No consensus No consensus, but consider correcting for PTT > 1.5x control Stop or reverse heparin for PTT > 1.5x control
Platelets <50k/uL: transfuse <50k/uL: transfuse <50k/uL: transfuse
Clopidogrel and Prasugrel


Hold 5 days

Hold 5 days

Hold 5 days

Hold 7 days

Hold 5 days

Hold 7 days

Aspirin Do not hold Do not hold Hold 5 days
LMWH Hold 1 dose before procedure Hold 1 dose before procedure Hold 24h or up to 2 doses
Short-acting (ibuprofen, indomethacin)

Intermediate-acting (Naproxen, celecoxib)

Long acting (meloxicam)

Do not hold

Do not hold

Do not hold

Do not hold

Do not hold

Do not hold

Hold 1d

Hold 2-3d

Hold 10d

NOACs Do not hold 5 half lives? 5 half lives?

Cat 1 procedures include:

  • Vascular: Dialysis access interventions Venography, Central line removal, IVC filter placement, PICC placement
  • Nonvascular: Drainage catheter exchange (biliary, nephrostomy, abscess catheter) Thoracentesis Paracentesis Superficial aspiration and biopsy (excludes intrathoracic or intraabdominal sites): thyroid, superficial lymph node Superficial abscess drainage

Cat 2 procedures include:

  • Vascular - Angiography, arterial intervention with access size up to 7 F Venous interventions, Chemoembolization, Uterine fibroid embolization, Transjugular liver biopsy, Tunneled central venous catheter Subcutaneous port device
  • Nonvascular- Intraabdominal, chest wall, or retroperitoneal abscess drainage or biopsy, Lung biopsy, Transabdominal liver biopsy (core needle), Percutaneous cholecystostomy, Gastrostomy tube: initial placement, Radiofrequency ablation: straightforward Spine procedures (vertebroplasty, kyphoplasty, lumbar puncture, epidural injection, facet block)

Cat 3 procedures include:

  • Vascular - TIPS
  • Nonvascular - Renal biopsy, Biliary interventions (new tract), Nephrostomy tube placement, Radiofrequency ablation: complex

Commonly used devices

Central venous catheter types

Central venous catheter types:
Non-Tunneled Tunneled
General access Hohn +/- power injectable (brochure, IFU) Hickman (brochure, IFU)
Pheresis Hemocath ST (brochure, IFU) Trifusion (brochure, IFU)
Dialysis Trialysis (brochure, IFU) Duraflow (brochure, IFU)

Drainage catheter types

~8.5 Fr ~10.2 Fr 12 Fr 14 Fr 16 Fr 20 Fr 24 Fr 28 Fr Practical considerations
Dawson-Mueller Multipurpose Drainage (DM) 25 cm 25 cm 25 cm 25 cm - - - - 5 side ports

10mm loop diameter

Small cavity sizes

Cope Loop (aka Mac-Loc Multipurpose Drainage) 25 cm 25,45 cm 25,45 cm 25,45 cm 25 cm - - - 6 side ports

25mm loop diameter

Standard cavity sizes

Ring biliary drain - 50cm 50cm - - - - - Multiple side ports along 25 cm
Amplatz Universal Drain (AUD) - 45 cm 45 cm - 45 cm - - - 6 side ports

Non-locking pigtail

Potentially less encrustation (no pigtail string)

Gordon Large-bore - - - - 40 cm - - - Easy to cut proximal side-holes

Nonrestrictive drainage connection (Foley bag)

Thal-quick abscess drainage - - - - 41 cm 41 cm 41 cm - 3 oval Sideports

Nonrestrictive drainage connection (Foley bag)

Uresil (UIti-Flo general purpose catheter) - - - - - 41 cm 41 cm 41 cm Nonrestrictive drainage connection (Foley bag)

8 Fr and 10 Fr catheters may come in slightly different sizes. Other diameters may be available pending availability.

  1. Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology. 2017;126(3):376-393.http://anesthesiology.pubs.asahq.org/article.aspx?articleid=2596245
  2. Doyle DJ, Garmon EH. American Society of Anesthesiologists Classification (ASA Class) [Updated 2019 Jan 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441940/
  3. Patel IJ, Davidson JC, Nikolic B, et al. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol. 2012;23(6):727-36. https://www.jvir.org/article/S1051-0443(12)00297-7/pdf
  4. Patel IJ, Davidson JC, Nikolic B, et al. Addendum of newer anticoagulants to the SIR consensus guideline. J Vasc Interv Radiol. 2013;24(5):641-5. https://www.jvir.org/article/S1051-0443(12)01238-9/pdf

Contributing Authors

BGG, Kevin Liu