PULMONARY ANGIOGRAPHY – Indications, Client Preparation, Procedure, Post-Procedural Care, Contraindications and Potential Complications
Pulmonary angiography done through an injection of a radiography contrast material into the pulmonary arteries, pulmonary angiography permits visualization of the pulmonary vasculature.
When congenital embolism is suspected, lung scanning should be performed first. If the lung scan is normal, pulmonary embolism is ruled out first. Definitive diagnosis of pulmonary embolism may require pulmonary angiography. Bronchial angiography is now being in some facilities to identify bleeding sites in the lungs
INDICATION
- Angiography is used to detect pulmonary embolism
- Congenital and acquired lesions of the pulmonary vessels
CLIENT PREPARATION
- Explain the procedure to the client
- Ensure that written and informed consent for this procedure is obtained
- Inform the client that a warm flash will be felt when the dyes is injected
- Check the client for allergies to iodinated dyes and shellfish
- Determine if the patient has ventricular arrhythmias
- Keep the client NPO after midnight on the test
- Administer preprocedural medications as ordered. Atropine may be given to decrease secretions. Meperidine may be used for sedation and relaxation
PROCEDURE
- The clients are placed on an X-ray table in the supine position
- Electrocardiography electrodes are attached for cardiac monitoring
- The catheter is placed into the femoral vein and passed into the inferior vena cave
- With fluoroscopic visualization, the catheter is advanced to the right atrium and the right ventricle
- The catheter is manipulated into the main pulmonary artery, where the dye is injected
- X-ray films of the chest are immediately taken in timed sequence. This allows all vessels visualized by the injection to be photographed. If filling defects are seen in the contrast-filled vessels, pulmonary emboli are present
- If bronchial artery is performed, the femoral artery is cannulated instead of the vein
- During injection of dye, inform the client that he or she will feel a burning sensation and flush throughout the body
POST-PROCEDURAL CARE
- Observe the catheter insertion site for inflammation, hemorrhage and hematoma
- Assess the client’s vital signs for evidence of bleeding (decreased blood pressure, increased pulse)
- Apply cold compress to puncture site if needed to reduce swelling or discomfort
- Inform the client that coughing may occur after this study
- Educate the client regarding the need for bed rest for 12 to 24 hours after the rest
CONTRAINDICATIONS
- Clients with allergies to shellfish of iodinated dye
- Clients who are pregnant, unless the benefits outweigh the risks
- Clients with bleeding disorders
POTENTIAL COMPLICATIONS
- Allergic reaction to iodinated dye
- Hypoglycemia or acidosis may occur in clients who are taking metformin (glucophage) and receive iodine dye
- Cardiac arrhythmia: premature ventricular contractions during right-sided heart catheterization may lead to ventricular tachycardia and ventricular fibrillation
