Today our topic of discussion is Cerebral Angiography.
Cerebral Angiography
CEREBRAL ANGIOGRAPHY
- Cerebral angiography is an X-ray study of the cerebral circulation following injection of contrast material into a selected artery.
- Cerebral angiography is the primary investigative tool for intracranial aneurysm, arteriovenous malformation, cerebral vascular occultation disease and study of collateral blood flow.
Definition
Cerebral angiography is the X-ray study by injecting radiopaque contrast medium into an artery visualization of intracranial and extracranial blood vessels.
Purposes
- To diagnose intracranial lesions
- To detect abnormalities of blood vessels such as stenosis, aneurysms and arteriovenous malformation
- To detect any displacement of cerebral vessels due to cysts, tumors or abscess
- To visualize the cerebral arteries and veins to determine the size and nature of pathological process
- It is done as a preparatory investigation to neurovascular interventional therapy It also has value in localizing mass lesion and may aid in preparative diagnosis
- It is frequent done prior to craniotomy.
General Instructions
- The client needs to prepare physiologically and psychologically
- The majority of cerebral angiograms are done by the transfemoral route, but the procedure may be accomplished by direct puncture of the carotid/ vertebral artery or by retrograde injection of contrast medium into the brachial artery
- The skin to be shaved at puncture site, for direct puncture. In male client, beard and neck to be shaved.
- For transfemoral approach shaving to be done for both male and females from umbilicus to mid-thigh on both sides
- The client should be informed that the lie still during the procedure and he will feel a burning sensation during the injection for 4-6 seconds
- Indwelling catheter for female and condom connected to urosac placed for male clients
- Keep the client nothing per oral for 6-8 hours, those posted under general anesthesia Mark the appropriate peripheral pulses with a felt tipped pen on the skin.
Client Preparation
- Explain the procedure to the client that X-ray films will be taken from different angles during procedure
- Obtain informed consent from the client
- Remove any metal objects and jewelry from the client Assess the client for allergic reactions to dye
- Maintain nothing per oral before six hours to the procedure
- Perform skin preparation and remove the hair from the sites of catheter insertion
- Monitor the baseline neurological signs
- Explain the client the local anesthesia is administered before insertion of catheter.
Procedure (Figs. 29.68 and 29.69)
- The nurse in the angiogram room will receive the client
- The nurse explain the entire procedure thoroughly to get cooperation
- The client placed in the treatment table comfortably
- Blood pressure cuff and ECG leads are applied and connected to the monitor
- The client is hydrated with IV fluids
- Xylocain test dose given .Painting and draping is done for femoral artery puncture Administration of injection heparin given after puncture
- Vital signs are monitored continuously
- At the end of puncture, heparin is neutralized by giving protamine injection
- Apply direct pressure over punctured site for 15-20 minutes
- Pressure crape bandage is applied in the punctured site
- Check the peripheral pulse after conformation shift the client to the ward.
After Care
- Maintain strict bed rest for 12-24 hours
- Observe for bleeding, swelling, redness and changes in the temperature
- After bleeding stops, apply a pressure dressing and place sand bag over the dressing If the punctured site is femoral artery, the leg immobilized for 24 hours to prevent bleeding
- Monitor vital signs and neurological signs is Icebags may also be used to provide pressure and relieve tenderness.
Complications
- Cerebral embolus caused by the catheter dislodging a segment of atherosclerotic plaque in the vessel
- Hemorrhage or clot formation at the insertion site
- Vasospasm of a vessel caused by the irritation of catheter placement
- Thrombosis of the extremity distal to the injection site
- Allergic reaction to the contrast medium.
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