Norm of Arteriogram
Even filling of the arteries with radiographic dye. The artery walls show progressive narrowing without abrupt occlusions, isolated bulging, or narrow areas. No evidence of leakage of the dye into tissues, which would indicate hemorrhage. No evidence of vascular anomalies. No displacement of vessels.
Usage of Arteriogram
Aids diagnosis of arterial occlusion, aneurysm, abnormal vascular development, hemorrhage and transient ischemia attacks (TIAs). Helps identify areas of arterial narrowing caused by plaque buildup, degree of stenosis after myocardial infarction (MI), tumor, or vascular abnormalities. Useful preoperatively to help identify potential failing arterial bypass grafts.
Description of Arteriogram
An arteriogram is a radiographic examination of arteries through which radiographic contrast medium is flowing. The arteries are assessed for abnormalities in blood flow, such as narrowing or outpouching of the walls, and for collateral circulation.
Professional Considerations of Arteriogram
Consent form IS required.
Aphasia, cerebrovascular accident, dysrhythmias, embolus, endocarditis, hematoma, hemiplegia, hemorrhage, infection, MI, paresthesia, allergic reaction to dye (itching, hives, rash, tight feeling in the throat, shortness of breath, bronchospasm, anaphylaxis, death), renal toxicity.
Anticoagulant therapy, bleeding disorders, thrombocytopenia, dehydration, uncontrolled hypertension, previous allergy to radiographic dye, iodine, or shellfish, renal insufficiency, and pregnancy (if iodinated contrast medium is used, because of radioactive iodine crossing the blood-placental barrier).
- See Client and Family Teaching.
- Obtain baseline CBC, PT, and APTT values.
- Remove all jewelry and metal objects.
- The client should void just before the procedure.
- Obtain baseline vital signs, and mark peripheral pulses.
- Have emergency equipment readily available for anaphylaxis and cardiac arrest.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure and site.
- Client is placed supine on the radiograph table.
- A maintenance intravenous line is started.
- The peripheral pulses are marked, and the extremity is immobilized.
- The femoral or brachial artery area is located and cleansed with povidone-iodine solution and allowed to dry, and the surrounding area is covered with a sterile drape.
- A local anesthetic (1% to 2% lidocaine) is injected intradermally and subcutaneously over the artery.
- The femoral or brachial artery is punctured with a large-bore needle. A wire is passed through the needle and the needle removed over the guidewire.
- The catheter is then inserted into the artery over the guidewire, and placement is confirmed by fluoroscopy.
- The catheter is advanced under fluoroscopy to a location depending on the area to be examined, and radiographic dye is injected.
- Several rapid radiographic pictures are taken of the artery and its branches during and after dye injection.
- The catheter is removed, and sterile gauze is applied immediately, with pressure, to the site for at least 15 minutes.
- Apply pressure dressing to arterial puncture site.
- The client remains on bed rest with the affected extremity immobilized for 12 hours.
- Assess the site and dressing for hematoma or bleeding; the distal pulses for presence and strength; and color, motion, temperature, and sensation of the affected extremity every 15 minutes × 4, every half hour × 4, then every hour × 4, and then every 4 hours.
- Apply pressure for at least 15 minutes if bleeding occurs.
- Encourage oral intake of fluids if not contraindicated.
Client and Family Teaching
- If the abdominal vasculature is to be examined, a cathartic may be administered 1 day before the test and a tap-water enema may be given on the morning of the test.
- Consume clear liquids only for 24 hours and fast from food and fluids for 8 hours before the test.
- It is normal to experience a brief flushing sensation and possibly nausea when the dye is injected, but the feeling will pass quickly.
- It is important to lie still throughout the procedure.
- Bed rest and frequent site and extremity checks are performed as standard postprocedure care.
- In women who are breast-feeding, formula should be substituted for breast milk for 1 or more days after the procedure.
Factors That Affect Results
- Movement of the client during filming may obscure the pictures.
- Clients with cardiomegaly need to be monitored carefully during this procedure or assessed to see if this procedure is fundamentally necessary.
- Odds of receiving this test are lower for Hispanics when compared to non-Hispanic Caucasian counterparts (Elixhauser et al., 2002).
- See also Cardiac catheterization; Cerebral angiogram; Pulmonary angiogram or Renal angiogram.