Norm of Pulmonary Angiogram (Pulmonary Angiography, Pulmonary Arteriography)
Radiopaque iodine contrast material should circulate symmetrically and without interruption through the pulmonary circulatory system.
Usage of Pulmonary Angiogram (Pulmonary Angiography, Pulmonary Arteriography)
Visualization of the size and shape of the pulmonary artery, its branches, and the pulmonary vascular bed; measurements of pressures within these structures, cardiac output, and pulmonary vascular resistance; assessment of pulmonary vascular perfusion defects, including aneurysms, blood vessel displacement, stenosis, thrombi, and vascular filling defects; definitive diagnostic test for pulmonary thromboembolism, in the symptomatic client and in clients at risk on anticoagulation therapy and when lung scans are normal or inconclusive; definitive test for lung torsion; and evaluation of the pulmonary circulatory system preoperatively in clients with congenital heart disease.
Description of Pulmonary Angiogram (Pulmonary Angiography, Pulmonary Arteriography)
Pulmonary angiography is an invasive roentgenographic, fluoroscopic procedure after injection of iodine radiopaque contrast material via a catheter inserted through an antecubital or femoral vein into the pulmonary artery or one of its branches. Recurrence rates of pulmonary embolism are low if a normal result is found.
Professional Considerations of Pulmonary Angiogram (Pulmonary Angiography, Pulmonary Arteriography)
Consent form IS required.
Acute pulmonary hypertension, acute renal failure (related to the presence of contrast material), arterial occlusion, dysrhythmias, embolism, hemorrhage, infection, allergic reaction to dye (itching, hives, rash, tight feeling in the throat, shortness of breath, bronchospasm, anaphylaxis, death), perforation of pulmonary artery or myocardium, renal toxicity from contrast medium, venous occlusion, ventricular dysrhythmias.
Previous allergy to iodine, radiographic dye, or shellfish; pregnancy (because of radioactive iodine crossing the blood-placental barrier); renal insufficiency. Sedatives are contraindicated in clients with central nervous system depression.
- Recent coagulation times, platelet count, and renal function should be noted.
- A mild sedative may be prescribed.
- Establish intravenous access for use in the event of a hypersensitivity or dysrhythmic complication.
- Obtain electrocardiographic patches, surgical scrub solution, povidone-iodine solution, sterile drapes, 1%–2% lidocaine (Xylocaine), radiopaque contrast material, a pulmonary artery catheter, and a pulmonary angiography tray. The amount of contrast dye used is based on the client's body weight.
- Have an emergency cart readily available.
- See Client and Family Teaching.
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
- The client is placed in the supine position. Electrodes are connected to a cardiac monitor.
- The femoral or antecubital vein site is cleansed with surgical scrub solution followed by povidone-iodine solution, and the area is then covered with sterile drapes.
- After a local anesthetic is injected over the site, a needle puncture is made into the vein, a guidewire is placed through the needle, and a long catheter is introduced over the wire through the antecubital or femoral vein and advanced into the pulmonary vasculature. Pressures are measured as the catheter passes through the right atrium, right ventricle, and into the pulmonary artery.
- As the contrast material is injected, rapid, serial roentgenographic images or films record the circulation of the dye through the pulmonary vasculature.
- Monitor the client throughout the procedure for cardiac dysrhythmias or a hypersensitivity reaction to the contrast material.
- The catheter is removed, and a pressure dressing is applied over the insertion site.
- Monitor the catheter insertion site for bleeding, inflammation, or hematoma formation.
- Assess vital signs according to institutional protocol (usually every 15 minutes × 4 and then every 4 hours × 4).
- Although hypersensitivity reactions usually occur during the first 30 minutes after injection of radiopaque iodine, a delayed reaction is possible.
- Resume previous diet.
- No blood pressures should be taken from the extremity used for injection for 24 hours.
Client and Family Teaching
- Fast for 8 hours before the procedure.
- For 5 minutes after the injection of the contrast material, an urge to cough, flushing, nausea, or salty taste may occur.
- The client must lie motionless during the procedure.
Factors That Affect Results
- The client must be able to lie motionless during the procedure.
- Small peripheral emboli may not be visible with angiography, but these rarely produce symptoms or result in the usual outcomes of embolism.