Definition
Cerebral angiography is a specialized imaging procedure used to visualize the blood vessels in and around the brain. It’s often considered the gold standard for diagnosing vascular abnormalities that other imaging methods (like CT or MRI) might miss or only suggest..
Purposes for cerebral Angiography
- To diagnose intracranial lesions.
- To detect abnormalities of blood vessels:
- Stenosis.
- Aneurysms.
- Arteriovenous malformation.
- To detect any displacement of cerebral vessels due to cysts, tumor, or abscess.
Preparation of the Patient for cerebral Angiography
Preparing for and assisting with cerebral angiography involves several critical steps to ensure patient safety and the success of the procedure:
- Fasting:
- Patients are typically required to avoid eating or drinking for 4-8 hours before the procedure to ensure the stomach is empty.
- Medication Adjustments:
- Inform the healthcare provider about any medications being taken, especially blood thinners, as adjustments may be necessary.
- Disclose any allergies, particularly to contrast agents or iodine.
- Medical History Review:
- Discuss the patient’s medical history, including any current or past health problems, allergies, or symptoms.
- Consent and Communication:
- Explain the procedure to the patient, addressing any concerns or questions.
- Obtain informed consent before proceeding.
- Clothing and Accessories:
- Advise the patient to wear loose, comfortable clothing and remove any jewelry or metallic items.
Procedure for cerebral Angiography
| Nursing actions | Rationale | |
| Before procedure | ||
| 1. | Explain procedure to the patient and inform him that X-ray films will be taken from different angles during procedure. | Allays anxiety and helps in obtaining cooperation of the patient. |
| 2. | Remove any metal objects and jewelry from patient. | Presence of these may interfere with procedure results. |
| 3. | Assess the patient for allergic reactions to dye | Prevents complications during dye injection. |
| 4. | Maintain nil per orally (NPO) for 6 hours before the procedure, and keep patient well hydrated with intravenous (IV) fluids. | Prevents vomiting and aspiration during procedure. |
| During procedure | ||
| 5. | Perform skin preparation and remove hair from the sites of catheter insertion (femoral, carotid, and brachial). | Prevents risk of iatrogenic infection. |
| 6. | Document baseline neurological signs. | Helps in comparison after the procedure. |
| 7. | Mark peripheral pulses with a pen, distal to the insertion site before the procedure. | Helps in comparison after the procedure. |
| 8. | Instruct patient about the effects of contrast medium to be expected, such as feeling of warmth in face, behind the eyes, jaws, teeth, tongue, lips and a metallic taste in the mouth when it is injected. | Gives psychological support and reassurance to the patient. |
| 9. | Local anesthesia is administered before insertion of catheter. | Reduces arterial spasm and prevents pain. |
| 10. | Catheter is introduced into the femoral artery or other sites chosen and contrast agent is injected. X-ray films are taken in different angles. | |
| 11. | Caution the patient to lie still during the procedure. |
Postprocedural care
- Maintain bed rest for 12-24 hours.
- Apply direct pressure over puncture site for 15-20 minutes. Observe for bleeding, swelling, redness, etc. After bleeding stops, apply a pressure dressing and place a sandbag over the dressing.
- The extremity on which arterial puncture was performed should be kept straight for 12 hours.
- Check the patient frequently for neurological symptoms, such as motor or sensory alterations, reduced level of consciousness. Speech disturbances, dysrhythmias and blood pressure fluctuations.
- Monitor for adverse reactions to contrast medium (e.g., restlessness, respiratory distress, tachycardia, facial flushing, nausea and vomiting).
- Assess skin color, temperature, and peripheral pulses of the extremity distal to the IV site. Change may indicate impaired circulation due to occlusion.
Complications
- Facial weakness on the side opposite to the injection site.
- Seizures.
- Aphasia.
- Stroke.
- Visual disturbances.
- Carotid sinus hypersensitivity.
- Infection.
- Hematoma (bleeding from puncture site).
- Air embolism.
Special Consideration
- Confirm the patient’s medical history, including allergies to contrast agents or iodine.
- Ensure necessary blood tests, such as kidney function tests and clotting studies, have been conducted.
- Verify that blood-thinning medications have been stopped as per the healthcare provider’s instructions.
- Monitor for any contraindications, such as severe coagulopathy or kidney dysfunction.
- Explain the procedure to the patient, addressing any concerns or questions.
- Obtain informed consent and reassure the patient to reduce anxiety.
- Maintain strict sterile conditions to minimize the risk of infection.
- Ensure all equipment, including the catheter and contrast dye, is properly sterilized and functioning.
- Observe the patient for signs of discomfort, allergic reactions, or complications during the procedure.
- Continuously monitor vital signs, including heart rate, blood pressure, and oxygen saturation.
- Assist the patient in achieving the correct position, typically lying flat with the head immobilized for optimal imaging.
- Monitor for delayed complications, such as bleeding, infection, or allergic reactions.
- Apply pressure to the catheter insertion site to prevent bleeding and apply a compression dressing.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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