Definition
Digital subtraction angiography (DSA) is a type of fluoroscopy technique used in interventional radiology to clearly visualize blood vessels in a bony or dense soft tissue environment. Images are produced using contrast medium by subtracting a per-contrast image” or the mask from later images, once the contrast medium has been introduced into a structure, hence the term “digital subtraction angiography.”
Indications
- To identify the cause of transient ischemic attacks.
- Serial follow-up evaluations for known carotid stenosis.
- Assessment of intracranial tumors.
- Postoperative assessment of aneurysm.
- Follow-up evaluation after extracranial or intracranial bypass procedures.
- Assessment of dural venous sinuses.
- Intravascular or extravascular tumors or other masses.
- Total occlusion of arteries.
- Preoperative and postoperative evaluation for vascular and tumor surgery.
Preparation of the Patient
Preparing for and assisting with Digital Subtraction Angiography (DSA) involves several key steps to ensure patient safety and the success of the procedure:
- Fasting:
- Patients are typically required to avoid eating or drinking for 4-6 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
| Nursing actions | Rationale | |
| Before procedure | ||
| 1. | Explain to the patient that he has to lie still during the procedure and what he will be experiencing during the procedure and how he has to cooperate. | Helps in obtaining cooperation of the patient. Allays anxiety. |
| 2. | Ensure that patient is coherent and cooperative and able to hold his breath and remain absolutely still when instructed. | Even the act of swallowing may result in unsatisfactory images. |
| 3. | Obtain informed consent from patient. | Prevents litigations. |
| 4. | Determine whether the patient is allergic to iodine, contrast media, or latex. | Reduces risks of hypersensitivity reactions. |
| 5. | In female patient, check if the patient is pregnant. | This procedure is contraindicated in pregnancy. |
| 6. | Obtain the following laboratory results before procedure: Prothrombin time drawn on the day of the procedure for patients on anticoagulation therapy. Creatinine levels. Recent prothrombin time and partial thromboplastin time. Platelet count (generally within 30 days of procedure). | |
| During procedure | ||
| 7. | Administer glycogen intravenously just before the procedure as ordered. | Reduces motion artifacts by stopping peristalsis. |
| 8. | Maintain NPO status before 2 hours of study. | Minimizes risk of vomiting if an iodine contrast reaction occurs. |
| 9. | Assist the physician in cleansing, preparing and injecting the vascular access area with a local anesthetic using sterile techniques. | Prevents spread of microorganisms. |
| 10. | The physician advances the catheter containing a guidewire into the desired vessel and removes the guidewire and connects the catheter to a power injector that administers contrast medium under pressure in defined quantity at prescribed intervals. X-ray images are taken and stored. | |
| After procedure | ||
| 11. | Remove the catheter after the procedure is terminated. | |
| 12. | Place a dressing over the insertion site and apply manual pressure to the puncture site for about 10-20 minutes. | Pressure application prevents bleeding. |
| 13. | Monitor the patient frequently for hemorrhage or hematoma formation. | Identifies early signs of complications. |
| 14. | Record the procedure in nurse’s record. | Acts as a communication between staff members. |
Postprocedural care
- Check vital signs frequently. Report unstable signs to the physician.
- Observe the catheter insertion site for signs of infection, hemorrhage, or hematoma formation.
- Monitor neurovascular status of the extremity. Report any problems to the physician immediately.
- Observe for allergic reactions, such as nausea, vomiting, dizziness, and urticaria.
- Instruct the patient to increase fluid intake during the first 24 hours following the procedure to facilitate excretion of the iodine contrast substance.
Special considerations
- Check vital signs, observe puncture site, and do neurovascular assessment every 15 minute for few hours after the procedure.
- Neurovascular assessment includes color, motion, sensation, capillary refill time, pulse quality, and temperature of the extremity.
- If an arterial puncture was performed, the affected extremity should be kept straight for 12-24 hours and the patient must lie flat.
- Do not raise the head of the bed because this can cause a strain on the femoral puncture site.
- Sudden onset of pain, numbness or tingling, greater degree of coolness, and absence of pulse are signs of complication and should be informed to physician immediately.
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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