DUKE IR – Pulmonary Angiography Protocol

Pre-procedure considerations:

If possible, sedation should be avoided.

Patients are often coming to IR from the cath lab and may have received sedation.

• Assess patient for alertness prior to moving onto angio table
  • Can the patient follow breathing instructions?
  • A full inspiratory breath hold is critical to adequate imaging
• If patient is unlikely to follow breathing instructions d/t cath lab sedation, move patient to recovery and delay procedure until patient is more alert
• Coach patient on breath-hold technique early on, prior to prep/drape
• If patient unable to breath-hold due to SOB (not related to sedation), notify ordering team that image quality may be suboptimal, and document conversation in report
• If patient is s/p lung transplant, use reduced injection rate*

Pulmonary angiography protocol:

Approved Rooms: K1, K2, K3, K4 (not K5 until new unsubtracted feature added))

Imaging Protocol: Lung

Contrast:  100%

Frame rate:  6 frames/second

Measure main pulmonary artery pressure*

Breath hold: Maximal inspiration

Injection rates:

25 mL/sec x 2 sec for right and left main PA injections*

15 mL/sec x 2 sec for subselective injections

Projections:

Right and left main PA projections:

Right PA:  AP, 45 degree RAO, 45-degree LAO

Left PA:   AP, 45 degree RAO, 45-degree LAO

Subselective projections (catheter beyond upper lobe branches):

• Right interlobar artery:
  • Magnified contralateral oblique (LAO)
• Left lower lobar artery:
  • Magnified contralateral oblique (RAO)

*If main PA pressure > 60 mmHg  -or-  patient is status post lung transplant:

– Reduce injection rate to 10 mL/sec x 2 sec, or 15 mL/sec x 2 sec.  Use test puff of 8 mL contrast (hand injection) to assess clearance.