{"id":1572,"date":"2021-05-14T11:29:25","date_gmt":"2021-05-14T15:29:25","guid":{"rendered":"https:\/\/geiselmed.dartmouth.edu\/radiology\/?page_id=1572"},"modified":"2025-07-02T13:55:38","modified_gmt":"2025-07-02T17:55:38","slug":"guidelines","status":"publish","type":"page","link":"https:\/\/geiselmed.dartmouth.edu\/radiology\/divisions\/clinical-divisions\/interventional-radiology\/guidelines\/","title":{"rendered":"Guidelines"},"content":{"rendered":"

Pre-procedure IR Guidelines<\/h1>\n

 <\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Procedure<\/td>\neDH Order Name
\n(IMG Code)<\/td>\n		Modification if Anticoagulated<\/td>\nLaboratories Required*<\/td>\nLaboratory Timeframe<\/td>\nLaboratory Cutoffs<\/td>\nAntibiotic Prophylaxis<\/td>\nSedation Plan<\/td>\nFollow-up<\/td>\nReferences<\/td>\n<\/td>\n<\/tr>\n
Ablation<\/td>\nBone<\/td>\nCT Guided Ablation
\n\u2022 Cryotherapy-Bone (4536)
\n\u2022 Microwave: Spine (4703)
\n\u2022 RFA: Bone (4572)<\/td>\n		Check Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		PTT \/ INR
\nCBC<\/td>\n		30 days<\/td>\nINR \u2264 1.8
\nPlatelets > 50<\/td>\n		osteoid osteoma : none.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 cefazolin 2 g (3 g if \u2265120 kg) OR
\nclindamycin 900 mg IV OR
\nvancomycin 15 mg\/kg IV; max 2 g<\/td>\n		General Anesthesia<\/td>\n<\/td>\nChehab MA, et al.\u00a0 Adult and pediatric antibiotic prophylaxis during vascular and IR Procedures A SIR practice parameter update\u2026JVIR 2018;29:1483-1501<\/td>\n<\/td>\n<\/tr>\n
Kidney<\/td>\nCT Guided Ablation
\n\u2022 Cryothreapy-Renal (4514)
\n\u2022 IRE: Renal (4605)
\n\u2022 Microwave: kidney (4629)
\n\u2022 RFA: renal (4404)<\/td>\n		Check Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		PTT \/ INR
\nCBC, Cr<\/td>\n		30 days<\/td>\nINR \u2264 1.8
\nPlatelets > 50<\/td>\n		ceftriaxone 2 g IV<\/td>\nGeneral Anesthesia<\/td>\nMR \/ CT Follow Up per Urology<\/td>\nGunn, Andrew J. et al., Society of Interventional Radiology Quality Improvement Standards on Percutaneous Ablation in Renal Cell Carcinoma . JVIR,\u00a0 2020;31, 195 - 201.e3<\/td>\n<\/td>\n<\/tr>\n
Liver<\/td>\nCT Guided Ablation
\n\u2022 Alcohol-Liver (4406)
\n\u2022 Cryotherapy-Liver (4513)
\n\u2022 IRE: Liver (4603)
\n\u2022 Microwave: liver (4628)
\n\u2022 RFA liver (4401)<\/td>\n		Check Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		PTT \/ INR
\nCBC<\/td>\n		30 days<\/td>\nINR \u2264 1.8
\nPlatelets > 50<\/td>\n		ampicillin-sulbactam 3 g IV
\nOR
\nceftriaxone 2 g IV &
\nmetronidazole 500 mg IV<\/td>\n		General Anesthesia<\/td>\n2 month MR, or per Oncoligy \/ Liver Tumor Conference<\/td>\nSeo, 2019:30:1895<\/td>\n<\/td>\n<\/tr>\n
Lung<\/td>\nCT Guided Ablation:
\n\u2022 Cryotherapy-Lung (4537)
\n\u2022 Microwave-Chest (4627)
\n\u2022 RFA lung (4525)<\/td>\n		Check Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		PTT \/ INR
\nCBC<\/td>\n		30 days<\/td>\nINR \u2264 1.8
\nPlatelets > 50<\/td>\n		cefazolin 2 g (3 g if \u2265120 kg) OR
\nclindamycin 900 mg IV OR
\nvancomycin 15 mg\/kg IV; max 2 g<\/td>\n		General Anesthesia<\/td>\n<\/td>\nChehab MA, et al.\u00a0 Adult and pediatric antibiotic prophylaxis during vascular and IR Procedures A SIR practice parameter update\u2026JVIR 2018;29:1483-1501<\/td>\n<\/td>\n<\/tr>\n
Pancreas<\/td>\nCT Guided Ablation
\n\u2022 IRE: pancreas (4604)
\n\u2022 RFA: pancreas (4403)<\/td>\n		Check Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		PTT \/ INR
\nCBC w diff\u00a0\u00a0\u00a0 CMP<\/td>\n		30 days<\/td>\nINR \u2264 1.5
\nPlatelets > 100<\/td>\n		ampicillin-sulbactam 3 g IV
\nOR
\nceftriaxone 2 g IV &
\nmetronidazole 500 mg IV<\/td>\n		General Anesthesia<\/td>\n<\/td>\nPanfire, Radiology 2016<\/td>\n<\/td>\n<\/tr>\n
Soft Tissue<\/td>\nCT Guided Ablation
\n\u2022 IRE Soft Tissue (4606)
\n\u2022 IRE: Other Site (4607)<\/td>\n		Check Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		PTT \/ INR
\nCBC<\/td>\n		30 days<\/td>\nINR \u2264 1.8
\nPlatelets > 50<\/td>\n		cefazolin 2 g (3 g if \u2265120 kg) OR
\nclindamycin 900 mg IV OR
\nvancomycin 15 mg\/kg IV; max 2 g<\/td>\n		General Anesthesia<\/td>\n<\/td>\nChehab MA, et al.\u00a0 Adult and pediatric antibiotic prophylaxis during vascular and IR Procedures A SIR practice parameter update\u2026JVIR 2018;29:1483-1501<\/td>\n<\/td>\n<\/tr>\n
Arteriogram<\/td>\nPeripheral \/ Body<\/td>\nInterventional<\/td>\nIR Therasphere (Y-90) (6719)<\/td>\nCheck Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		CMP
\nPTT \/ INR
\nCBC<\/td>\n		2 weeks<\/td>\nINR \u2264 1.8 fem, < 2.2 radial
\nPlatelets > 50<\/td>\n		None<\/td>\nModerate<\/td>\n<\/td>\nACR-ABS-ACNM-ASTRO-SIR-SNMMI Practice Parameters for Selective Internal Radiation Therapy (SIRT) or Radioembolization for Treatment of Liver Malignancies\u00a0Revised 2019 (Resolution 21)<\/a><\/td>\n<\/td>\n<\/tr>\n
IR Arterial Intervention (6670)
\nthrombolysis
\nIR Arteriogram:
\n\u2022 Bronchial (6714)
\n\u2022 GI bleed (6715)
\n\u2022 Liver bland (6706)
\n\u2022 Liver chemo (6704)
\n\u2022 Lower extremity (6742)
\n\u2022 Mesenteric (6743)
\n\u2022 Renal (6717)
\n\u2022 Upper Extremity (6745)
\n\u2022 Splenic (6724)<\/td>\n		Check Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		Creatinine
\nCBC
\nPTT \/ INR<\/td>\n		30 days<\/td>\nINR \u2264 1.8
\nPlatelets > 50<\/td>\n		Arterial endografts : cefazolin 2g IV<\/p>\n

GI embo :\u00a0 if hemobilia :\u00a0 ceftriaxone 1g IV OR\u00a0\u00a0 ampicilli\/sublactam 3g\u00a0 IV OR\u00a0 Vancomycin.<\/p>\n

Splenic embo >70%: gent 10 mg\/k\/d, cefoxitin 100 mg\/k\/d x 5d<\/td>\n

Moderate<\/td>\n<\/td>\nChehab MA, et al.\u00a0 Adult and pediatric antibiotic prophylaxis during vascular and IR Procedures A SIR practice parameter update\u2026JVIR 2018;29:1483-1501<\/td>\nKhan, W., Sullivan, K.L., McCann, J.W. et al.\u00a0Moxifloxacin prophylaxis for chemoembolization or embolization in patients with previous biliary interventions: a pilot study.\u00a0AJR Am J Roentgenol.\u00a02011;\u00a0197:\u00a0343\u2013345<\/td>\n<\/tr>\n
\u2022 Uterine Artery\u00a0 (6720)<\/td>\nCheck Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		Creatinine
\nCBC
\nPTT \/ INR
\nUrine Qualitative Pregnancy<\/td>\n		30 days
\n(Except Urine Pregnancy, day of procedure)<\/td>\n		INR \u2264 1.8 fem, < 2.2 radial
\nPlatelets > 500<\/td>\n		cefazolin 2 g (3 g if \u2265120 kg) OR
\nclindamycin 900 mg IV + gentamicin 1.5 mg\/kg OR
\nvancomycin 15 mg\/kg IV; max 2 g<\/td>\n		Moderate<\/td>\n<\/td>\nChehab MA, et al.\u00a0 Adult and pediatric antibiotic prophylaxis during vascular and IR Procedures A SIR practice parameter update\u2026JVIR 2018;29:1483-1501
\nPetruzzi, N.J., McCann, J.W., Patel, N.A., and Gonsalves, C.F. Safety of uterine artery embolization in patients with preexisting hydrosalpinx. J Vasc Interv Radiol. 2012; 20: 796\u2013799<\/td>\n		<\/td>\n<\/tr>\n
Diagnostic<\/td>\nIR arteriogram:
\n\u2022 Bronchial (6714)
\n\u2022 Hypogastric (6691)
\n\u2022 Lower Extremity (6742)
\n\u2022 Mesenteric (6743)
\n\u2022 Renal (6717)
\n\u2022 Renal artery (6673)
\n\u2022 Splenic (6724)
\n\u2022 Upper Extremity (6745)
\nIR therasphere pre (Y-90) (6721)<\/td>\n		Check Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		Creatinine
\nCBC
\nPTT \/ INR<\/td>\n		30 days<\/td>\nINR \u2264 1.8 fem, < 2.2 radial
\nPlatelets > 50<\/td>\n		None<\/td>\nModerate<\/td>\n<\/td>\nChehab MA, et al.\u00a0 Adult and pediatric antibiotic prophylaxis during vascular and IR Procedures A SIR practice parameter update\u2026JVIR 2018;29:1483-1501<\/td>\n<\/td>\n<\/tr>\n
Neurologic<\/td>\nInterventional<\/td>\nIR Arterial Intervention (6670)
\nIR Embolization:
\n\u2022 Cerebral (6748)
\n\u2022 Extracranial (6644)
\n\u2022 Intracranial (6645)
\n\u2022 Middle Meningeal Unilateral (6778)
\n\u2022 Middle Meningeal Bilateral (6779)<\/td>\n		Check Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		Creatinine
\nCBC
\nPTT \/ INR<\/td>\n		30 days<\/td>\nINR \u2264 1.8
\nPlatelets > 50<\/td>\n		None<\/td>\nGeneral anesthesia or Moderate<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Diagnostic<\/td>\nIR Arteriogram:
\n\u2022 Cerebral (6741)
\n\u2022 Spinal (6744)<\/td>\n		Check Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		Creatinine
\nCBC
\nPTT \/ INR<\/td>\n		30 days<\/td>\nINR \u2264 1.8
\nPlatelets > 50<\/td>\n		none<\/td>\nModerate<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Biopsy<\/td>\nSuperficial<\/td>\nPalpable lesion, lymph node, soft tissue, breast, thyroid, superficial bone<\/td>\nCT Guided Biopsy:
\n\u2022 Subcutaneous Mass (Chest, Abdomen, or Pelvis) (4687)
\n\u2022 Subcutaneous Mass (Extremities) (4688)
\nIR all biopsy procedures (6636)<\/td>\n		Check Specific Anticoagulant
\n\"Low Risk\" Category<\/td>\n		None per procedure protocol*<\/td>\n<\/td>\nINR \u2264 3.0
\nPlatelets > 20<\/td>\n		None<\/td>\nLocal or Fentanyl<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Deep<\/td>\nVisceral Organ, Bone, Deep Abdominal, etc.<\/td>\nCT Guided Biopsy:
\n\u2022 Abdominal (4564)
\n\u2022 Adrenal (4565)
\n\u2022 Liver (4434)
\n\u2022 Lung (4432)
\n\u2022 Lymph Node (Chest, Abdomen, or Pelvis) (4686)
\n\u2022 Mediastinum (4685)
\n\u2022 Other (4676)
\n\u2022 Pancreas (4444)
\n\u2022 Peritoneal \/ Omental (4654)
\n\u2022 Pleura (4581)
\n\u2022 Renal (4452)
\n\u2022 Retroperitoneal (4456)
\n\u2022 Spleen (4695)
\nIR all biopsy procedures (6636)
\nIR biopsy lymph node chest \/ abdomen \/ pelvis (6775)
\nIR biopsy liver percutaneous (6701)<\/td>\n		Check Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		PTT \/ INR
\nCBC<\/td>\n		30 days<\/td>\nINR \u2264 1.8
\nPlatelets > 50<\/td>\n		None<\/td>\nModerate<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Transjugular<\/td>\nTransjugular liver<\/td>\nIR biopsy liver transjugular (6703)<\/td>\nCheck Specific Anticoagulant
\n\"Low Risk\" Category<\/td>\n		None per procedure protocol*<\/td>\n<\/td>\nINR \u2264 3.0
\nPlatelets > 20<\/td>\n		None<\/td>\nModerate<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Central Venous Access
\n(CVC)<\/td>\n		Catheter Removals<\/td>\nIR line\/tube removal in recovery room (6688)
\nIR mediport removal (6700)<\/td>\n		Check Specific Anticoagulant
\n\"Low Risk\" Category<\/td>\n		None per procedure protocol*<\/td>\n<\/td>\nINR \u2264 3.0
\nPlatelets > 20<\/td>\n		None<\/td>\nLocal Ideally;
\nMediport Removal Option of Patient (Local, Fentanyl, or Moderate)<\/td>\n		<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Non-tunneled venous access placement<\/td>\nIR dialysis access - temporary line (6767)
\nIR temporary venous access non-dialysis (6707)
\nIR PICC placement (6757)<\/td>\n		Check Specific Anticoagulant
\n\"Low Risk\" Category<\/td>\n		None per procedure protocol*<\/td>\n<\/td>\nINR \u2264 3.0
\nPlatelets > 20<\/td>\n		None<\/td>\nLocal or Fentanyl<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Tunneled venous catheter placement<\/td>\nIR dialysis access - tunneled line (6639)
\nIR central venous access - tunneled non-dialysis (6662)
\nIR mediport placement\/exchange (6676)<\/td>\n		Check Specific Anticoagulant
\n\"Low Risk\" Category<\/td>\n		None per procedure protocol*<\/td>\n<\/td>\nINR \u2264 3.0
\nPlatelets > 20<\/td>\n		\u00a0\u00a0\u00a0 None\u00a0\u00a0 OR\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 cefazolin 2 g IV\u00a0\u00a0\u00a0 OR
\nclindamycin 900 mg IV OR
\nvancomycin 15 mg\/kg IV; max 2g<\/td>\n		Moderate<\/td>\n<\/td>\nJohnson, E.\u00a0 JVIR 2016;27:339-343.<\/td>\n<\/td>\n<\/tr>\n
Drainage & Subsequent Catheter Interventions<\/td>\nAbscess Drainage \/ Aspiration - Superficial<\/td>\nCT Guided Aspiration (149)
\nCT Guided Aspiration Fine Needle (4673)
\nIR all drainage procedures (6642)<\/td>\n		Check Specific Anticoagulant
\n\"Low Risk\" Category<\/td>\n		None per procedure protocol*<\/td>\n<\/td>\nINR \u2264 3.0
\nPlatelets > 20<\/td>\n		Location-dependent. Only if not already on.<\/td>\nLocal or Fentanyl<\/td>\nAbscess: 2-4 weeks<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Abscess Drainage \/ Aspiration - Deep
\n(Lung, Abdominal, Pelvic, Retroperitoneal)<\/td>\n		CT Guided Aspiration (149)
\nCT Guided Aspiration:
\n\u2022 Disc (4594)
\n\u2022 Fine Needle (4673)
\n\u2022 Liver (4576)
\n\u2022 Other (4675)
\n\u2022 Pancreas (4578)
\n\u2022 Peritoneal (4450)
\n\u2022 Renal (4451)
\n\u2022 Retroperitoneal (4455)
\nCT Guided Drain (190)
\nCT Guided Drain:
\n\u2022 Abdomen (321)
\n\u2022 Chest Tube \/ Pleural Drain (4415)
\n\u2022 Liver (4431)
\n\u2022 Lung (4567)
\n\u2022 Muscle (4570)
\n\u2022 Other (4677)
\n\u2022 Ovarian Abscess (4657)
\n\u2022 Ovarian Cyst (4656)
\n\u2022 Pancreatic (4521)
\n\u2022 Peritoneal (238)
\n\u2022 Peritoneal (Transrectal or Transvaginal) (4672)
\n\u2022 Renal Abscess (4526)
\n\u2022 Retroperitoneal Abscess (4457)
\nCT Guided Sclerotherapy (4632)
\nIR all drainage procedures (6642)
\nIR endocavitary drain placement (6725)<\/td>\n		Check Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		PTT \/ INR
\nCBC<\/td>\n		30 days<\/td>\nINR \u2264 1.8
\nPlatelets > 50<\/td>\n		Location-dependent. Only if not already on.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Intraabdominal: meropenem OR piperacillin\/tazobactam OR metronidazole + ciprofloxacin<\/td>\nModerate<\/td>\nAbscess: 2-4 weeks<\/td>\nChehab MA, et al.\u00a0 Adult and pediatric antibiotic prophylaxis during vascular and IR Procedures A SIR practice parameter update\u2026JVIR 2018;29:1483-1501<\/td>\nFadl JVIR 2015;26:539<\/td>\n<\/tr>\n
Catheter exchanges (abscess, biliary, gastrostomy, G\/GJ conversions, nephrostomy)<\/td>\nIR drain check\/change\/remove (6702)
\nIR biliary tube check\/change\/remove (6635)
\nIR chait\/cecostomy tube replace\/exchange (6681)
\nIR G-tube check\/change (6751)
\nIR GJ-tube check\/change (6749)
\nIR nephrostogram\/nephrostomy tube exchange (6753)
\nIR nephroureteral (nu) stent placement\/check\/change (6756)<\/td>\n		Check Specific Anticoagulant
\n\"Low Risk\" Category<\/td>\n		None per procedure protocol*<\/td>\n<\/td>\nINR \u2264 3.0
\nPlatelets > 20<\/td>\n		Nephrostomy or nephroureteral catheter: ciprofloxacin 500 mg PO<\/td>\nLocal or Fentanyl<\/td>\nBiliary: 6-8 weeks
\nNephrostomy: 1-3 months
\nNephroureteral: 1-3 months<\/td>\n		<\/td>\n<\/td>\n<\/tr>\n
Non-tunneled chest drains<\/td>\nIR chest tube placement (6675)<\/td>\nCheck Specific Anticoagulant
\n\"Low Risk\" Category<\/td>\n		None per procedure protocol*<\/td>\n<\/td>\nINR \u2264 3.0
\nPlatelets > 20<\/td>\n		None<\/td>\nFentanyl<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Paracentesis<\/td>\nCT Guided Paracentesis (4671)
\nIR paracentesis (6695)<\/td>\n		Check Specific Anticoagulant
\n\"Low Risk\" Category<\/td>\n		None per procedure protocol*<\/td>\n<\/td>\nINR \u2264 3.0
\nPlatelets > 20<\/td>\n		None<\/td>\nLocal<\/td>\n<\/td>\nalbumin 6-8 g \/ liter removed:\u00a0 European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010;53:397\u2013417.<\/td>\n<\/td>\n<\/tr>\n
Thoracentesis<\/td>\nCT Guided Thoracentesis (4469)
\nIR thoracentesis (6696)<\/td>\n		Check Specific Anticoagulant
\n\"Low Risk\" Category<\/td>\n		None per procedure protocol*<\/td>\n<\/td>\nINR \u2264 3.0
\nPlatelets > 20<\/td>\n		None<\/td>\nFentanyl<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Tunneled drainage catheter (Peritoneal \/ Pleural PleurX) and removal<\/td>\nIR pleurx drain placement abdominal (6758)
\nIR pleurx drain placement thoracic (6759)
\nIR pleurx drain removal (6722)<\/td>\n		Check Specific Anticoagulant
\n\"Low Risk\" Category<\/td>\n		None per procedure protocol*<\/td>\n<\/td>\nINR \u2264 3.0
\nPlatelets > 20<\/td>\n		cefazolin 2 g (3 g if \u2265120 kg) OR
\nclindamycin 900 mg IV OR
\nvancomycin 15 mg\/kg IV; max 2g.\u00a0 REMOVAL : None<\/td>\n		Moderate<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Enteric Access (GI)<\/td>\nGastrostomy or gastrojejunostomy catheter placements<\/td>\nCT Guided Drain Chait Tube (4569)
\nCT Guided Drain Gastrostomy (4697)
\nCT Guided Inserion of G-Tube (4666)
\nIR G-tube placement (6752)
\nIR GJ-tube placement (6750)<\/td>\n		Check Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		PTT \/ INR
\nCBC<\/td>\n		30 days<\/td>\nINR \u2264 1.8
\nPlatelets > 50<\/td>\n		cefazolin 2 g (3 g if \u2265120 kg) OR
\nclindamycin 900 mg IV OR
\nvancomycin 15 mg\/kg IV; max 2g<\/td>\n		Moderate<\/td>\n2 wk gastropexy release
\n6 mo gastrojejunal change<\/td>\n		<\/td>\nIngraham JVIR 2018;29:55<\/td>\n<\/tr>\n
Simple Exchanges<\/td>\nSee \"Drains\" within the \"Catheter Exchanges\" Section<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Genitourinary
\n(GU)<\/td>\n		Urinary Drain Placements or Interventions
\n(nephrostomy tube placement, ureteroplasty, stone removal)<\/td>\n		CT Guided Aspiration Bladder (4659, 4660)
\nCT Guided Drain Nephrostomy (4698)
\nCT Guided Nephrostomy Placement (4658 or 4663)
\nCT Guided Nephrostomy Dilitation (4664)
\nIR nephrostomy tube placement percutaneous (6709)
\nIR nephroureteral (nu) stent placement \/ check \/ change (6756)
\nIR suprapubic cath placement (6708)
\nIR suprapubic cath upsize (6760)
\nIR ureteroplasty (6790)<\/td>\n		Check Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		PTT \/ INR
\nCBC<\/td>\n		30 days<\/td>\nINR \u2264 1.8
\nPlatelets > 50<\/td>\n		Ciprofloxacin 400 mg IV
\nOR
\nCeftriaxone 2 g IV
\nOR
\nampicillin\/sublactam 3 g IV<\/td>\n		Moderate<\/td>\nNephrostomy: 3 months
\nNephroureteral: 6 months
\nUreteroplasty: 1 month<\/td>\n		<\/td>\n<\/td>\n<\/tr>\n
Simple Exchanges<\/td>\nSee \"Drains\" within the \"Catheter Exchanges\" Section<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Hepatobiliary<\/td>\nCholecystostomy<\/td>\nPlacement<\/td>\nCT Guided Cholecystostomy (4696 \/ 4670)
\nIR Cholecystostomy Tube Placement (6711)<\/td>\n		Check Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		CMP
\nPTT \/ INR
\nCBC<\/td>\n		30 days<\/td>\nINR \u2264 1.8
\nPlatelets > 50<\/td>\n		piperacillin-tazobactam 3.375 g IV
\nOR
\nceftriaxone 2 g IV &
\nmetronidazole 500 mg IV<\/td>\n		Moderate<\/td>\n6-week Evaluation<\/td>\nChehab MA,,JVIR 2018;29:1483-1501<\/td>\n<\/td>\n<\/tr>\n
Percutaneous Transhepatic Cholangiography<\/td>\nPlacement or Revision<\/td>\nCT Guided Drain Biliary (4665)
\nIR Transhepatic Cholangiogram Percutaneous (6683)<\/td>\n		Check Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		CMP
\nPTT \/ INR
\nCBC<\/td>\n		30 days<\/td>\nINR \u2264 1.8
\nPlatelets > 50<\/td>\n		piperacillin-tazobactam 3.375 g IV
\nOR
\nceftriaxone 2 g IV &
\nmetronidazole 500 mg IV<\/td>\n		Pleacement: General Anesethia<\/td>\n<\/td>\nChehab MA,,JVIR 2018;29:1483-1501<\/td>\n<\/td>\n<\/tr>\n
Biliary Subsequent Interventions<\/td>\nSimple Exchanges<\/td>\nSee \"Drains\" within the \"Catheter Exchanges\" Section<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Portal Vein Interventions<\/td>\nIR portal vein recanalization \/ embolization (6718)<\/td>\nCheck Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		CMP
\nPTT \/ INR
\nCBC<\/td>\n		30 days<\/td>\nINR \u2264 1.8
\nPlatelets > 50<\/td>\n		ampicillin-sulbactam 3 g IV
\nOR
\nceftriaxone 2 g IV &
\nmetronidazole 500 mg IV<\/td>\n		Moderate<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
TIPS<\/td>\nPlacement<\/td>\nIR TIPS(6660)<\/td>\nCheck Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		CMP
\nPTT \/ INR
\nCBC<\/td>\n		30 days<\/td>\nINR \u2264 1.8
\nPlatelets > 50<\/td>\n		ampicillin-sulbactam 3 g IV
\nOR
\nceftriaxone 2 g IV &
\nmetronidazole 500 mg IV<\/td>\n		General Anesthesia<\/td>\n2 week US<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Revision<\/td>\nIR TIPS revision (6684)<\/td>\nCheck Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		CMP
\nPTT \/ INR
\nCBC<\/td>\n		30 days<\/td>\nINR \u2264 1.8
\nPlatelets > 50<\/td>\n		ampicillin-sulbactam 3 g IV
\nOR
\nceftriaxone 2 g IV &
\nmetronidazole 500 mg IV<\/td>\n		Moderate<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Musculoskeletal
\n(MSK)<\/td>\n		Aspirations & Drainages<\/td>\nCT Guided Aspiration:
\n\u2022 Ganglion Cyst (1126)
\n\u2022 Joint - Large Left (4689)
\n\u2022 Joint - Large Right (4690)
\n\u2022 Joint - Medium Left (4691)
\n\u2022 Joint - Medium Right (4692)
\n\u2022 Joint - Small Left (4693)
\n\u2022 Joint - Small Right (4694)
\n\u2022 Muscle (4575)<\/td>\n		Check Specific Anticoagulant
\n\"Low Risk\" Category<\/td>\n		None per procedure protocol*<\/td>\n<\/td>\nINR \u2264 3.0
\nPlatelets > 20<\/td>\n		None<\/td>\nLocal<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Biopsy<\/td>\nCT Guided Biopsy:
\n\u2022 Bone (Extremity \/ Pelvis) (4408)
\n\u2022 Bone (Spine \/ Skull) (4684)
\n\u2022 Bone Marrow (4655)
\n\u2022 Bone Superficial (4669)
\n\u2022 Muscle (Chest, Abdomen, or Pelvis) (4436)
\n\u2022 Muscle (Extremities) (4699)<\/td>\n		Check Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		PTT \/ INR
\nCBC<\/td>\n		30 days<\/td>\nINR \u2264 1.5
\nPlatelets > 50<\/td>\n		None<\/td>\nModerate<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Joint and Musculoskeletal Injections<\/td>\nCT Guided Joint Injection (4554)
\nCT Guided Injection:
\n\u2022 Piriformis (4712)
\n\u2022 Tendon (4558)
\n\u2022 Tendon Sheath (4557)
\nXR fluoro arthrogram:
\n\u2022 ankle (2567)
\n\u2022 hip (2565)
\n\u2022 wrist (2635)
\nXR fluoro guided joint injection:
\n\u2022 small (2631)
\n\u2022 medium (2630)
\n\u2022 large (2628)<\/td>\n		Check Specific Anticoagulant
\n\"Low Risk\" Category<\/td>\n		None per procedure protocol*<\/td>\n<\/td>\nINR \u2264 3.0
\nPlatelets > 20<\/td>\n		None<\/td>\nLocal<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Neurologic
\n(Neuro)<\/td>\n		Non-vascular<\/td>\nBiopsy - Superficial<\/td>\nIR Biopsy:
\n\u2022 lymph node head\/neck (6699)
\n\u2022 parotid (6727)
\n\u2022 soft tissue neck mass (6788)
\n\u2022 thyroid FNA (6698)<\/td>\n		Check Specific Anticoagulant
\n\"Low Risk\" Category<\/td>\n		None per procedure protocol*<\/td>\n<\/td>\nINR \u2264 3.0
\nPlatelets > 20<\/td>\n		None<\/td>\nLocal or Fentanyl<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Biopsy - Deep<\/td>\nCT Guided Biopsy:
\n\u2022 Lymph Node (Head or Neck) (4435)
\n\u2022 Salivary Gland (4571)
\n\u2022 Thyroid (4566)
\nIR all biopsy procedures (6636)
\nIR aspiration disc (6746)
\nIR biopsy spine (6747)<\/td>\n		Check Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		PTT \/ INR
\nCBC<\/td>\n		30 days<\/td>\nINR \u2264 1.8
\nPlatelets > 50<\/td>\n		None<\/td>\nModerate<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Drainages & Aspriations<\/td>\nCT Guided Aspiration:
\n\u2022 Disc (4594)
\n\u2022 Synovial Cyst (4592)<\/td>\n		Check Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		PTT \/ INR
\nCBC<\/td>\n		30 days<\/td>\nINR \u2264 1.8
\nPlatelets > 50<\/td>\n		None<\/td>\nModerate<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Lumbar puncture<\/td>\nIR fluoro lumbar puncture (1111)
\nIR lumbar puncture\/myelogram recovery (6687)<\/td>\n		Check Specific Anticoagulant
\n\"Low Risk\" Category<\/td>\n		PTT \/ INR
\nCBC<\/td>\n		30 days<\/td>\nINR \u2264 1.8
\nPlatelets > 50<\/td>\n		None<\/td>\nLocal<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Joint Injections<\/td>\nCT Guided Injection:
\n\u2022 Epidural Steroid - Lumbar (4711)
\n\u2022 SI Joint (4461)<\/td>\n		Check Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		PTT \/ INR
\nCBC<\/td>\n		30 days<\/td>\nINR \u2264 1.8
\nPlatelets > 50<\/td>\n		cefazolin 2 g (3 g if \u2265120 kg) OR
\nclindamycin 900 mg IV OR
\nvancomycin 15 mg\/kg IV; max 2 g<\/td>\n		Moderate<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Nerve Blocks - Peripheral<\/td>\nXR fluoro guided joint injection:
\n\u2022 small (2631)
\n\u2022 medium (2630)
\n\u2022 large (2628)<\/td>\n		Check Specific Anticoagulant
\n\"Low Risk\" Category<\/td>\n		None per procedure protocol*<\/td>\n<\/td>\nINR \u2264 3.0
\nPlatelets > 20<\/td>\n		None<\/td>\nLocal<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Nerve Blocks - Paraspinal<\/td>\nCT Guided Nerve Block:
\n\u2022 Cervical Multiple Levels (4647)
\n\u2022 Cervical Single Level (4441)
\n\u2022 Lumbar Multiple Levels (4438)
\n\u2022 Lumbar Single Level (4442)
\n\u2022 Suprascapular (4640)
\n\u2022 Thoracic Multiple Levels (4634)
\n\u2022 Thoracic Single Level (4633)<\/td>\n		Check Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		PTT \/ INR
\nCBC<\/td>\n		30 days<\/td>\nINR \u2264 1.8
\nPlatelets > 50<\/td>\n		cefazolin 2 g (3 g if \u2265120 kg) OR
\nclindamycin 900 mg IV OR
\nvancomycin 15 mg\/kg IV; max 2 g<\/td>\n		Moderate<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Spine procedures with risk of spinal or epidural hematoma (vertebroplasty, epidural injections, c-spine facet blocks)<\/td>\nCT Guided Sacroplasty \/ Vertebroplasty (4551)
\nIR vertebral augmentation lumbar
\n\u2022 single (6780)
\n\u2022 multiple (6782)
\nIR vertebral augmentation thoracic
\n\u2022 single (6781)
\n\u2022 multiple (6783)
\nIR vertebroplasty lumbar
\n\u2022 single (6772)
\n\u2022 multiple (6773)
\nIR vertebroplasty thoracic
\n\u2022 single (6761)
\n\u2022 multiple (6762)<\/td>\n		Check Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		PTT \/ INR
\nCBC<\/td>\n		30 days<\/td>\nINR \u2264 1.8
\nPlatelets > 50<\/td>\n		cefazolin 2 g (3 g if \u2265120 kg) OR
\nclindamycin 900 mg IV OR
\nvancomycin 15 mg\/kg IV; max 2 g<\/td>\n		Moderate<\/td>\n<\/td>\nShaffer, W.O., Baisden, J.L., Fernand, R., Matz, P.G., and North American Spine Society. An evidence-based clinical guideline for antibiotic prophylaxis in spine surgery. Spine J. 2013; 13: 1387\u20131392<\/td>\n<\/td>\n<\/tr>\n
Filter<\/td>\nIVC filter removal (complex)<\/td>\nIR IVC filter removal (6716)<\/td>\nCheck Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		PTT \/ INR
\nCBC<\/td>\n		30 days<\/td>\nINR \u2264 1.8
\nPlatelets > 50<\/td>\n		None<\/td>\nModerate<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
IVC filter placement or removal (simple)<\/td>\nIR IVC filter placement or svc (6650)
\nIR IVC filter removal (6716)
\nIR IVC filter check (6793)<\/td>\n		Check Specific Anticoagulant
\n\"Low Risk\" Category<\/td>\n		None per procedure protocol*<\/td>\n<\/td>\nINR \u2264 3.0
\nPlatelets > 20<\/td>\n		None<\/td>\nModerate<\/td>\nPlacement - 3 month Clinic Phone Call<\/td>\nChehab MA, et al.\u00a0 Adult and pediatric antibiotic prophylaxis during vascular and IR Procedures A SIR practice parameter update\u2026JVIR 2018;29:1483-1501<\/td>\n<\/td>\n<\/tr>\n
Venogram & Lymphangiogram<\/td>\nDiagnostic<\/td>\nDiagnostic venography and lymphangiography<\/td>\nIR adrenal vein sampling (6713)
\nIR venogram (6769)
\nIR lymphangiogram (6785)<\/td>\n		none<\/td>\nnone<\/td>\n30 days<\/td>\nINR \u2264 3.0
\nPlatelets > 20<\/td>\n		None<\/td>\nModerate except for non-intervention venogram (local only)<\/td>\n<\/td>\nChehab MA, et al.\u00a0 Adult and pediatric antibiotic prophylaxis during vascular and IR Procedures A SIR practice parameter update\u2026JVIR 2018;29:1483-1501<\/td>\n<\/td>\n<\/tr>\n
Intervention<\/td>\npelvic and extremity interventions<\/td>\nvaricocele embolization
\nIR varicose vein ablation (6705)<\/td>\n		Check Specific Anticoagulant
\n\"Low Risk\" Category<\/td>\n		Creatinine
\nCBC
\nPTT \/ INR<\/td>\n		30 days<\/td>\nINR \u2264 3.0
\nPlatelets > 20<\/td>\n		None<\/td>\nModerate<\/td>\n<\/td>\nChehab MA,,JVIR 2018;29:1483-1501<\/td>\n<\/td>\n<\/tr>\n
Portal vein\/TIPS<\/td>\nsee \"Hepatobiliary\" section<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Catheter directed thrombolysis (DVT, PE, portal vein)<\/td>\nIR venous intervention aka thrombolysis (6663)<\/td>\nCheck Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		Creatinine
\nPTT \/ INR
\nCBC
\nFibrinogen<\/td>\n		30 days<\/td>\nINR \u2264 1.8
\nPlatelets > 50<\/td>\n		None<\/td>\nModerate<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
Venous interventions (intra-thoracic and CNS)<\/td>\nIR venous intervention (6663)<\/td>\nCheck Specific Anticoagulant
\n\"High Risk\" Category<\/td>\n		Creatinine
\nCBC
\nPTT \/ INR<\/td>\n		30 days<\/td>\nINR \u2264 1.8
\nPlatelets > 50<\/td>\n		None<\/td>\nModerate<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
<\/td>\nSclerotherapy<\/td>\nvenous malformation<\/td>\n<\/td>\nCheck Specific Anticoagulant
\n\"Low Risk\" Category<\/td>\n		none<\/td>\nna<\/td>\nINR \u2264 3.0
\nPlatelets > 20<\/td>\n		cefazolin 2 g (3 g if \u2265120 kg) OR
\nclindamycin 900 mg IV + gentamicin 1.5 mg\/kg OR
\nvancomycin 15 mg\/kg IV; max 2 g. PEDS:\u00a0 Cefazolin 25 mg\/keg<\/td>\n		Moderate<\/td>\n<\/td>\nChehab MA, et al.\u00a0 Adult and pediatric antibiotic prophylaxis during vascular and IR Procedures A SIR practice parameter update\u2026JVIR 2018;29:1483-1501<\/td>\n<\/td>\n<\/tr>\n
Dialysis<\/td>\nHemodialysis Access interventions<\/td>\nIR dialysis access - AV fistula evaluations (6640)<\/td>\nCheck Specific Anticoagulant
\n\"Low Risk\" Category<\/td>\n		If missed HD, K<\/td>\nDay of procedure<\/td>\nINR \u2264 3.0
\nPlatelets > 20<\/td>\n		None<\/td>\nModerate<\/td>\n<\/td>\nChehab<\/td>\n<\/td>\n<\/tr>\n
<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\nUnless otherwise noted:<\/td>\n<\/td>\n<\/tr>\n
<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\nSociety of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions\u2014Part II: Recommendations<\/td>\n<\/td>\n<\/tr>\n
<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\nPatel, Indravadan J. et al.\u00a0 JVIR,\u00a0 2019; 30:1168 - 1184.e1<\/td>\n<\/td>\n<\/tr>\n
<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n","protected":false},"excerpt":{"rendered":"

Pre-procedure IR Guidelines   Procedure eDH Order Name (IMG Code) Modification if Anticoagulated Laboratories Required* Laboratory Timeframe Laboratory Cutoffs Antibiotic Prophylaxis Sedation Plan Follow-up References Ablation Bone CT Guided Ablation \u2022 Cryotherapy-Bone (4536) \u2022 Microwave: Spine (4703) \u2022 RFA: Bone (4572) Check Specific Anticoagulant “High Risk” Category PTT \/ INR [\u2026] <\/p>\n

<\/div>\n

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