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1057.e2 Angiogram, Nonselective

Angiogram, Nonselective Client Education
Sheet
VetBooks.ir

• Transparent, aqueous IV contrast material
Difficulty level: ♦♦♦
• Placement of IV catheter
(iodinated, ionic) (e.g., Renografin-76, • A 12-hour fast if sedating animal
Synonyms Renovist 69%, Hypaque-M75, Conray 60%); • Discuss possible complications with owner
Nonselective radiographic contrast study of maximal total cumulative dose given during as indicated below.
the heart procedure, assuming maintenance IV fluid
administration to promote diuresis: 3 mL/kg Possible Complications and
Overview and Goal Common Errors to Avoid
To perform an intravenous (IV) contrast Nondiagnostic study; improve likelihood of
TIME (SEC) FROM
study that highlights the venous return START OF INJECTION diagnostic result by
to the heart and the right-sided cardiac Site Enhanced • Using large-diameter catheter
structures by Contrast Dog Cat • Using fluoroscopy instead of serial
radiographs
Indications Cranial vena cava 1-2.5 0.5-1.5 • Injecting contrast rapidly
• Suspected venous obstruction Right ventricle 2-3 1.5-2.5 • Injecting adequate volume of contrast
• Ill-defined abnormalities of the right side of Pulmonary arteries 2-3 1.5-2.5
the heart when echocardiography is equivocal Left atrium 4-5.5 4.5-7 Procedure
or unavailable • Catheter patency is checked.
• Pulmonary thromboembolism: rarely diag- Left ventricle 4.5-6 5-7 • Animal is placed on radiographic table,
nostic as a nonselective procedure (often Aorta 4.5-6.5 5-7 usually in lateral recumbency.
requires power-injected contrast through • Position of radiographic beam is set over area
large-bore catheter in pulmonary artery) Adapted from Wise M: Nonselective angiocardiography in the of interest (usually thorax, neck, or limb).
normal dog and cat. Vet Radiol 23:144-151, 1982. • Contrast is injected IV by hand as quickly
Contraindications as possible (maximal manual pressure).
• Lesions that are equally or better defined • Radiographic facility, including radiographic Recommended single dose is 1-2 mL/kg
machine, films and cassette, and developer
without the administration of contrast (i.e., and/or fluoroscopic unit (440 mg iodine/kg).
by echocardiography) • Radiographic views are obtained at the
• Hypersensitivity to contrast material Anticipated Time appropriate times, or the flow of contrast
• Renal failure (decreased ability to excrete is observed in real time with fluoroscopy.
contrast material and/or risk of contrast- About 15-30 minutes after catheter placement
induced renal failure) Postprocedure
• Arteriovenous (AV) fistulas are not an indica- Preparation: Important IV fluid diuresis is provided if appropriate. The
tion for this procedure. AV fistulas shunt Checkpoints goal is to increase excretion of contrast medium,
from artery to vein and require selective • Thoracic radiographs: must precede contrast but excessive volume load must be avoided if
arteriography. study because a diagnosis may be apparent heart disease exists.
from these alone.
Equipment, Anesthesia • Congestive heart failure must be controlled Alternatives and Their
• Can be done with or without anesthesia; before procedure. Relative Merits
sedation in most patients (see inside back • Clipping of hair over vein to be catheterized • An echocardiogram and thoracic radiographs
cover of book) (typically jugular or cephalic); jugular may be should be performed before angiography.
• Hair clippers preferable in small animals (<10 kg) because ○ Noninvasive, excellent diagnostic yield
• Surgical scrub solution, rubbing alcohol, and the cephalic can be too small to allow easy • Vascular ultrasound
gauze/sponge for prepping skin flow of viscous contrast solution through ○ Noninvasive but limited by lungs: poor
• IV catheter (jugular or peripheral) catheter visualization of intrathoracic vessels
○ A 19- or 20-gauge catheter for cats or
small dogs; a 16- or 18-gauge catheter
for medium or large dogs
• The catheter cap or T-port should be a screw
tip to avoid detachment under high-pressure
of contrast injection.
• ± Sterile surgical gloves if using a nonsheathed
jugular catheter
• ± Lidocaine for local anesthesia if large-bore
jugular catheter (18 gauge or larger)
• Routine tape and bandage material for
catheter fixation to skin
• ± Suture material (e.g., 3-0 nylon), needle
holders, and suture scissors if anchoring
jugular catheter to skin of neck
• Syringe for IV contrast material. A syringe
with a screw tip is recommended to avoid
pressure-induced separation of the syringe ANGIOGRAM, NONSELECTIVE Lateral nonselective angiogram in a normal cat. Contrast was injected in
from the T-port or catheter cap during a cephalic vein; right side of the heart and pulmonary circulation are opacified, and early opacification of left
high-pressure injection of contrast. side of the heart and aorta is also seen. (Courtesy Dr. Brett Kantrowitz.)

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