Interventional Radiology

Patient Care 

Goals and Objectives 

  1. Interpret the results of initial focused clinical evaluations (history, physical examination, laboratory data) to determine the need for image guided
    1. CVC insertion
    2. diagnostic or therapeutic thoracentesis, catheter thoracostomy, and/or tube thoracostomy
    3. aspiration or drainage af abdominal/pelvic fluid collections
  2. Identify the factors that affect the risk/benefit ratio of the above types of  percutaneous procedures, including
    1. Comorbidities
    2. Anemia
    3. Coagulopathy
  3. Optimize patient preparation for the above percutaneous procedures including
    1. Prevention of infection
    2. Management of hematologic issues
    3. Management of contrast allergy
    4. Management of renal disease
  4. Analyze the patients comorbidities and the nature of the planned procedure to select the optimal conscious sedation plan
  5. Analyze the results of post-procedure monitoring to managepatient recovery after the above percuteneous, image-guided procedures
  6. Analyze the results of postoperative monitoring to identify and manage complications after the above procedures including
    1. Bleeding
    2. Adjacent organ injury
    3. Catheter tube malfunction
    4. Vessel thrombosis
    5. Hemothorax
    6. Pneumothorax 

Responsibilities and Expectations 

  1. Participate in clinical activities as assigned by the IR faculty and NP
  2. Compose H&Ps, daily progress notes, and procedure notes.
  3. Attend daily morning rounds and be prepared to present patients in an organized and succinct manner
  4. Implement the clinical decisions made by the team during rounds.
    1. Communicate with the admitting service
    2. Arrange consultations
    3. Communicate with the bedside RN
    4. Review ongoing diagnostic studies
  5. Notify the service NP if unable to implement the clinical plan
  6. Communicate the results of consultations, diagnostic tests, and therapeutic procedures to the service NP in a timely manner 

Medical knowledge 

Goals and objectives 

  1. Compare indications for
    1. Central insertion and peripheral insertion of CVCs
    2. IJ and SC vein CVC insertion
    3. Tunneled and non-tunneled catheters
    4. Catheter and tube thoracentesis or thoracostomy
    5. Open and percutaneous drainage of abdominal or pelvic fluid collections
  2. Analyze the complications of
    1. CVC insertion
    2. Tunneled and non tunneled catheters
    3. Thoracentesis and thoracostomy
    4. Percutaneous drainage of abdominal or pelvic fluid collecitons
  3. Describe the normal anatomy and common anatomic variations of
    1. Upper extremity peripheral venous system
    2. Central veins of the chest
    3. The pleural space
  4. Identify the optimal diagnostic approach to evaluate a patient with possible
    1. Pleural effusion
    2. Central venous obstruction
    3. Intra-abdominal fluid collection
  5. Compare the pathophysiology of the following condition to identify the optimal approach to successful percutaneous drainage or catheter insertion
    1. Pleural effusion
      1. Acute vs. chronic
      2. Simple vs. complex
      3. Fluid vs. blood
    2. Central venous obstruction
      1. Acute vs. chronic
    3. Intra-abdominal fluid collection
      1. Acute vs. chronic
      2. Simple vs. complex
  6. Compare contrast agents used for vascular imaging, particularly in terms of
    1. Cost
    2. Risk of allergy
    3. Risk of contrast nephropathy
  7. Understand the various levels of conscious sedation in terms of
    1. Appropriate agents
    2. Appropriate monitoring, intra and post procedure
    3. Indications for consult with anesthesia for monitored anesthesia care
    4. Factors that increase the risk of conscious sedation
      1. Airway
      2. GI tract disease
      3. Neurologic disease
      4. Mental status
      5. Communication limitations
  8. Describe the basic sheaths, wires, and catheters used for the above procedures
  9. Use fundamental principles of radiation safety to reduce the radiation exposure associated with the above procedures
    1. Approaches to reducing patient and personnel exposure
    2. Minimize fluoroscopy time
    3. Use of collimation, filters, field of view
    4. Distance to patient and personnel
    5. Use of protective shields and gear 

Practice-Based Learning and Improvement 

Goals and Objectives 

  1. Analyze outcomes to improve patient care 

Responsibilities and Expectations 

  1. Attend morning educational conference
  2. Participate in review of cases and analysis of treatment outcomes during morning rounds
  3. Compile a list of all procedures performed and any complications
  4. Meet with the NP fellowship director at least once during the rotation to review goals and objectives 

Interpersonal and Communication Skills 

Goals and Objectives 

  1. Communicate effectively as a member of the multidisciplinary team which rounds together
  2. Communicate effectively with patients and families
  3. Work effectively as a member of a professional group
  4. Consistently demonstrate sensitivity to patients from different cultures 

Responsibilities and Expectations 

  1. Establish appropriate role in the multidisciplinary care team
  2. Maintain appropriate lines of communication within the care team and across disciplines
  3. Notify the primary team members of the results of a procedure in a timely manner, including outcome, complications, monitoring needs, and patient status at procedure completion 

Professionalism 

Goals and Objectives 

  1. Enhance the body of knowledge in advanced practice nursing through exchange of ideas and knowledge in professional organizations, conferences, research activities, and written publications.
  2. Functions as a licensed independent practitioner 

Responsibilities and Expectations 

  1. Demonstrate respect, compassion, and integrity
  2. Demonstrate a commitment to excellence and on-going professional development
  3. Provides patient centered care recognizing cultural diversity and the patient or designee as a full partner in decision making 

Systems-Based Practice 

Goals and Objectives 

  1. Effectively use the radiologic picture archiving system (PACS)
  2. Understand the triaging system for scheduling patients for IR based procedures 

Responsibilities and Expectations 

  1. Learn approximate costs and resource allocation needs for the devices most commonly inserted in IR
  2. Know how to partner with health care managers and health care providers to assess and coordinate health care discharge planning for patients with indwelling IR inserted devices 
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