• Medications

  • Anesthesia

    • Local anesthetic: 1% lidocaine

    • Conscious sedation: Fentanyl, midazolam

    • General anesthesia (if needed)

  • Prophylactic antibiotics

    • Based to local protocol

  • Management of co-morbidities  (allergy, blood glucose, blood pressure, nausea, etc)

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• Trolley/Equipment​

  • Access micropuncture kit

  • Catheters 

    • Flush and directional catheters

  • IVC Filter deployment kit

  • Sheaths

    • Short 6Fr

  • Wires 

    • 0.035" standard, hydrophilic, Amplatz superstiff 

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• Checklist

  • CIRSE (IR Patient Safety Checklist)

  • LocSSIPs (Local Safety Standards for Invasive Procedures)

  • NatSSIPs (National Safety Standards for Invasive Procedures)

  • WHO (World Health Organization Surgical Safety Checklist)

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• Access

  • Supine position for right IJV or right CFV access

    • Transjugular approach:

      • Occluded common femoral veins

      • Occluded iliac veins

      • Thrombosed lower IVC

      • Large pelvic mass/Pregnancy

    •  Transfemoral approach:

      • Occluded jugular access

  • Ultrasound guided is recommended

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• Technique

  • Cleanse the access site and cover with sterile drape

  • Ultrasound guided venous access with seldinger technique

  • Sheath insertion over the wire (Flush the sheath)

  • Catheter and wire negotiated to a common iliac vein under fluoroscopy

  • Exchange the catheter with a diagnostic pigtail catheter

  • Connect the catheter with the contrast injector and perform a venogram in AP view

    • Verify patency of IVC and level of renal veins

    • Use an overlay of the venographic image and the bony landmarks to assess the correct level for deployment 

  • Exchange the catheter and sheath with the filter delivery system, over the wire

  • Independently from the approach, the apex of the filter should be at or below the renal arteries

  • Deploy the filter as indicated

  • Perform final venogram to verify satisfactory deployment and to exclude complications

    • The venogram is performed from the deployment sheath 

      • Femoral approach: tip below the filter

      • Jugular approach: tip just above the filter

  • Remove deployment kit

  • Manual compression of the access site for 5’

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• Tips​

  • Ask for the patient to hold breath during venograms

  • Contrast injection: usually 20ml at 15ml/s are satisfactory

  • Alternatively, to the above technique, the deployment kit can be used for the initial access and venogram, without the need for extra sheath and catheters

 

• Report

  • Describe any pathology noted at the venograms

  • Mention anatomic variations

  • Report the technique

  • Post-procedure instructions if needed

  • Consider a retrieval date if possible