Angiogram

Angiogram Image
Angiogram Image 

What is an angiogram?

An angiogram (say: AN-gee-o-gram) is a procedure that uses medical imaging devices to see the arteries inside your child’s body. Ultrasound, X-rays, computed tomography (CT), and magnetic resonance imaging (MRI) are types of medical imaging devices. An artery is a blood vessel, which carries blood away from the heart to the tissues in the body.

What is Image Guided Therapy (IGT)?

IGT refers to procedures done by interventional radiologists to help diagnose and treat patients. Using medical imaging devices, these doctors are able to perform procedures that may have required traditional surgery in the past.

Risks of an angiogram

All procedures carry some risk. These risks vary from low to high. Angiograms are usually low-risk procedures. Although the risk of this procedure may be small, it may increase depending on how sick your child may be, the age and size of your child, if treatment of the arteries is undertaken, and any other problems your child may have.

The risks of an angiogram may include:

  • bleeding
  • bruising
  • infection
  • pain or discomfort in the groin or leg where the catheter was inserted to inject the dye
  • bleeding inside the body in the area examined
  • a bulge or weakness in the artery wall (aneurysm)
  • allergy to X-ray dye or contrast
  • clotting of the artery
  • poor circulation to the leg
  • stroke
  • death (very rare)

Before doing any procedure, your child’s doctor will discuss the risks and benefits of the procedure with you. This will help you to decide if the procedure is right for your child.

Giving consent before the procedure

The radiologist will go over a consent form with you, which will outline the potential risks of the procedure. If you have any questions about the procedure, you are encouraged to ask them at this time. If you understand all of the risks and potential benefits of the biopsy and you agree to the procedure, you can give consent for treatment by signing the consent form. For young children, a parent or legal guardian must be the one to sign.

An examination before the angiogram

Your child will be examined to make sure she is healthy and it is safe for her to have an angiogram. This examination will also include taking blood for lab tests.

How to prepare your child for the procedure

Before any treatment, talk to your child about what will happen. Use words she can understand. Be honest, calm, and supportive. Tell your child that medicines will be given to her so she will feel comfortable during the procedure. Children feel less anxious and scared when they know what to expect. Children also feel more relaxed when they see their parents are calm and supportive.

Your child will have medicine for pain

Children are given medicine for treatments that may be frightening, uncomfortable, or painful. This medicine can be broken down into three different categories:

  • local anaesthesia
  • sedation
  • general anaesthesia

Local anaesthesia

Local anaesthesia is simply a freezing agent injected through a very thin needle into the skin. It is used for older, cooperative children who choose to do the procedure this way. Your child does not need any special preparation for a local anaesthetic.

Sedation

Sedation is medicine that helps your child relax during the procedure. In most cases, sedation is used when children are healthy, have no major illnesses, are able to cooperate, and are having a short procedure.

Your child will have an intravenous needle (IV) put into her hand. The nurse or doctor will then give your child a sedative through the IV. The medicine may or may not cause your child to fall asleep completely. The nurse will make sure your child is comfortable at all times.

General anaesthesia

General anaesthesia may be used if your child has any specific medical conditions, or if your doctor thinks this is the best option. The deep level of sedation (sleep) caused by general anaesthesia will require your child to breathe with the help of a tube. The tube is removed when the general anaesthetic is reversed and your child is able to breathe independently. This usually happens shortly after the procedure.

Food, drink, and medicines before the procedure

Your child’s stomach must be empty during and after sedation or general anaesthetic. An empty stomach lowers the chances of throwing up (vomiting) and choking on food. Here are some things to remember when preparing your child for sedation or general anaesthetic:

  • Your child cannot have any solid food or milk for eight hours before the procedure. This includes gum, Jell-O, and candy.
  • Your child may drink clear liquids like apple juice, ginger ale, or water up to two hours before the procedure.
  • If your child is breastfeeding, she may drink breast milk up to four hours before the procedure.
  • Give your child her regular morning medicine with only a sip of water two hours before the procedure.
  • Medicines such as ASA (Aspirin), anti-inflammatory drugs, such as naproxen or ibuprofen (Advil or Motrin), blood thinners, such as warfarin (Coumadin) or enoxaparin​, may increase the risk of bleeding. Do not give these to your child before the procedure. If your child is taking any of these medicines, please discuss this with her doctor.

If these guidelines are not followed, your child’s procedure will be postponed, and you may have to come back another day to have it done.

If your child has special needs during fasting, her doctor will let you know what to do before the procedure.

During an angiogram

Your child will be placed on her back. The interventional radiologist will insert a tiny tube, called a catheter, into an artery in the groin (the area at the top of the leg). It is then directed into the area that requires imaging. Next, a special dye, called contrast, is injected into the catheter. The dye is a clear, colourless liquid that helps to outline the arteries so they will show up on an X-ray. The doctor then uses a special X-ray to take pictures of the arteries.

When the procedure is finished, the catheter is taken out of the artery. The radiologist presses on the artery in the groin to stop the bleeding. Your child may have a Band-Aid on the puncture site after the angiogram.

An angiogram can take between 45 minutes to two hours, depending on how complex the arteries being examined are. It can also take longer if any additional treatments are done to the arteries.

You will be asked to wait in your child's room or in the surgical waiting area while the procedure is happening.

After the angiogram

When the procedure is over, the radiologist will find you and tell you how it went. Your child will be moved to the recovery area. As soon as your child starts to wake up, a nurse will come and get you so you can be with her.

While in the recovery area, your child should remain on her back with her leg kept straight. Some pressure may be applied to the angiogram site to prevent further bleeding.

Pain relief

Some children feel mild discomfort at the angiogram site for the first day or two. If this happens, your child may be given pain medicine. Give her acetaminophen (Tylenol) for pain. Do not give her any medicines that thin the blood, such as ibuprofen (Advil or Motrin) or warfarin​. Check with your child’s doctor first.

Going home

In most cases, children go home the same day as the procedure. Your child will be ready to go home when she is wide awake and stable. This usually occurs about six hours after the procedure. Your child’s nurse will watch her to make sure she is well enough to go home.

For more details on how to care for your child after an angiogram, please see Angiogram: Caring for Your Child at Home After the Procedure.

Key points

  • An angiogram uses medical imaging to create a map of the arteries so they can be seen on an X-ray. Contrast dye is injected through the artery to outline the artery shape.
  • You will be asked to sign a consent form before the procedure.
  • Be calm, honest, and tell your child what to expect. Children feel less nervous and scared when they are given honest information.
  • After the procedure, check with your child’s doctor before giving her any pain medication.

Joao Amaral, MD

Candice Sockett, BScN

2/17/2011




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