A pre-procedure work-up includes:

1. What procedure is being requested and why?
2. Who is the referring staff and who is the resident contact (name and pager or phone #)?
3. Urgency of exam:
   1. EMERGENT PROCEDURES ((i.e. trauma arch; cold foot; etc) need to be done ASAP. Please do not delay emergent cases, even for labs. IR fellow must go and evaluate the patient.
   2. URGENT PROCEDURES are those that can be done as the first case in the morning.
4. Can the patient consent? If not, who has the authority to do so? (Spouse, parent, or child.)
   1. Emergency Consent: the policy is the same at all hospitals; two notes written by attending physicians, one of who can be the IR physician. No fellows or senior residents may sign.
   2. The note must clearly state the nature of the emergency and document (unsuccessful) attempts to contact family members.
5. Is the patient allergic to contrast? If yes, has the patient been premedicated? (32 mg methylprednisolone 12 and 2 hours before procedure, may substitute with 40 mg prednisone.)
6. Has the patient been NPO for at least 6 hours? (If not, conscious sedation cannot be used.)
7. Labs: BUN, creatinine, platelets, INR, PT, PTT, WBC, Hgb; Hct. Other labs may be needed depending on the type of case (i.e. LFT's)
   1. For arterial cases the INR should be ≤ 1.3 and for venous cases the INR should be ≤ 1.8. Otherwise it should be corrected for all urgent and elective procedures. Please discuss with IR Staff because of they may have an individual case-by-case preference.
   2. Tunneled catheter criteria include: platelets > 25K, INR ≥ 1.5. Platelets ≤ 25K and INR ≤ 2 will be considered on an individual basis.
   3. Chest port criteria include platelets ≥ 50 K and INR ≤ 1.5.
8. Ask for the weight of the patient. Table limits are 400# at IUH, 440# at WMH, and 440# at VA.
9. Is the patient cooperative?
10. Can the patient lay completely supine or prone? (Depending on the procedure to be performed.)
11. Can the patient hold his breath? (Important for diagnostic studies, especially pulmonary arteriography and trauma arches.)
12. Has the patient had any oral contrast within 24-48 hours? (Affects diagnostic abdominal angiography.)
13. For pulmonary angiography, must have 12 lead ECG to exclude left bundle branch block.