According to the American Board of Surgery, "vascular surgery encompasses the diagnosis and comprehensive, longitudinal management of disorders of the arterial, venous, and lymphatic systems, exclusive of the intracranial and coronary arteries." In other words, vascular surgery involves the arteries, veins, and lymphatic vessels of the body - except for the heart and the brain. Minimally invasive catheter procedures and surgical reconstruction are both seen in the field of vascular surgery.
Vascular can seem like a scary specialty, but using these ten tips that I'm going to share with you today will help you prepare yourself for these cases with confidence.
#1 Pulses are important!
It is imperative to know that blood is flowing to all areas before the patient leaves the OR. Knowing where pulses are felt and marked at the end of the surgery can help identify any potential post-op complications.
#2 Always have a doppler.
Remember how we just talked about the importance of pulses? In vascular patients it can be difficult to palpate pulses so always have a doppler and cord ready to go in any vascular procedure.
#3 Get to know your interventional radiology tech.
Interventional radiology (IR) techs are a specially-trained group of professionals who do procedures under fluoroscopy and many times do vascular cases. They have a wide knowledge of how to do angiograms, arteriograms, aortograms - all procedures that fall under vascular surgery. Many times they know how to trouble-shoot vascular-specific radiology equipment. They are vital to successful vascular surgery.
#4 Know the status of blood products.
There is always a risk of rupturing or injuring arteries and veins in vascular surgery which can lead to a significant blood loss. Ensuring a patient is type and crossed with product ready to go, or even better, already in the room, will help minimize a serious situation.
#5 Know your labs!
Pay special attention to a patient’s BUN and creatine. Vascular surgery uses fluoroscopy for cases and contrast can be hard on the kidneys and their function. Knowing how well the kidneys are working can determine how much contrast can be used for a case, and if it's ok to use or not.
#6 Ensure radiology films are ready.
There are vascular specific CT scans and MRIs that are done pre-operatively that can help plan how the surgery will be done. Even with a plan, as we know in the OR, things can change. Having access to these studies can help minimize time when a surgical plan changes and gives reference to what was seen several weeks ago verses what is currently being seen on screen.
#7 Know how to be ready to convert from a minimally invasive to open procedure.
While we may plan for a minimally invasive, or endovascular, procedure, situations can change at any given moment. We have to be ready to convert to an open procedure if necessary.
#8 Sides are important.
One thing I have learned in endovascular surgery is that you may be operating on the right side of the body but you’re making an incision on the left side of the body. It was very concerning for me to think the wrong side was being operated on! It wasn’t until I was educated that it is easier to access the diseased site through a good flowing vessel on the opposite side of the body that I understood why the incision was made where it was.
#9 Be aware of the effects of radiation.
Fluoroscopy is used in many vascular cases. There can be long-term bodily effects related to prolonged radiation exposure. Therefore, it is incredibly important that you protect yourself around radiation. Proper fitting lead that covers all areas of the body, thyroid shield, radiation hat and radiation safety goggles will help protect you from harmful radiation rays.
#10 Have Protamine and Heparin available for administration.
Heparin is an anti-coagulant used to decrease the clotting ability of blood and it prevents clots in blood vessels. It’s given in vascular surgery to prevent thrombosis and ischemia during surgery. To reverse the effects of heparin, protamine will be administered. It’s used to help the body effectively clot blood. Always have both available!
Knowing these ten things will help set you up for success in vascular surgery! And remember, don't be afraid to ask questions if you're unsure. It's always better to ask than to risk patient safety because you didn't know. You can do this!