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Samenvatting Taken als TMB bij interventies
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Samenvatting Taken als TMB bij interventies
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Taken als TMB bij interventies1. Inleiding ........................................................................................................................................... 5
1.1 Histologie – anatomopathologie ............................................................................................. 5
1.2 Patiëntgebonden noodsituatie................................................................................................ 5
1.3 Procedures............................................................................................................................... 5
1.4 Ter herhaling ........................................................................................................................... 6
1.5 Taken – algemeen ................................................................................................................... 6
1.6 bloedwaarden afhankelijk van laboratorium .......................................................................... 7
2. Zonder geleide beeldvorming ......................................................................................................... 8
2.1 Centraal-veneuze-catheter...................................................................................................... 8
2.1.1 Reden van CVK................................................................................................................. 8
2.1.2 Complicaties .................................................................................................................... 8
2.1.3 Verloop plaatsen CVK ...................................................................................................... 8
3. Bij US-geleide interventies .............................................................................................................. 8
3.1 Taken bij US-geleide interventie ............................................................................................. 8
3.1.1 Toestelgebonden voorbereidingen ................................................................................. 8
3.1.2 Uitvoering & afronding .................................................................................................... 8
3.1.3 Patiënt verzorgen na interventie..................................................................................... 9
3.2 Thoraxdrainage........................................................................................................................ 9
3.2.1 Indicaties ......................................................................................................................... 9
3.2.2 Types drainages ............................................................................................................... 9
3.2.3 positionering patiënt ....................................................................................................... 9
3.2.4 Types abces ..................................................................................................................... 9
3.2.5 indicaties en contraindicaties thoraxpunctie ................................................................ 10
3.2.5.1 Indicaties ................................................................................................................... 10
3.2.5.2 Contraindicaties......................................................................................................... 10
3.2.6 Complicaties .................................................................................................................. 10
3.2.7 Steriele tafel .................................................................................................................. 10
3.2.8 procedure Thoraxdrainage ............................................................................................ 11
3.2.9 Drainagespecifiek materiaal .......................................................................................... 11
3.2.10 Post-interventie ............................................................................................................. 11
3.2.11 Drain verwijderen .......................................................................................................... 11
3.3 Biopsie ................................................................................................................................... 12
3.3.1 Indicaties ....................................................................................................................... 12
3.3.2 Positionering patiënt ..................................................................................................... 12
3.3.3 Steriele tafel .................................................................................................................. 12
3.3.4 Biopsiespecifiek materiaal ............................................................................................. 12
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, 3.3.5 Post-interventie ............................................................................................................. 12
3.4 Acites-/ pleurapunctie ........................................................................................................... 12
3.4.1 Positionering patiënt ..................................................................................................... 12
3.4.2 Indicaties en Contraindicaties ....................................................................................... 13
3.4.2.1 Indicaties ................................................................................................................... 13
3.4.2.2 Contraindicaties......................................................................................................... 13
3.4.3 Complicaties .................................................................................................................. 13
3.4.4 Steriele tafel .................................................................................................................. 13
3.4.5 Punctiespecifiek materiaal ............................................................................................ 13
3.4.6 Procedure ...................................................................................................................... 14
3.4.7 Post-interventie ............................................................................................................. 14
3.5 Clipmarkering ........................................................................................................................ 14
3.5.1 Positionering patiënt ..................................................................................................... 14
3.5.2 Steriele tafel .................................................................................................................. 14
3.5.3 Punctiespecifiek materiaal ............................................................................................ 15
3.5.4 Post-interventie ............................................................................................................. 15
4. Bij CT-geleide interventies ............................................................................................................. 15
4.1 Patiëntengegevens pre-operatief (/interventie) ................................................................... 15
4.2 CT-toestel bedienen .............................................................................................................. 15
4.3 Voorbereiding patiënt ........................................................................................................... 15
4.4 Wortelinfiltratie ..................................................................................................................... 16
4.4.1 Positionering patiënt ..................................................................................................... 16
4.4.2 Steriele tafel .................................................................................................................. 16
4.4.3 CT toestel bedienen....................................................................................................... 16
4.4.4 Post-interventie ............................................................................................................. 16
4.5 Drainage ................................................................................................................................ 16
4.5.1 Positionering patiënt ..................................................................................................... 16
4.5.2 Steriele tafel .................................................................................................................. 16
4.5.3 Drainagespecifiek materiaal .......................................................................................... 17
4.5.4 Post-interventie ............................................................................................................. 17
4.6 Biopsie ................................................................................................................................... 17
4.6.1 Positionering patiënt ..................................................................................................... 17
4.6.2 Steriele tafel .................................................................................................................. 17
4.6.3 Biopsiespecifiek materiaal ............................................................................................. 17
4.6.4 Post-interventie ............................................................................................................. 17
5. Bij MR-geleide interventie (exotisch) ............................................................................................ 18
5.1 Prostaatbiopsie...................................................................................................................... 18
5.1.1 Patiëntengegevens pre-operatief (/interventie) ........................................................... 18
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, 5.1.2 MR-toestel bedienen – Profylactisch antibioticum ....................................................... 18
5.1.3 Voorbereiding patiënt ................................................................................................... 18
5.1.4 Tafelopbouw.................................................................................................................. 19
5.1.5 Positionering patiënt op MRI onderzoekstafel.............................................................. 19
5.1.6 Materiaal ....................................................................................................................... 19
5.1.7 Biopsieweefselcassetten ............................................................................................... 20
5.1.8 Needle-guide houder neutrale instelling 0° - start........................................................ 20
5.1.9 Post interventie ............................................................................................................. 20
6. Bij interventionele angiografie ...................................................................................................... 21
6.1 Onderzoeksspectrum ............................................................................................................ 21
6.2 Toestelgebonden voorschriften ............................................................................................ 21
6.3 Mogelijkheden toestel........................................................................................................... 21
6.4 stralenbescherming volgens firma toestel ............................................................................ 21
6.5 Patiëntengegevens pre-operatief (/interventie) ................................................................... 22
6.6 Positionering patiënt ............................................................................................................. 22
6.7 Voorbereiden Contrasinjector............................................................................................... 22
6.8 Medicatie ............................................................................................................................... 22
6.9 Steriele instrumententafel dekken........................................................................................ 23
6.10 Materiaal bevochtigen – flushen........................................................................................... 23
6.11 instellingen Rö-toestel........................................................................................................... 24
6.12 TMB – instrumenteren .......................................................................................................... 24
6.12.1 S Kledijvoorschriften...................................................................................................... 24
6.12.2 Voor de procedure ........................................................................................................ 24
6.12.3 Tijdens procedure .......................................................................................................... 24
6.12.4 Na de procedure ............................................................................................................ 24
6.13 Verzorging punctieplaats....................................................................................................... 24
6.14 TMB – assisterende – NS ....................................................................................................... 25
6.14.1 Tijdens de procedure ..................................................................................................... 25
6.14.2 Na de procedure (01) .................................................................................................... 25
6.14.3 Na de procedure (02) .................................................................................................... 25
6.15 Na verwerking van de beelden .............................................................................................. 25
6.16 Stralenbescherming patiënt .................................................................................................. 26
6.17 Startpunctie ........................................................................................................................... 26
6.17.1 A. femoralis communis (AFC) ........................................................................................ 26
6.18 CO²-angiografie ..................................................................................................................... 26
7. Specifiek angiografisch onderzoek ................................................................................................ 26
7.1 Thrombolyse .......................................................................................................................... 26
7.1.1 Specificaties lyse ............................................................................................................ 26
3
, 7.1.2 Lysemedicament............................................................................................................ 26
7.1.3 Verloop lyseprocedure .................................................................................................. 27
7.2 Thrombectomie ..................................................................................................................... 27
7.2.1 Specificaties ................................................................................................................... 27
7.2.2 Speciale gebruiksregels ................................................................................................. 27
7.3 Chemoembolisatie van de lever ............................................................................................ 27
7.3.1 Specificatie Leverembolisatie (TACE) ............................................................................ 27
7.3.2 Specifiek materiaal ........................................................................................................ 28
7.3.3 Extra bescherming ......................................................................................................... 28
7.3.4 Specifiek medicament ................................................................................................... 28
7.3.5 Cytostaticum.................................................................................................................. 28
7.3.5.1 Doxorubicin ............................................................................................................... 28
7.3.6 Specifieke voorbereiding ............................................................................................... 28
7.3.7 Verloop TACE-procedure ............................................................................................... 29
7.3.8 Werking ......................................................................................................................... 29
7.3.9 Direxion and Direxion HI-FLO Torqueable Microcatheters ........................................... 29
7.4 PTCD ...................................................................................................................................... 30
7.4.1 Specifieke materialen .................................................................................................... 30
8. Beeldproductie en -verwerking ..................................................................................................... 30
8.1 Bediening toestel ................................................................................................................... 30
8.1.1 Arcadis Varic C-boog Siemens ....................................................................................... 30
8.1.1.1 Collimatie................................................................................................................... 31
8.2 Beelden verwerken................................................................................................................ 32
8.2.1 Subtractie ...................................................................................................................... 32
8.2.2 Standaard onderste ledematen..................................................................................... 32
8.2.3 Documentatie ................................................................................................................ 32
8.2.4 Vergroting gebruiken – meer detail zichtbaar .............................................................. 33
8.2.5 Vergroting gebruiken meer detail zichtbaar ................................................................. 34
8.3 Zaalinrichting ......................................................................................................................... 36
8.3.1 Angiografiezaal .............................................................................................................. 36
8.3.2 Voorbeeld Angiografie-inrichting Gö-Hei ...................................................................... 36
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