Before You Start: Evaluation of the Patient and the Procedure Krishna Jain MD, FACS Clinical professor of Surgery Western Michigan University Homer Stryker MD School of Medicine Society for Vascular Surgery, 2019

Disclosures President and CEO National Office Endovascular Labs LLC CEO National Surgical Ventures

Not Suitable for Office Intervention Morbid Obesity Severe dye allergy Inability to lay flat Pain control and anxiety Sever seizure disorder ASA 4 Poor airway Severe sleep apnea MI < 3 months Stroke < 3 months Previous anesthetic complications ( If conscious sedation planned )

Pre procedure Checklist Name, Date of Birth Sex Age Weight Medical record number Informed Consent Procedure Type Site marked

Pre Procedure Checklist Anticoagulants Not applicable Stopped Pt, PTT checked Blood sugar Checked before procedure GFR Checked Normal Abnormal: hydration protocol

Pre Procedure Checklist Allergies Drugs Antibiotics Contrast Agent Allergy Prevention Not Applicable Medicines administered Administered Not indicated

Pre Procedure Checklist Special Equipment Available Not needed Cardiopulmonary status Abnormal, unchanged from baseline Blood pressure Radiation Precautions All personnel adequately protected

Patient With Renal Insufficient But Not On Dialyses Less than 5 CC of dye Use of intravascular ultrasound Ultrasound guided intervention

Patients for Port Insertion Platelet count White blood cell count PT,PTT

PAD Intervention Hostile groin Retrograde tibial approach If diseased one vessel run off, may be contraindicated Obesity Indication for procedure ( Poor outcome in Rutherford 6)

Anesthesia Local anesthesia Does not need to be NPO Can receive narcotics Conscious sedation Needs to be NPO

Procedure Is it appropriate Is indication well documented? Procedures scheduled on regular intervals are not indicated and may result in fines. No difference in indications based on geographical location of the procedure Should not be driven by financial incentive