Position: Supine, arms tucked
Time: 1-2 hours (average)
Blood Loss: Low (10-50 ml)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: Yes
Lead: Yes

Heparin – Have 10,000 units of heparin ready to give when the surgeon orders it. Once the heparin is administered, start a timer. The surgeon usually likes to know when 3 minutes have passed.

Heparin Reversal – Protamine should also be drawn up at the appropriate dosage (1mg/100 units of heparin given).

Phenylephrine Drip – These patients tend to be very labile in blood pressures. If you suspect the patient will need blood pressure support, it is recommended to have a phenylephrine drip ready and attached. Once the patient is tucked – it’s going to be very difficult to do that during the procedure.

Tucked Arms (general considerations): Consider a second IV – once the procedure has started, it’s going to be VERY difficult to handle IV issues – especially if your only IV has problems. Ensure the IV is running and monitors are still functioning after tucking the patient’s arms

Fluoroscopy / Xray (general considerations): Have lead aprons and thyroid shields available. Alternatively, distancing yourself 3 to 6 feet will reduce scatter radiation to 0.1% to 0.025% respectively. Occupational maximum exposure to radiation should be limited to a maximum average of 20 Sv (joules per kilogram – otherwise known as the Sievert/Sv) per year over a 5 year period. Limits should never exceed 50 Sv in a single year.

Arterial line (general considerations): Preoperatively check pulses to gauge the best side to attempt the A-line. Perform an Allen test to ensure adequate blood flow. Have the A-line equipment set up and ready in the room.