Interventional Radiology Frequently Asked Questions

Where Concord Hospital entrance should I use for my Interventional Radiology appointment?

There are two ways to enter the Concord Hospital campus. Whichever one you take, please follow the signs to the Main Entrance or Parking Lot A.

Parking Lot A is in front of the Main Entrance. When you enter the lobby, stop at the Hospitality Services desk and ask for directions to the Ambulatory Care Center (ACC). It is a bit of a walk, so ask the receptionist for a wheelchair escort if necessary.

Check in with the receptionist at ACC. Please keep in mind that your scheduled time is approximate, as unexpected emergencies and delays may arise. If you find yourself waiting for more than 30 minutes, please ask the receptionist for an update.

What is Interventional Radiology?

Interventional Radiology (IR) is a medical specialty that uses imaging to guide the doctor while he or she uses special catheters and needles to diagnose and treat various conditions. Three types of imaging are used: CT scan, ultrasound, or fluoroscopy (real-time X-rays that can be taken at different angles).

Some procedures require a consultation with an IR doctor before the procedure is scheduled. Examples of such procedures include kyphoplasty, vascular arteriograms, cryoablation, TIPS, Spyglass, and embolization of the uterus, prostate, or middle meningeal artery.

Other procedures do not require consultation with an IR doctor. The patient will meet the IR doctor on the day of the procedure, when he/she will explain how the procedure will be performed, any potential risks, and answer any questions. Some of our common procedures that do not require consultation are listed below, followed by a brief description. Specifics regarding your procedure will be discussed on the day of the procedure. You will be informed if moderate sedation will be used when your appointment is booked. (See moderate sedation section for details.) Also, during the scheduling process, you will be informed if any of your medications need to be held. Blood thinners such as Coumadin, Eliquis, Xarelto, Plavix, and Brilinta may need to be held. DO NOT HOLD THE MEDICATIONS UNLESS INSTRUCTED TO BY A MEMBER OF THE IR TEAM.

• Drain placement: Depending on where in the body the drain will be placed, moderate sedation may be used. CT scan or fluoroscopy are the most common types of imaging used for drain placement.  Patients will be instructed on how to take care of their drain after the procedure. The length of time the drain remains varies. Patients will periodically return for a dye study. This is a fast, simple procedure where contrast is injected into the drain during fluoroscopy. The image will show if the fluid collection has been resolved and the drain can be removed.
• Tube placement: Suprapubic tubes (SPT) and gastric tubes are common procedures. Fluoroscopy is used for both. SPT requires moderate sedation (please read how to prepare for moderate sedation), and gastric tubes are usually placed under general anesthesia. Nephrostomy tubes are also placed using fluoroscopy and moderate sedation. Patients lie on their stomachs for this procedure. 
• Biopsy: Special needles are used for all biopsies; no incisions are made, and patients leave with a Band-Aid or small gauze dressing. Many different types of biopsies are performed in IR and run the gamut from quick ultrasound-guided thyroid biopsies called fine needle aspiration to more involved biopsies of the lung or kidney, which require CT scan imaging. Thyroid biopsies or superficial lymph node biopsies use lidocaine to numb the area; no sedation is needed, and patients leave after the procedure is done.

Liver, bone, bone marrow, kidney, or lung biopsies also use lidocaine plus moderate sedation (read section on how to prepare for moderate sedation). Moderate sedation is followed by a recovery period, the length of which depends on the type of biopsy. Bone biopsy recovery usually lasts one hour, whereas kidney, lung, or liver biopsy recovery can last from two to four hours. X-ray or lab results taken during the recovery period help to determine the length of time. Your recovery room nurse will call your ride to inform him/her what time you will be ready for discharge.

• Chest port placement: This is a common procedure in which a small incision is made, and a small round vessel (port) is placed under the skin. The port has a tube that is tunneled under the skin and ends in a large vein called the internal jugular vein. This vein carries blood back to the heart. Chemotherapy can be very harsh on smaller arm veins, so infusing chemotherapy through a port is more comfortable and safer for a patient since the medication flows through a larger vein. The port is not visible but a small bump under the skin can be felt. This procedure uses ultrasound and fluoroscopy, local anesthetic, and moderate sedation (read how to prepare for moderate sedation). The recovery period following the procedure is one hour. Once the port is no longer needed, the IR team can also remove the port.
• Injections: Several different types of steroid injections are done in IR, including joint injections and epidural steroid injections (back injections). Lidocaine is used to numb the area, and fluoroscopy assists the provider in finding the correct location before a needle is inserted. Patients do not need to fast. Back injection patients need to have someone drive them home.
• Dialysis catheter placement: These catheters are usually placed in the right chest about one inch below the collar bone by using fluoroscopy. Lidocaine is used to numb the area and is frequently accompanied by moderate sedation (read the section on how to get ready for moderate sedation). Dialysis catheters are ready to be used once inserted. If a dialysis catheter is no longer needed, it can also be removed by the IR team.
• Fistulogram: This is a procedure that is performed using both ultrasound and fluoroscopy when a dialysis fistula is not working properly. Lidocaine and moderate sedation are frequently used for the procedure. A special device is placed in the fistula, and several wires and catheters are threaded through the device. These wires and catheters can improve narrowing or other problems that are discovered through the use of an X-ray. Recovery time is usually one to two hours.
• Paracentesis and Thoracentesis: Both of these procedures use ultrasound to remove excess fluid from the abdomen (paracentesis) or the lung (thoracentesis). Lidocaine is used to numb the area before a needle is inserted, which will drain the fluid. The needle for paracentesis patients is attached to a suction device to help remove the fluid, and it may take up to 45 minutes to drain. A thoracentesis patient’s needle is attached to a vacuum bottle, and drainage usually takes less than 15 minutes. Patients do not need to fast, but they do need to have someone drive them home.
• Lumbar Puncture: Patients lie on their stomachs for this procedure. Using fluoroscopy guidance, the provider numbs the area with an injection of lidocaine, then inserts a special needle into the spinal canal and drains off fluid for diagnostic testing. Patients lie flat for one hour following the procedure and need to have someone drive them home.

What is Moderate Sedation?

Not all procedures require moderate sedation. You will be informed if it will be used when you schedule the appointment for your procedure.

Moderate sedation is different from general anesthesia. Patients receiving moderate sedation breathe on their own and are easily arousable. The intent is to keep a patient comfortable and relaxed; often, a light sleep or "twilight sleep" is the result.

Fentanyl and Midazolam (Versed) are the IV medications used to achieve twilight sleep. Fentanyl diminishes pain sensation, and Midazolam promotes relaxation and short-term amnesia, so the patient does not remember the procedure.

These medications are safely administered by trained nurses who monitor the patient's level of consciousness, vital signs, oxygenation, and EKG throughout the case.

How to prepare for moderate sedation: A patient must not eat or drink after midnight except for a small amount of water with morning medications. 

Because moderate sedation requires fasting, diabetic patients may want to adjust or hold their diabetes medications to avoid low blood sugar, especially if their procedure is scheduled in the afternoon.

Please inform the appointment scheduler if you are taking an injection medication for weight loss, such as Ozempic, Wegovy, or Mounjaro.

A patient receiving moderate sedation cannot operate a vehicle for 24 hours, so you need to arrange a ride home after your procedure. Uber, taxi, and bus services are not acceptable forms of transportation after moderate sedation.