Radioembolizaton (Y90)

PREOP

• All patients will be seen in clinic
• Need labs: CBC, Chem comp, INR
• NEED INSURANCE AUTHORIZATION PRIOR TO SCHEDULING
• Imaging: need CT/MRI within 30 days of the procedure

ANTICOAGULATION/ANTIPLATELETS

• Aspirin or Plavix- Stop 7 days before biopsy
• Lovenox, Low Molecular Weight Heparin (LMWH), Arixtra – Stop 24h prior to procedure
• Pradaxa – stop 3 days prior to procedure if possible.  See “Warfarin” immediately below for “bridge” anticoagulation, if necessary (CONTACT IR physician if uncertain)
• Warfarin (Coumadin) – Depends upon procedure and indication, as well as the reason the patient is taking this medication (CONTACT IR physician or PA)

PRESCRIPTIONS (give to patient in prep consult)

• Norco 5/325mg take one tablet po q4h prn pain
• Colace 250mg po daily – for at least 3 days. Continue while taking narcotics
• Zofran sublingual 4mg po q8h prn for nauseA

PATIENT WILL NEED 2 SEPARATE VISITS TO THE HOSPITAL

1st procedure

• Diagnostic angio with embolization (cath lab)
• Nuclear medicine Liver-lung shunting study (needs to be scheduled radiology to be done within 1h from embolization)
• If patient is appropriate for second procedure, need to order SIR-Spheres ASAP (deadline is WED at noon)

2nd procedure

• Needs labs in the day of the procedure (CBC, chem comp, INR)
• SIR spheres will be delivered on Tuesday
• Patient needs to be contacted the night before to be sure they know where to go since spheres cost 16k dollars

LOCATION OF THE PROCEDURES

• Cath lab

PREOPERATIVE ORDERS

• IV with NS (Normal Saline) 75ml/hr

FOLLOW UP

• Phone call (1-2 days)
• 1-2 wks Clinic visit: to follow up symptoms
• 3mo followup with imaging (CT or MRI with contrast)