INFERIOR VENA CAVA (IVC) FILTER INSERTION
An Inferior Vena Cava (IVC) filter is a small, cone-shaped device that is implanted in the inferior vena cava (the large vein that carries blood from the lower half of the body back to the heart) to prevent blood clots from traveling from the legs or pelvis to the lungs, where they could cause a pulmonary embolism, a potentially life-threatening condition. The insertion procedure of an IVC filter typically goes as follows:
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Preparation: The patient is usually placed on a table in a procedure room and given local anesthesia or a mild sedative, depending on the patient's condition and the doctor's judgment.
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Access: A small incision is made in the skin, often in the neck or groin area. Using ultrasound or fluoroscopy (real-time X-ray imaging), the doctor guides a catheter (a thin, flexible tube) into the inferior vena cava.
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Placement: The IVC filter, which is attached to the end of a catheter, is then threaded up to the correct location in the vena cava. The filter is designed to expand and fit snugly against the walls of the vena cava once in position.
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Completion: The catheter is withdrawn, leaving the filter in place. The small incision in the skin is closed with stitches if needed.
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Post-procedure care: After the procedure, patients are observed for a period of time for any immediate complications. Further instructions regarding activity restrictions, potential symptoms, or necessary follow-up imaging will be given before discharge.
IVC filters can be temporary or permanent, depending on the patient's condition and risk of blood clots. Temporary (or retrievable) filters can be removed once the risk of clotting has decreased.
Anesthetic Implications for IVC Filter Insertion
Anesthesia type: General, local anesthesia, and sedation (MAC)
Airway: LMA or ETT
Preoperative:
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Fluoroscopy/Xray is used for this procedure
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Lead aprons and thyroid shields should be available
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The filter is placed endovascularly
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Can be inserted into the right femoral vein, arm vein, or internal jugular vein
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Assess patient's coagulation status
Intraoperative:
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Position: Supine, arms tucked
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Duration: 30-60 minutes
Postoperative:
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Pain management
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PONV prophylaxis
Complications:
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IVC thrombosis
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Filter migration
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Vena cava obstruction
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Vascular complications
Sources:
Longnecker, D. E., Brown, D. L., Newman, M. F., & Zapol, W. M. (2012). Anesthesiology, 2nd ed.
Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice.
Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.).
Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.