INFERIOR VENA CAVA (IVC) FILTER REMOVAL
Inferior Vena Cava (IVC) filters are small, cage-like devices that are implanted in the IVC, the main vessel returning blood from the lower half of the body to the heart. These filters are designed to catch blood clots and prevent them from reaching the lungs, where they can cause a potentially fatal pulmonary embolism.
IVC filters are typically used in patients who have a high risk of developing blood clots but cannot take anticoagulant medication, or in whom anticoagulants have failed. While some IVC filters are intended to be permanent, others are designed to be retrievable and can be removed once the risk of clotting has decreased.
IVC filter removal is a minimally invasive procedure. Here's a basic rundown of what it might look like:
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Preparation: The patient is prepared for the procedure, usually with a mild sedative to help them relax. They will be positioned on an X-ray table.
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Access: The doctor will numb a small area of skin, usually in the neck or groin, where a thin tube called a catheter can be inserted into a vein.
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Procedure: Using fluoroscopy (real-time X-ray imaging), the doctor guides the catheter to the location of the IVC filter. A small snare or other device is passed through the catheter to the IVC filter. The filter is then carefully grasped and pulled into the catheter.
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Removal: Once the filter is inside the catheter, both are removed together.
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Post-procedure: After the filter is removed, pressure will be applied to the catheter insertion site to prevent bleeding. The patient will be observed for a certain period of time before being discharged.
Anesthetic Implications for IVC Filter Removal
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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Assess the 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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Bleeding
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Infection
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Damage to the vena cava
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Failure to retrieve the filter
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Clot formation
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.