The use of an emergency induction checklist is recommended. Airway and resuscitation equipment should be organised as per the equipment governance recommendations of the collaborative framework of the Royal College of Emergency Medicine and the Faculty of Intensive Care Medicine.54
Transfer of patients within the hospital to the intensive care unit, radiology department or the operating theatre is not without risk and will require the use of a tipping transfer trolley, oxygen cylinders, suction, a transport ventilator, infusion pumps, monitor with adequate battery life, and a portable defibrillator, if appropriate. Local guidelines, together with use of a formal intrahospital transfer...
Procedural sedation and analgesia in the ED should follow the recommendations from the RCoA and the Royal College of Emergency Medicine.36 Medications and medication safety systems in the ED should align with the recommendations of the collaborative framework of the Royal College of Emergency Medicine and the Faculty of Intensive Care Medicine.54
The provision of anaesthesia services should be considered when designing interventional radiology services and there should be agreement about the level of provision and protocols to request anaesthetic support for both elective and emergency cases.
Procedure-specific agents, such as those required to manipulate coagulation, intracranial pressure or arterial blood pressure, should be available.60
Interventional vascular radiology may involve treating unstable patients with severe haemorrhage. Such patients may include those with significant gastrointestinal bleeding or patients with postpartum haemorrhage.61,62,63 Equipment to deal with these situations should be immediately available. This includes a variety of intravascular catheters, rapid infusion devices, blood and fluid warming devices, and patient warming devices.
The local protocol for major haemorrhage should be available and should be rehearsed periodically as a team by formal simulation or other training sessions.
Exposure to ionising radiation should be kept to a minimum using screens and personal protective equipment such as lead gowns and thyroid shields. Remote secondary monitors in screened viewing areas should be provided and staff should remain as distant from the imaging source as possible if they remain in the x-ray environment.56,57
Anaesthetists who work regularly within the radiology department should be issued with personal dosimeters by their employer to monitor their radiation exposure and to ensure that levels remain within statutory dose limits.58
The anaesthetist accompanying transferred patients to the radiology department should be suitably skilled and experienced to manage all eventualities in an isolated environment and should be accompanied by a dedicated trained assistant.7
