27.10
Études d’imagerie VII : Imagerie vasculaire
Définition
L’angiographie rénale, également appelée artériographie rénale, est une technique d’imagerie utilisée pour obtenir une vue détaillée du flu…
Une angiographie rénale est un test d’imagerie qui examine les vaisseaux sanguins du rein, évalue le flux sanguin et aide à diagnostiquer les blocages, les anévrismes, les rétrécissements ou les tumeurs.
Avant le test, l’infirmière explique la procédure, obtient le consentement, vérifie s’il y a des allergies aux colorants de contraste et conseille de jeûner pendant 6 à 8 heures et de vider la vessie.
Au cours de la procédure, le patient est positionné en décubitus dorsal sur la table d’imagerie, où une ligne IV est mise en place et un sédatif est administré.
Le site de l’artère fémorale est nettoyé à l’aide de techniques aseptiques, et un cathéter est inséré dans l’artère fémorale et guidé vers les artères rénales à l’aide de la fluoroscopie.
Une fois en place, un colorant de contraste est injecté dans les artères rénales, puis le radiologue capture des images radiographiques du flux sanguin dans les artères, les capillaires et les veines.
Après l’intervention, le radiologue retire le cathéter et applique une pression pour prévenir les saignements.
Dans la salle de réveil, l’infirmière surveille les signes vitaux, vérifie le site d’insertion, encourage l’apport hydrique et conseille le repos au lit avec la jambe maintenue.
View the full transcript and gain access to JoVE Core videos
Q1: What does a renal angiogram examine and why is it performed?
A renal angiogram is an imaging test that examines the kidney's blood vessels and evaluates blood flow through arteries, capillaries, and veins. It helps diagnose vascular abnormalities including blockages, aneurysms, narrowing, stenosis, thrombosis, and vascular tumors. The procedure also evaluates kidney function and guides interventional treatments like angioplasty or stent placement.
Q2: How should patients prepare for a renal angiogram procedure?
Before the procedure, patients must fast for 6-8 hours and empty the bladder. The nurse obtains informed consent, reviews medical history including allergies to iodine or contrast dye, and conducts renal function tests such as serum creatinine or eGFR. An IV line is established, baseline vital signs are recorded, and the patient receives education about sensations like warmth from the contrast dye and the importance of staying still during imaging.
Q3: What happens during the renal angiogram procedure itself?
The patient is positioned supine on the imaging table and receives mild sedation. Using aseptic techniques, the physician inserts a catheter into the femoral artery and guides it to the renal arteries using fluoroscopy. Contrast dye is then injected into the renal arteries, and the radiologist captures X-ray images as the dye travels through blood vessels. The nurse continuously monitors vital signs and oxygen levels throughout the procedure.
Q4: What is the role of contrast dye in renal angiography?
Contrast dye is injected into the renal arteries to make blood vessels visible on X-ray images. The dye travels through arteries, capillaries, and veins, allowing the radiologist to visualize blood flow and identify vascular abnormalities. Patients may experience warmth or flushing from the dye during injection, which is a normal sensation.
Q5: What care is required immediately after the renal angiogram?
After catheter removal and pressure application to prevent bleeding, the nurse monitors vital signs, checks the insertion site for bleeding or swelling, and encourages fluid intake to help flush contrast dye from the kidneys. The patient remains on bed rest for several hours with the accessed leg kept straight to prevent bleeding. The nurse observes for complications such as decreased urine output or elevated serum creatinine levels.
Q6: Why is hydration important before and after renal angiography?
Adequate hydration before the procedure reduces potential complications from sedation and contrast dye. After the procedure, oral or IV fluids promote kidney filtration and help eliminate contrast dye from the system, reducing the risk of contrast-induced nephropathy. Encouraging fluid intake is a key nursing intervention in post-procedure recovery.
Q7: What complications should nurses monitor for after renal angiography?
Nurses should monitor the insertion site for bleeding, swelling, or hematoma formation. They must also watch for signs of contrast-induced nephropathy, such as decreased urine output or elevated serum creatinine levels. Regular vital sign monitoring, particularly blood pressure and heart rate, helps identify immediate complications and ensures patient safety during recovery.