The 411 on IR
- When you are on IR, you will be a 1, 2, 3, or VA. This means:
- 1 = you have first dibs on inpatient cases, you also stay late (after 5 p.m. to help clean up cases from the day with the call team).
- 2 = you have first dibs on private cases (the attendings name written in red ink on the patient information card if it is a private case). You also stay late and help clean up cases when the #1 person is on call.
- 3 = consult week, you carry the consult pager and fill out the patient info cards
- Don’t forget to include labs: especially INR, if the patient is NPO, and if patient can give consent and if not name and contact number of person who can. Then discuss the cases with any attending to see if this is something IR can do and when (if it becomes later in the day, around 3:30 or 4 p.m., it’s best to discuss these cases with the call attendings, as they may be coming his way later that night.) If an attending okays the case, put their initials in the bottom left hand corner and put FTL (faxed to Lynn) in the upper left corner once you fax it to Lynn. Then give the card to the main tech so they can schedule it. You will also have to gets consents for cases that day and possibly the next.
- On your consult week, you will carry the pager 3 of the 5 days, the other 2 days, it is carried by an NP. On days you are not carrying the pager, the NP will sign it out to you at 4 p.m., and the call person will pick it up at 5 p.m.
- VA (aka VAspa) = you are the only resident their and work one on one with the attendings.
- You are on call with a fellow one day a week and one weekend during your month.
- Pick up the pager from the consult person, and basically you are “consult” after hours for urgent cases. Discuss emergent cases with the call attending; if you have questions about a case, discuss it with the fellow first. If a case discussed with an attending is emergent, you need to page the on call nurse and tech. People should not be paging you for nonemergent studies or to schedule studies the next day, that is inappropriate and you need to document the person’s name who contacted you and their attending’s name (Dr. Pollak collects this information and discussed it with the attendings the next day).
- If you get paged regarding a GI bleed, be sure to ask what the patients vitals are (are they hemodynamically stable), if they have been transfused (how many unit of pRBC), if the source if known (seen on contrast enhanced CT, endoscopy, or tagged RBC study), pertinent labs. If the source is unknown, and it is a UGI bleed, GI must scope the patient source, if they are unable to find the source, then a tagged RBC study should be ordered. Until then, IR cannot do anything.
- If you get called to the VA after hours, you need to enter from the ER entrance.
- If the call team has to come in after hours, figure out when the case will be, contact the Tech and Nurse on call (at Yale) and the Tech on call if you are going to the VA. If the patient is an ICU patient, you will not need to call the nurse in, however if not, the nurse on call at Yale or the nursing operator at the VA will need to be contacted.
- Other useful info:
- Don’t forget to wear lead!
- Always double glove, green gloves on bottom, white on top.
- If you complete a case in prep hold, be sure to tell the tech in the control room that the case is completed before you dictate it.
- Before your consult week or call, make sure a fellow shows you how to remove a tunneled catheter, place a purse string suture and how to place surgicell.
- If you need Pediatric anesthesia with a case, it is the referring physician’s responsibility to contact them and set it up (not IR’s)
- Working with the NP is wonderful. They will teach you step by step how to put in tunneled lines, etc. and will let you do them.
- You can get all dictation templates from Dr. Pollak. Be sure to include sedation time and fluoroscopy time in the dictation.
