• This document provides guidance on safe and effective discharge of elective admissions for angiograms and for angioplasty patients.

• For use by Vascular Clinical Nurse Specialists and Advanced Practitioners.

Definitions

Angiography is a medical imaging technique used to visualize the inside, or lumen, of blood vessels and organs of the body, with particular interest in the arteries, veins and the heart chambers. An angiogram is the term for the examination undertaken by this technique.

Angioplasty, also known as balloon angioplasty and percutaneous transluminal angioplasty (PTA), is a minimally invasive, endovascular procedure to widen narrowed or obstructed arteries or veins, typically to treat arterial atherosclerosis.

Elective – non-urgent / non-emergency cases.

Vascular hub - centralised hospital providing all major vascular procedures.

Vascular spoke - outlying hospital which provides inpatient and outpatient services but transfers all major arterial cases to vascular hub.

Abbreviations

1.1 The overall purpose of this guideline is to reduce organisational risk by ensuring a consistent and comprehensive nurse led discharge process.

1.2 Frimley Health is the Southwest Thames regional vascular hub, performing upward of 300 elective angiograms per annum. Current expansion in the vascular catchment areas means this figure is expected to increase dramatically.

1.3 There is currently a team of Clinical Nurse Specialists (CNS) who cover both the vascular hub and spoke hospitals. It has been identified that, by utilising the Vascular CNSs’ clinical expertise, patients will receive a more timely discharge with appropriate clinical follow up, and correct post procedural medication. GIRFT (Getting It Right First Time) 2018 recommendations state patients post angiography are to be discharged at 0.7 days (patients without diabetes) and 0.9 days (patients with diabetes).

1.4 If the national average length of stay could be reduced to the aforementioned figures nationwide, some 10,025 inpatient bed days a year could be released with a financial saving of £3 million a year – incentive enough to consider initiatives to reduce length of stay (GIRFT 2018).

2.1 Patients will be discharged in a timely manner in accordance with GIRFT recommendations.

2.2 Patients will be medically fit for discharge and on the correct risk modifying medication on discharge.

2.3 Patients will have correct and appropriate follow up.

2.4 Inclusion criteria

• Patients who have undergone elective angiography/angioplasty.

• Emergency admissions requiring diagnostic imaging.

2.5 Duties of the Discharging Nurse

• Review procedural notes for any specific post procedure requests.

• Physical examination of the groins for evidence of haematoma, pain, bleeding; and neurovascular examination of the feet.

• Ankle Brachial Pressure Index.

• Patients should be discharged on duel antiplatelet therapy, Aspirin 75mg and clopidogrel 75mg for period of 6 weeks for iliac and SFA intervention (EJVS2024) and atorvastatin 80mg ON.

• To be converted to voyager antiplatelet regimen after 6 weeks duration. This must be clearly communicated to GP in discharge letter.

• Rivaroxaban should not be prescribed with an eGFR less than 15. Rivaroxaban should not be prescribed for patients undergoing dialysis, regardless of eGFR.

• Arrange follow up appointment with consultant and MDT discussion if necessary. Any deviation or change to these follow up intervals must be documented in the patient notes by the individual requesting the deviation.

2.6 All diabetics to stop metformin on the day of and for 48 hours post procedure.

3.1 The Vascular CNS will only be permitted to perform nurse led discharge once deemed competent in Ankle Brachial Pressure Indices and physical examination of patient post angiography.

3.2 Competency may be assessed by the Lead Vascular CNS, Vascular Consultant, Lead Vascular Consultant or Consultant Radiologist.

The Lead Vascular CNS will monitor compliance to the guideline on a quarterly basis and present to the Vascular Consultant Committee numbers of discharges, readmissions, complications, drug errors.

NHS England (no date) Vascular Surgery. Available at: https://gettingitrightfirsttime.co.uk/surgical_specialties/vascular-surgery/ (Accessed: 05 June 2024)

The Royal Australian and New Zealand College of Radiologists (2018) RANZCR Iodinated Contrast Guidelines. Available at: https://www.ranzcr.com/college/document-library/iodinated-contrast-guidelines-2016 (Accessed: 05 June 2024)

Rivaroxaban in peripheral arterial disease after revascularisation. (2020) New England Journal of Medicine 2020,328

This guideline has been registered with the trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt, contact a senior colleague or expert. Caution is advised when using guidelines after the review date.

This guideline is for use in Frimley Health Trust hospitals only. Any use outside this location will not be supported by the Trust and will be at the risk of the individual using it.

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