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​Procedure Note Template

Whenever possible, use standardized templates (these start with "zzz IR Standard").

PROCEDURE: 

 HISTORY: 

OPERATORS: 

ANESTHESIA:

TOOLS:

ENDOVENOUS LASER THERAPY SYSTEM: Medilas D FlexiPulse Diode (WAVELENGTH: 940 nm) Laser System, 600 micron, 250 cm DMT Laser Fiber.
POWER: 15 watts.
TOTAL LENGTH OF THE TREATED VEIN: [].
ENERGY: [] joules ([] Joule/cm).
​TIME: [] seconds.

CO2 LASER MACHINE: Lumenis 40 C, 10600 nm
CO2 LASER SETTING: [] Watts continuous wave energy.
TOTAL CO2 LASER TREATED SURFACE AREA: [] cm² .

SCLEROSANTS:

MEDICATIONS: 


CONTRAST: [] of Omnipaque 300.

RADIATION DOSE: [] mGy

TASKS: List all individual tasks in numbered lists, include imaging modality used for guidance.

TECHNIQUE:

Consent was obtained from [], laterality was confirmed and [] was marked with initials. The patient was brought to the angiography suite, placed in the [] position. General anesthesia was induced.

[] was prepped and draped in the usual sterile fashion. Timeout and patient identification were performed.

Pre-procedure sonogram demonstrated - list detailed ultrasound findings. 

Under continuous ultrasound guidance, [] was accessed and representative sonographic images were recorded.

The vascular sheath and needles were removed and manual pressure was applied to the access sites until hemostasis was achieved. A [] cm Safeguard pressure device was applied, inflated with [] mL of air.

FINDINGS: Review all of the images at the time of dictation. This allows you to confirm the findings, identify missed findings and ensure that the exam is transferred in its entirety.

COMPLICATIONS: No immediate complications were identified.
​
IMPRESSION:

PLAN: []. 


MONTAGE
​Examples of  prior notes can be found on Montage.

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  • Home
  • Procedures
  • Protocols
  • Online Library
    • Pediatric IR Papers
    • Presentations and Webinars
    • IR Equipment and IFU
  • BCH IR Fellows Homepage
  • About Us