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Fiche infiltration rachidienne – INTERVENTIONAL RADIOLOGY
INFILTRATION DEFINITION : L’infiltration foraminale consiste à injecter sous contrôle scanner un corticoïde directement au contact du nerf dont l’irradiation est responsable de la douleur.
MATERIEL : – 1 sarrot stérile
– 1 charlotte
– 1 masque
– 1 paire de gants stérile
– 1 set de soin stérile
– bétadine rouge
– bétadine jaune
– eau stérile
– 1 champ de table
– 1 champ percé
– 1 protection stérile pour la télécommande (si smart step)
– compresses stériles
– 2 cupules stériles
– 1 seringue 10cc luer lock
– 1 seringue 20cc
– 1 petite aiguille noire ou bleue
– 1 PL noire longue ou 1 Chiba
– 1 flacon de Xylocaïne 1%
– petit pansement
A la demande : Altim ou hydrocortancyl
Omnipaque 180 ou Iomeron 300
– Télécommande, écran de rappel et pédale pour Smart Step.
PREPARATION DU PATIENT : – bilan sanguin : Plaquettes (entre 150000 et 450000/mm3), TP (>70%) et TCA (entre 27 et 35s).
– Douche bétadinée la veille et le matin de l’examen.
– Blouse, charlotte et surchaussures.
– Interrogatoire pour allergie à l’iode/bétadine et pour remplir la fiche d’évaluation infiltration.
INSTALLATION : – Patient en procubitus, tête en premier, les bras tendus en avant, coussin sous la tête, coussin sous le ventre (pour le confort du patient et pour réduire la cambrure afin de faciliter l’accès au disque intervertébral).
– Mise en place de l’écran de rappel et du paravent plombé.
– Centrage : crêtes iliaques comme pour le rachis lombaire.
– Protocole : 7.11 Rachis Infiltration.
REALISATION DU GESTE : – Acquisition volumique (du disque intervertébral, du sus-jacent et du sous-jacent, en général les 3 ou 4 derniers disques).
– Choix de l’image de référence par le médecin.
Placer le repère métallique au niveau choisi sur la peau du patient.
– Pour vérifier le bon positionnement, cliquer sur Presc. Biopsie.
Cliquer sur Centré (même nombre d’images au dessus et en dessous de l’image de référence).
Rentrer la position de la table dans Emplacement Biopsie. Si il y a deux niveaux différents de repérage, rentrer la moitié de la distance séparant les 2 niveaux dans l’Emplacement Biopsie.
Rentrer un nombre d’image impaire. Laisser une épaisseur de 1.25 mm.
Cliquer sur Confirmer Presc.Biops. Déplacer la table et lancer l’acquisition.
Cette série apparaît dans la case en bas et à droite de l’écran.
Confirmer ou infirmer le positionnement du (des) repère(s).
– Marquer la position à l’aide d’un feutre dermique et faire la chaîne bétadinée.
– Cliquer sur Presc. Biops. (nbre impair d’images) ou sur Presc.Smart Step (3 coupes).
– Smart Step : épaisseur = 7.5 interv = 5
Confirmer. Continue.
3 cases apparaissent sur l’écran de droite.
Cliquer sur la case du milieu et en bas. Cliquer sur Liste/Sélection. Cliquer sur le patient, la série et sur l’image de référence. Cliquer sur Accepter.
Pour zoomer l’image, cliquer sur Zoom et clic droit de la souris.
Pour déplacer l’image, cliquer sur Parcourir et clic droit de la souris.
Recliquer sur l’image du milieu des 3. Cliquer sur Préparation > le Smart Step est activé.
– Le médecin centre son (ses) aiguilles(s) sous les lasers avec la télécommande.
Pédale : les 3 coupes apparaissent.
Pour ressortir le patient, le médecin appuie sur la pédale de sortie de la table.
– L’Omnipaque 180 (ou Iomeron 300) permet de confirmer le bon positionnement de l’aiguille avant d’injecter le corticoïde.
– Injection du corticoïde et retrait de l’aiguille.
FIN DU GESTE : – Nettoyer le point de ponction et placer le pansement.
– Finir de remplir la fiche d’évaluation d’infiltration.
– Retour du patient en décubitus (si hospitalisé).
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