Pre-Procedure Patient Education Sheet

You are scheduled to have a(n): _______________________________on_____________ at __________

Before your procedure:

Diet Instructions:

For procedures requiring sedation:

( ) Nothing to eat or drink after midnight prior to procedure.

( ) Nothing to eat or drink after 6 am day of procedure.

Diabetics on insulin:

Please contact your Primary Care Physician regarding insulin instructions.

• Please be sure to bring all medications with you the day of your procedure. Including your personal CPAP machine. Our department does not have one for use, and this will be required if you receive sedation.

• You may bring your personal glucometer for use while awaiting your procedure.

• The PAT nurse will advise you of medications allowed the morning of your procedure.

• All blood thinners/platelet inhibitors MUST be stopped for 5 days prior to all non-emergent scheduled procedures. (coumadin, aspirin, ticlid, arixtra, lovenox, pradaxa, heparin, xarelto, aggrenox, pletal, BC powders, and ibuprofen).Please take your blood pressure medication with a sip of water the morning of your procedure.

Stop taking your _____________________________________ on_________________

The day of your procedure:

• Please arrive to the Outpatient Admissions Desk on the Ground floor at _____________

• The Interventional Radiologist will discuss the procedure with you and your family prior to the procedure being performed.

• Please bring all outside imaging (CT, MRI) with you the day of your procedure. The physician that will be performing your procedure requests that the actual imaging, NOT A REPORT be brought in for viewing. We will save the imaging to our system and return it to you. THIS ENSURES YOU ARE RECEIVING THE BEST CARE POSSIBLE!

• Wear comfortable clothing that is easy to remove. Please do not bring valuables (rings, watches, or money) to your visit.

After The Procedure:

Prior to discharge from your procedure and outpatient visit, you MUST have a driver present and a responsible adult to help with post procedural care for 24 hours following your procedure.

Recovery Time After Your Procedure :

( ) 1 hour ( ) 2-3 hours

( ) up to 5 hours ( ) requires 23 hour observation

Due to limited space, you may have 1 person stay with you in the recovery area after your procedure. All other family/friends will need to stay in Special Procedures waiting area.

If you have any further questions concerning your test/procedure, please feel free to contact the Radiology Department at (662) 377-5466. If calling outside normal business hours please dial (662) 377-4068.

We hope your stay was very good. We are committed to providing very good service. Your satisfaction with our hospital is a top priority for us. You may receive a satisfaction survey in the mail from a company called Press Ganey in the next few weeks requesting you to answer a confidential survey. We would appreciate you taking the time to complete and return it in the postage-paid envelope. We value your opinion and will use your comments to improve our service. We need your feedback.

Instructions given:

◊ Care of Feeding Tube Site, NMHS-Custom

◊ Discharge Instructions for Discontinuing a Perm Cath NMHS-Custom

◊ Discharge Instructions for Lumbar Puncture, NMHS-Custom

◊ Discharge Summary for Interventional Radiology, NMHS-Custom

◊ North MS Medical Center Interventional Radiology Moderate Sedation Education, NMHS-Custom

◊ Peripherally Inserted Central Catheter Information Sheet, NMHS-Custom

◊ Post Abscess Drain Insertion Discharge Instruction, NMHS-Custom

◊ Post Procedure Instructions, NMHS-Custom

◊ Post Tenex Procedure Patient Instructions, NMHS-Custom

◊ Post Peripherally Inserted Central Catheter (PICC), Discharge Instructions, NMHS-Custom

◊ Post Peripherally Inserted Central Catheter (PICC), NMHS-Custom

◊ Radiology Post Renal Biopsy Discharge Instructions, NMHS-Custom

◊ Radiology Specials Pre-Procedure Education Sheet, NMHS-Custom

◊ Uterine Fibroid Embolization Discharge Instructions, NMHS-Custom

◊ OTHER:_______________________________________________________________

Signature acknowledges the Patient and/or Guardian has received these instructions and understands them.