Approval: Physician's review of patient medical history
5
Set up FFR Measurement System
6
Insertion of guide catheter
7
Insertion of pressure wire
8
Measure Baseline Pressure Ratio
9
Administer Hyperemic Agent
10
Measure Pressure Ratio Under Hyperemia
11
Calculate Fractional Flow Reserve
12
Approval: Physician's review of FFR value
13
Decision on further intervention based on FFR values
14
Removal of pressure wire and catheter
15
Post procedure monitoring of the patient
16
Documentation and Reporting of Procedure
17
Approval: Quality Assurance review of procedure report
18
Patient discharge planning
Patient eligibility assessment for FFR Procedure
This task involves assessing the eligibility of the patient for the Fractional Flow Reserve (FFR) Procedure. Determine if the patient meets the criteria for undergoing FFR. Consider the patient's medical history, symptoms, and test results. The aim is to ensure that the patient will benefit from the procedure and that it is safe to proceed. What are the key factors to consider? What challenges may arise in assessing eligibility and how can they be addressed?
1
Yes
2
No
1
Chest pain
2
Shortness of breath
3
Dizziness
4
Fatigue
5
None
1
Angiography
2
Exercise stress test
3
Echocardiogram
4
CT scan
5
None
Obtain Patient Consent
In this step, obtain the patient's consent to proceed with the FFR procedure. Explain the purpose, procedures involved, potential risks, and benefits in simple and clear terms. Address any concerns or questions the patient may have. Ensure that the patient fully understands and agrees to the procedure by obtaining a signed consent form. How will you ensure effective communication with the patient? What measures will you take to address their concerns?
1
Yes
2
No
Preparation of the patient
This task involves preparing the patient for the Fractional Flow Reserve (FFR) procedure. Ensure that the patient is physically and mentally ready for the procedure. Provide instructions regarding fasting, medication, and any necessary preparations. How will you ensure patient comfort and cooperation? What resources or tools will be required?
1
NPO (Nothing by mouth) after midnight
2
Clear liquids only
3
No specific fasting requirements
1
Comfortable
2
Anxious
3
Nervous
4
Other
1
Pressure transducer
2
IV catheter
3
Syringes
4
Alcohol swabs
5
Gloves
1
Doctor
2
Nurse
3
Technician
4
Anesthesiologist
5
Others
Approval: Physician's review of patient medical history
Will be submitted for approval:
Patient eligibility assessment for FFR Procedure
Will be submitted
Set up FFR Measurement System
In this task, set up the Fractional Flow Reserve (FFR) measurement system. Ensure that all the necessary equipment is properly connected, calibrated, and functioning correctly. This includes the pressure transducer, monitor, and data recording system. Verify that the system is ready to provide accurate and reliable FFR measurements. How will you ensure the proper setup of the measurement system? What checks will you perform to verify its accuracy?
1
Yes
2
No
1
Yes
2
No
Insertion of guide catheter
This task involves inserting the guide catheter into the patient's artery to provide access to the coronary vessels. Follow the appropriate technique and ensure that the catheter is correctly positioned. Monitor the patient's vital signs and manage any complications or discomfort. What steps will you take to ensure proper catheter insertion? How will you handle any difficulties or complications that may arise?
1
Yes
2
No
Insertion of pressure wire
In this step, insert the pressure wire into the coronary artery to measure the fractional flow reserve. Use proper technique and positioning to obtain accurate measurements. Monitor the patient's condition and provide support as needed. What precautions will you take during the insertion of the pressure wire? How will you ensure patient safety and comfort?
1
Yes
2
No
Measure Baseline Pressure Ratio
This task involves measuring the baseline pressure ratio before inducing hyperemia. Obtain pressure measurements from the normal and stenosed parts of the coronary artery. Calculate the pressure ratio to establish the baseline value. Make sure the measurements are accurate and properly recorded. How will you ensure accurate pressure measurements? What steps will you take to calculate the pressure ratio?
1
Yes
2
No
Administer Hyperemic Agent
In this task, administer a hyperemic agent to induce maximal blood flow in the coronary arteries. Follow the appropriate dosage and administration method based on the patient's condition. Monitor the patient's response and manage any adverse effects. How will you ensure the safe and effective administration of the hyperemic agent? What measures will be taken to address any side effects?
1
Yes
2
No
Measure Pressure Ratio Under Hyperemia
This task involves measuring the pressure ratio in the coronary artery under hyperemic conditions. Obtain pressure measurements from the normal and stenosed parts of the artery. Calculate the pressure ratio while ensuring accuracy and proper recording of data. How will you ensure accurate pressure measurements? What steps will you take to calculate the pressure ratio?
1
Yes
2
No
Calculate Fractional Flow Reserve
In this task, calculate the Fractional Flow Reserve (FFR) using the pressure measurements obtained. Apply the appropriate formula to determine the FFR value. Make sure the calculation is accurate and properly recorded. How will you ensure the accuracy of the FFR calculation? What steps will be taken to record and document the FFR value?
1
Yes
2
No
Approval: Physician's review of FFR value
Will be submitted for approval:
Calculate Fractional Flow Reserve
Will be submitted
Decision on further intervention based on FFR values
This task involves making a decision on further intervention based on the obtained Fractional Flow Reserve (FFR) values. Assess the significance of the FFR value in determining the need for additional procedures such as stenting or bypass surgery. Consider the patient's overall condition and medical history. What factors will be considered in making the intervention decision? How will you communicate the decision to the patient?
1
Yes
2
No
Removal of pressure wire and catheter
In this step, remove the pressure wire and guide catheter from the patient's artery. Follow the appropriate technique to ensure safe and smooth removal. Monitor the patient for any complications or discomfort during the process. What precautions will you take to minimize any risks during the removal? How will you address any complications that may arise?
1
Yes
2
No
Post procedure monitoring of the patient
This task involves monitoring the patient after the Fractional Flow Reserve (FFR) procedure to ensure stability and detect any complications. Monitor the patient's vital signs, assess the access site, and provide necessary post-procedure care. Maintain documentation of the patient's condition and any interventions required. How will you ensure the patient's stability and comfort during the monitoring phase? What measures will be taken to address any complications or adverse events?
1
Yes
2
No
1
Pressure bandage application
2
Pain management
3
Fluid administration
4
Discharge instructions
5
Other
Documentation and Reporting of Procedure
In this task, document and report the details of the Fractional Flow Reserve (FFR) procedure. Ensure that all relevant information is recorded accurately and completely. This includes procedural data, patient information, measurements, and any complications or interventions. Prepare a comprehensive report to communicate the findings and recommendations. How will you organize and present the documentation? What measures will be taken to ensure data accuracy and confidentiality?
Procedure Report
Approval: Quality Assurance review of procedure report
Will be submitted for approval:
Documentation and Reporting of Procedure
Will be submitted
Patient discharge planning
This task involves planning the discharge of the patient after the Fractional Flow Reserve (FFR) procedure. Assess the patient's condition, provide necessary post-procedure instructions, and address any concerns or questions. Coordinate with the healthcare team for smooth discharge and follow-up care arrangements. How will you ensure the patient's understanding of the discharge instructions? What measures will be taken to facilitate a seamless transition post-procedure?
