Interventional Radiology Procedures, Antibiotic Prophylaxis (206)

A guideline is intended to assist healthcare professionals in the choice of disease-specific treatments.

Clinical judgement should be exercised on the applicability of any guideline, influenced by individual patient characteristics. Clinicians should be mindful of the potential for harmful polypharmacy and increased susceptibility to adverse drug reactions in patients with multiple morbidities or frailty.

If, after discussion with the patient or carer, there are good reasons for not following a guideline, it is good practice to record these and communicate them to others involved in the care of the patient.

Recommendations

Single dose, IV prophylaxis ≤ 60mins prior to skin incision/ intervention.
Repeat dosing of antibiotics rarely required (see NHS GGC surgical prophylaxis guidance for detail).

For gentamicin

See appendix 1 for prophylactic dosing
Doses of up to 400mg gentamicin can be given by slow IV injection over 3 – 5 minutes
If subsequent treatment using gentamicin is required, measure gentamicin concentration 6-14 hours post theatre gentamicin dose, and follow GGC guidance on staffnet for gentamicin dosing. Calculate the subsequent gentamicin dose using the online calculator. Discuss with pharmacy if further advice is required (or if out of hours, the on call pharmacist)
Teicoplanin and gentamicin are incompatible when mixed directly and must not be mixed before injection.

Teicoplanin

Give 400 mg teicoplanin by slow intravenous injection over 3-5 minutes.
Teicoplanin and gentamicin are incompatible when mixed directly and must not be mixed before injection.

MRSA: decolonise prior to procedure as per NHS GGC infection control guidelines and discuss with microbiology re antibiotic choice.

CPE carriers: If identified as Carbapenamase producing Enterobacterales carriers contact microbiology.

Obesity BMI > 40 Kg/m2

Obesity BMI > 40 Kg/m²
Consider increasing the dose of antibiotic as below:

	Weight > 100 Kg
Co-amoxiclav	Add 1 g IV amoxicillin to 1.2 g Co-amoxiclav

Table: Procedure> Recommended antibiotic / comments

Procedure	Recommended antibiotic / comments
Arterial interventions Angiography, angioplasty, thrombolysis, arterial closure device placement, uncovered stent placement	No prophylaxis required
Covered stent placement Endograft placement Abdominal or Thoracic Endovascular Aortic Aneurysm Repair (EVAR / TEVAR)	Flucloxacillin 1g IV or in penicillin allergy Teicoplanin IV 400mg
Transarterial Chemoembolisation (TACE) Uterine Artery Embolisation Pulmonary arterial venous malformation embolisation	Co-amoxiclav 1.2g IV or in penicillin allergy Teicoplanin IV 400mg + Gentamicin (see surgical prophylaxis dosing table below)
Venous Interventions Port-a-cath insertion Venous stent placement Haemodialysis access interventions including mechanical thrombectomy Varicocoele embolisation Lower-extremity superficial venous insufficiency treatment IVC filter placement and retrieval Tunnelled central venous catheter insertion*	No prophylaxis required * In “over the wire” CV catheter exchange give Teicoplanin IV 400mg
Gastrointestinal Interventions Per oral gastrostomy	Co-trimoxazole 960mg oral suspension (10ml 480 mg/ 5 ml) deposit in the PEG tube immediately post PEG insertion. or in co-trimoxazole allergy Co-amoxiclav 1.2g IV
Direct balloon gastrostomy & Gastrostomy replacement (existing track)	No prophylaxis required
Percutaneous cholangiogram (PTC) Biliary drainage procedures	Continue current antibiotics and do not give further additional antibiotic as prophylaxis. If no antibiotic therapy give Gentamicin IV (see surgical prophylaxis dosing table)
Transjugular Intrahepatic Porto-systemic Shunt (TIPSS) insertion, reduction and occlusion Percutaneous Ablation (liver)	Co-amoxiclav 1.2g IV or in penicillin allergy Teicoplanin IV 400mg + ΔGentamicin IV (see surgical prophylaxis dosing table) ΔIf decompensated liver disease, do not use gentamicin, oral co-trimoxazole 960mg 60 min prior to skin incision/ intervention
Urological Interventions Percutaneous nephrolithotomy (PCNL) Percutaneous nephrostomy insertion and change Ureteric stent insertion Radiofrequency Ablation (Renal)	Gentamicin IV (see surgical prophylaxis dosing table) Or Ciprofloxacin 750mg oral 1 hour prior to procedure
Abscess Drainage	Discuss/ agree with referring clinician. May require targeted antibiotic therapy following aspiration
Musculoskeletal Interventions Vertebroplasty / Cementoplasty	Flucloxacillin 1g IV or in penicillin allergy Teicoplanin 400mg IV