Interventional Radiology Procedures, Antibiotic Prophylaxis (206)

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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

Last reviewed: 17 November 2020

Next review: 30 November 2023

Author(s): Ysobel Gourlay

Author Email(s): [email protected]

Approved By: Antimicrobial Utilisation Committee

Document Id: 206