IR Nurse Brain Sheet | Interventional Radiology Procedure Report Sheet (Print + Fillable PDF)

Made by a nurse with 10 years in ICU, trauma, surgery, and the ER. One page per patient that follows an interventional radiology case from the pre-procedure checklist through access, contrast, findings and the site and drain checks afterward.

WHAT'S INCLUDED

• Patient info, allergies (contrast, latex, iodine), code status, procedure planned, radiologist and room, NPO time, ride home or disposition
• Pre-procedure checklist: consent, H&P, NPO, contrast allergy checked, labs reviewed, IV access, anticoagulant held, metformin held, pre-med, pregnancy test
• History: HTN, DM, CHF, CKD or dialysis, cirrhosis, cancer, COPD or OSA, bleeding risk, DVT or PE, prior IR procedure
• Anticoagulant and antiplatelet box with last doses and INR, plus home meds held or given
• Labs row: creatinine/GFR, K, Hgb, Plt, INR, PTT, WBC, LFTs
• Procedure type: biopsy, drain placement, port or PICC or line, IVC filter, embolization, ablation, nephrostomy, angioplasty or stent, paracentesis or thoracentesis
• Access and closure: femoral, radial, IJ or percutaneous; manual hold, closure device, pressure dressing, sutured
• Findings, samples sent, drain output, devices placed, sedation and reversal, contrast type and mL, antibiotic and time, fluids, meds given
• After-procedure table: BP, HR, SpO2, site, drain output and color, pain, initials
• Bedrest, drain care and flush, path and cultures sent, imaging follow-up, plus a handoff and to-do list

FORMATS: Moon theme / US Letter and A4 / Print version plus a fillable version for tablet or computer. 4 PDFs in the download.

Instant digital download. Nothing will be shipped.

For personal use. This is not a medical record or a substitute for your facility's charting, so always follow your unit's protocol. Follow your facility's privacy policy and shred after shift.

AI DISCLOSURE: Some design elements and mockup images were created with the help of AI tools. The layout and clinical content were designed by a registered nurse.