Vascular Device Placement

• Totally Implanted Venous Access Device (TIVAD) insertion or removal
• Peripheral Angioplasty/Stenting
• Deep Venous stenting
• IVC Filter insertion

No antibiotics needed for insertion or removal of the following

• Forearm arteriovenous fistula formation (radiocephalic and brachicephalic)
• Tunnelled central intravascular catheter (e.g. Hickman^®)
• Non-tunnelled central intravascular catheter
• Totally Implanted Venous Access Device (Portacath^®) 
• PICC (peripherally inserted central catheter)
• Tunnelled dialysis catheter (e.g. Tesio^®)

For selected cases at particularly high risk e.g neutropaenic or haematology/oncology patient, prophylaxis can be considered based on individual patient's circumstance:

Preferred: flucloxacillin 1g iv

For Penicillin allergy (non-severe or severe) or MRSA positive: teicoplanin 800mg iv 

Including:

• All transposition access operations
• Fistula revision or salvage
• Graft insertion (PTFE, omniflo^®)

Preferred: including for penicillin allergy (non-severe and severe) or MRSA positive patients: teicoplanin 800mg iv

Preferred (including for penicillin allergy (non-severe)): cefazolin iv (see dosing table below)

For penicillin allergy (severe) or MRSA positive patients: gentamicin 3mg/kg iv 

Preferred (including penicillin allergy (non-severe)): cefazolin iv (see dosing table below) + gentamicin 3mg/kg iv

For penicillin allergy (severe) or MRSA positive: teicoplanin 800mg iv + gentamicin 3mg/kg iv

24 hours of antibiotic cover is recommended

NB: the adult interventional radiology powerplan only contains single dose cefazolin and teicoplanin. Prescribers need to prescribe additional cefazolin or teicoplanin doses separately to provide 24 hours antibiotic cover. 

Pre-procedure:

Preferred (including penicillin allergy (non-severe)): cefazolin iv (see initial dosing table below) + gentamicin 3mg/kg iv 

For penicillin allergy (severe) or MRSA positive: teicoplanin 800mg iv + gentamicin 3mg/kg iv

Post-procedural antibiotics (to provide 24 hours antibiotic cover):

Preferred (including for penicillin allergy (non-severe)):  cefazolin iv for 24 hours, 2g tds but dose will need to be adjusted for renal function

For penicillin allergy (severe) or MRSA positive: teicoplanin 800mg iv single dose at 12 hours post procedure

Antibiotic prophylaxis is not routinely required unless prolonged/ complex procedure OR biliary puncture occurs OR previous biliary surgery then as below.  

Pre-procedure:

Preferred (including for penicillin allergy (non-severe)): cefazolin iv (see dosing table below)

For penicillin allergy (severe) or MRSA positive: gentamicin 3mg/kg iv

Post-procedural antibiotics are indicated as per BSG 2019 (reviewed 2024):

Preferred (including for penicillin allergy (non-severe)):  cefazolin 2g iv tds for 48h (from first dose preop) 

For penicillin allergy (severe) or MRSA positive: gentamicin 3mg/kg iv od for one further dose at 24 hours post procedure

NB: the adult interventional radiology powerplan only contains single dose cefazolin and gentamicin. Prescribers need to prescribe post-procedure antibiotics separately to provide 48 hours antibiotic cover. 

See guideline Cardiac and Thoracic Surgery

See guideline Cardiac and Thoracic Surgery

Practice Guideline for Adult Antibiotic Prophylaxis during Vascular and Interventional Radiology Procedures 2010 

British Society of Gastroenterology (BSG) 2019 (reviewed 2024) Transjugular Intrahepatic Portosystemic Stent-Shunt (TIPSS) in the management of portal hypertension. (bsg.org.uk)