5
Table 2. Ablation Safety Checklist for Early and Late Pre-
procedural Workflow
Early pre-procedural
Patient selection (cont'd)
• Relative and absolute contraindications to ablation explored
• Patient has normal voice ± vocal fold mobility
• Allergies recorded in notes
• Does the patient have an increased bleeding risk?
▶ If so, management plan discussed with treating physician
Follow-up planned
• Follow-up schedule discussed with patient
Late pre-procedural
Equipment and technical considerations
• Active tip size chosen based on nodule size/volume
• Generator and pump checked and working
• Optimal energy to be delivered to nodule calculated based on nodule volume (optional)
• Starting power chosen based on active tip size and nodule characteristics
• Cold saline available in fridge in adequate amounts for electrode cooling (RFA)
• Anxiolytic medication taken by patient if required
Patient and ablation approach considerations
• Consent signed
• Nodule ablation location confirmed with patient
• Patient re-counseled regarding normal versus abnormal expectations and
symptoms during the procedure
• All disposable equipment available, including cold dextrose 5% for
hydrodissection off critical structure and for injection in case of laryngeal nerve
injury, sterile ultrasound probe covers
• Maximal safe volume of local anesthetic calculated by patient body weight and
type of anesthetic used (most commonly 1% lidocaine)
• Patient positioned with neck extended
• Neural structures (vagus, middle sympathetic ganglion [MSG]), carotid sheath,
and neck viscera visualized; need for hydrodissection off nodule determined
• Danger zones identified
• Entry angle of technique applicator to skin determined based on nodule size and
location in thyroid; anterior neck veins identified on ultrasound
(cont'd)
