The patient, a middle-aged man, was having transient ischemic attacks — ministrokes — because his carotid artery had narrowed, deep inside his brain, so that it was almost blocked.

As he lay on the operating table, interventional radiology nurses at Texas Health Harris Methodist Hospital Fort Worth prepped and draped the patient, preparing him for a procedure to place a stent in the artery to restore full blood flow in his brain.

The physician, Matthew Fiesta, M.D., a neurointerventional radiologist on the medical staff, reviewed images of the narrowed artery. Radiology technologists prepared the C-arm, an X-ray machine and other equipment for the procedure.

Using X-rays to guide him, Fiesta would go in through the patient’s femoral artery, eventually inflating a balloon in the narrowed segment of artery and then placing the stent. The nurses — usually two scrub in for procedures — are a vital part of the team.

“In most interventional radiology units, nurses only are involved in patient care,” said Rob Reeb, M.D., an interventional radiologist who is medical director of the Vascular and Interventional Radiology Center. “Here, they also scrub in and directly assist physicians with doing the cases.”

Rachel White, B.S.N, R.N., VABC, manager of the center and the radiology care unit, said, “All our nurses want to be involved. They don’t want to sit back. They want to learn.”

Reeb said the nurses don’t take special training courses but instead learn from the physicians and through experience.

White said she’s constantly reading and learning at home as well.

Available 24-7

M’Liss Johnson, R.N. left,, clad in a red lead apron with her name embroidered on the chest, went in and out of the room throughout the 2.5-hour procedure, stopping at a computer to check everything from supplies to the patient’s status.

A nurse for 31 years, she has been at Texas Health Fort Worth since 2004 and started working in interventional radiology in 2012. She was circulating nurse for this procedure, responsible for continuous monitoring and accounting for all supplies and instruments. She also assisted with anesthesia.

“I like the technical part,” Johnson said, adding. “I love our doctors.”

Two teams of interventional radiology nurses are available 24-7 to handle emergencies — often strokes, gunshot wounds, gastrointestinal bleeds or septic patients. They get to the hospital in 30 minutes or less when called.

“You don’t know what you’re walking into when you’re on call,” White said.

Some of the more common procedures include removing blood clots for stroke patients, treating aneurysms, inserting ports for oncology patients and creating fistulas for dialysis patients. About 400 patients a month are seen in the interventional radiology center and about 50 different procedures are performed by physicians on the medical staff, nurses and radiology technologists.

“Our IR nurses are both nimble and lifelong learners,” said Elaine Nelson, D.N.P., R.N., NEA-BC, CENP, chief nursing officer at Texas Health Fort Worth. “They’re just one example of the ways our nurses adapt constantly to improve patient care.”

‘They wake up moving everything’

The work can be immensely satisfying. For example, stroke patients may arrive unable to move or talk. After surgery to remove a blood clot in the brain, they sometimes can go home the next day — fully functional.

“A lot of times, they can’t talk to us. They come in not moving an arm or leg,” White said. “They wake up moving everything. That’s enough for us to know we’ve done a good job.”

Reeb said when he came to Texas Health Fort Worth in 1988, IR had just one nurse, a licensed vocational nurse. Today the IR team and radiology care unit, which handles pre-op and post-op, sometimes floating to interventional radiology, have a total of 30.

“We obviously can’t function without them,” Reeb said. “They monitor to make sure everything goes the way they know it goes. Sometimes they’ll question, ‘What are you doing, why are you doing that?’

“We value their opinion. It’s important. It’s just a true teamwork we have. We are absolutely family.”