Cardiac catheterization


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  • Cardiac catheterization

    1. 1. Cardiaccatheterizationviews the anatomyof the heart using acontrast materialinjected into thecoronary arteriesunder fluoroscopicimaging. Fig. 1
    2. 2.  Assess the severity  Data collection and extent of coronary artery disease (CAD)  Cardiomyopathies Valvular or myocardial disorders Determine CAD in patient with chest pain of unknown  Genetic disorders origin
    3. 3.  Uncontrolled  Uncompensated hypertension congestive failure Severe anemia  Active infection or Ventricular febrile illness fibrillations  Electrolyte Acute stroke abnormalities GI bleeds  Severe Allergy to contrast coagulopathy Renal failure
    4. 4.  After patient is properly identified, the procedure must be explained before consent can be signed Baseline vital signs will be done and as long as these are within the doctor’s interest, can proceed with the procedure Blood tests must be done including BUN, creatnine, PTT, INR, insulin/sugar levels
    5. 5.  After patient is put on table, the area being puncture must be free from hair Hair removal done by disposable electric razor and removed by sticky side of cloth tape Patient must be surgically cleaned with hospital approved sterile surgical prep solution
    6. 6.  The technologist working with the cardiologist must be scrubbed in following basic sterile surgical technique The patient is then draped from neck down with sterile drapes All equipment (radiation shields, image intensifier, equipment used to manipulate machine) must be prepped with sterile covers
    7. 7. Procedure tray shouldinclude:-sterile gowns and glovesfor scrub tech and doctor-sterile towels and drapesfor procedure-equipment covers-gauze-scalpel, needles, scissors,hemostats-syringes forheparin/saline flush,lidocaine, and blooddraw-labels with marking penfor any item filled with asolution-basin for heparin/salinemixture, basin for wastefluids, small cup forlidocaine-skin prep solution-high power manifold-connection tubing Fig. 2
    8. 8. Fig. 3-Three catheters are used: JR4 (advances to right coronary arters, JL4 (advancesto left coronary arteries), and 145 degree pigtail catheter (to advance intoventricles-One 135cm wire-Sheath corresponds with catheter size (5F cath gets 5F sheath etc.)-Size of catheter depends on doctor’s preference but generallly 6F is used
    9. 9.  Patient relaxed with Versed or Fentanyl, sometimes both Two 500mL bags of saline infused with 2,000 units (2cc) heparin each for flushing all tubing, catheters, sheaths Lidocaine for tissue numbing Visipaque contrast unless otherwise specified
    10. 10. When doctor and tech arescrubbed and all equipmentand supplies are ready, theprocedure may begin
    11. 11.  Access is easiest from right side of patient due to aortic bend Puncture is generally done via the femoral artery Alternative sites include the radial and brachial arteries of the arm
    12. 12. After puncture of femoral, radial or brachial artery (primarily on right side ofpatient), a catheter is advanced into the aorta and then the coronary arteries
    13. 13.  After numbing the groin area, the femoral artery is palpated and a needle is inserted in that direction When blood comes out of needle, the artery has been accessed A small, flexible guidewire is then inserted into the lumen of the needle The needle can then be removed but the wire must maintain position
    14. 14.  After removing the needle, a flexible plastic tube can be placed over the wire and introduced into the artery. This is called a one-way sheath (allows insertion of catheters and wires without blood escaping) The catheter is then inserted over the guidewire but through the sheet and advanced into placement via the inferior vena cava to the aorta
    15. 15.  Movement of catheter is monitored under fluoroscopy (x-ray movies) with the cardiologist manipulating its movements The fluoroscopic machine is manipulated by a qualified, scrubbed in, radiologic technologist When catheter is in place, wire can be removed and contrast administered
    16. 16. Catheter in place to view left coronary arteries Catheter in place to view right coronary arteries
    17. 17. Pigtail catheter in leftventricle to measure ventricular pressure Aortagram used to assessascending and descending aorta
    18. 18. Right coronaary arteries shown with contrastLeft coronary arteries shown with contrast
    19. 19.  The x-ray machine is suspended from the ceiling. It can be manipulated in multiple angles and views to achieve a desired picture. The x-ray comes from the bottom of the machine and the image intensifier that transmits the image is above the patient. Lead shielding and a radiation badge is required for all personnel in the room during the procedure.
    20. 20.  The procedure is complete when the cardiologist has seen all the views and anatomy desired and all pressures recorded The catheter can be removed and manual pressure must be applied to entry site for 15 minutes
    21. 21.  The patient must lie flat and supine for a minimum of two hours to ensure the artery does not reopen After two hours, the patient can be released to person driving the patient home Dressing must remain dry, no lifting over five pounds for three days No shower for 24 hours
    22. 22.  No bathing or swimming for one to two weeks Drink plenty of fluids If severe pain, swelling or discoloration of limb occurs, doctor must be notified immediately
    23. 23. 1. Abdulla, Abdulla M. Cardiac Catheterization. Ed. Dr. Abdulla M. Abdulla. 18 February 2012. HeartSite. 24 Oct. 2012. ath.html2. Olade, Roger B. “Cardiac Catheterization of the Left Heart”. Medscape Reference. Ed.Karlheinz Peter. 10 Jan. 2012. Medscape Reference. 24 Oct. 2012. < 1819224-overview#aw2aab6b2b3>
    24. 24.  Figure 1. Hale, Jane. Untitled. 2008. The Flint Journal. 08/02/mclaren_opens_new_cardiac_cath.html Figure 2. AliMed. Medline Cardiac Catheterization Procedure Tray. Alimed. 24 Oct 2012. cardiac-catheterization-procedure-tray.html Figure 3. Merit Medical. Performa Multipack Angiographic Cardiology Catheters. Merit Medical. 24 Oct 2012. code=performamcath