Modern Approach on  Angioplasty
<ul><li>Angiography is a diagnostic tool to produce X-ray pictures of the inside of blood vessels. When blood vessels are ...
<ul><li>In our Desun Hospital We Do Radial Angiography with the same cost compared to conventional Femoral Angiogram.  The...
<ul><li>Over time, a fatty substance called plaque can build up in your arteries, causing them to harden and narrow & this...
<ul><li>Improve symptoms  of CHD, such as  angina   and shortness of breath. (Angina is chest pain or discomfort.) </li></...
<ul><li>Percutaneous coronary intervention (PCI)  </li></ul><ul><li>Percutaneous intervention  </li></ul><ul><li>Percutane...
 
 
 
 
<ul><li>Cardiologists  do coronary angioplasties at hospitals. </li></ul><ul><li>Doctor  will take a  medical history  (in...
<ul><li>Coronary angioplasty is done in a special part of the hospital called the  cardiac catheterization laboratory . Th...
<ul><li>The  doctor will use a needle to make a small hole in an artery in your arm or groin. </li></ul><ul><li>A thin, fl...
<ul><li>Technical innovations </li></ul><ul><li>image intensification </li></ul><ul><li>three-phase generators </li></ul><...
<ul><li>Vascular studies usually require a room or suite of rooms  </li></ul><ul><li>specifically designed to accommodate ...
<ul><li>The procedure room should be large enough to accommodate all of the equipment as well as radiologic and ancillary ...
<ul><li>Remote computerized equipment should also be housed adjacent to the special room.   </li></ul><ul><li>Although the...
<ul><li>Biplane C-arm digital imaging  </li></ul><ul><li>Autoinjector </li></ul><ul><li>syringes, a heating device,  </li>...
<ul><li>1 . Puncture Needle </li></ul><ul><li>      Stylet and  Cannula </li></ul><ul><li>large cannula size (1.6mm) </li>...
(having 2 tubes simultaneously)
<ul><li>A C-arm or U-arm device is preferable  </li></ul><ul><li>the equipment can be rotated rather than the patient when...
<ul><li>Generator:   </li></ul><ul><li>This must be a three-phase or high-frequency 12-pulse machine and at least 1000 mA ...
<ul><li>X-ray tube:   </li></ul><ul><li>High-speed rotating anode tubes. The object of an angiogram is to produce the high...
<ul><li>In most angiographic studies </li></ul><ul><li>contrast must be administered at a consistent speed  </li></ul><ul>...
<ul><li>Warms contrast – improve viscosity </li></ul><ul><li>Piston – motor driven plunger </li></ul><ul><li>SAFETY MEASUR...
<ul><li>After coronary angioplasty, pt will  be moved to a  special care unit. </li></ul><ul><li>He  stay there for a  few...
<ul><li>Nurses will check pt  heart rate and blood pressure. </li></ul><ul><li>They also will check your arm or groin for ...
<ul><li>How much  activity  or exercise pt  can do.  </li></ul><ul><li>When pt should  follow up  with his doctor.  </li><...
<ul><li>Your doctor will prescribe  medicine  to prevent blood clots .  </li></ul><ul><li>Taking  medicine as prescribed  ...
<ul><li>Lifestyle changes may include: </li></ul><ul><li>Changing  diet. </li></ul><ul><li>Quit smoking </li></ul><ul><li>...
<ul><li>Arterial sheaths will be removed by  designated  </li></ul><ul><li>personnel, or a cardiologist.  </li></ul><ul><l...
<ul><li>Verify that  dressing  supplies are available - 4x4 elastoplasts.  </li></ul><ul><li>Have 0.9% NS  IV infusion  se...
<ul><li>Monitor  HR, B/P and O 2  saturation q  10  minutes x 30 minutes immediately after sheath removal. </li></ul><ul><...
FemoStop  /  Gold Compression Assist Device The FemoStop Gold Compression Assist Device includes an integrated  digital ma...
<ul><li>Maintain  bed rest  while pressure is in place. </li></ul><ul><li>No  bending of groin  is permitted. May turn sid...
<ul><li>PATIENT TEACHING: </li></ul><ul><li>Reinforce need for: no  bending  of affected limb, frequent vital  signs and p...
 
<ul><li>Image </li></ul><ul><ul><li>IVUS brings the diagnostic process to a new level of detail.  By sending, receiving an...
<ul><li>Stenting of smaller vessels </li></ul><ul><ul><ul><ul><li>Vessels ≤ 3mm </li></ul></ul></ul></ul><ul><li>Intra-ste...
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Desun Hospital Health Insights : Modern Approach on Angioplasty

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  • For Boston Scientific Corporation Confidential Internal Use Only. Do Not Copy or Distribute. This document is intended for internal use only and shall not be distributed outside of Boston Scientific. Presenter What are we seeing? IVUS brings the diagnostic process to a new level of detail. By sending, receiving and processing sound waves, IVUS creates a cross-sectional picture of an artery. This cross sectional picture can offer a tremendous amount of information: Plaque composition Lumen measurements Important morphologic features Pre and Post-therapeutic assessment
  • For Boston Scientific Corporation Confidential Internal Use Only. Do Not Copy or Distribute. This document is intended for internal use only and shall not be distributed outside of Boston Scientific. Presenter Clinical Utility for IVUS IVUS may not be clinically warranted in all interventions, and should be seen as an adjunct to angiography. IVUS provides information about vessel morphology, plaque topography, and therapeutic outcomes that is often either equivocal or unavailable in angiographic images. There are 3 situations in which IVUS has the most clinical utility: Small vessel stenting : Studies have shown that post-stent restenosis rates are higher in small vessels. This is particularly true for vessels with diameters of 3.0mm or less, wherein small increases in stent diameter have been shown to significantly decrease the rate of restenosis. A study by Moussa et al showed that, as measured by IVUS, the incidence of restenosis has an inverse relationship to the post-procedure in-stent lumen CSA 1 . In-Stent restenosis : In these cases, IVUS helps to determine whether the restenosis is due to inadequate stent deployment (underexpansion or incomplete apposition) due to intimal hyperplasia. IVUS will also help you select the proper device size for treatment of the stented area. Difficult to assess lesions : At times, images of a lesion and the adjacent reference segment are often hazy. IVUS should be used to identify whether the angiographic appearance is due to dissection, thrombus, residual plaque, or is benign. 1. Moussa C, et al J Am Coll Cardiol 1997; 29 (Suppl A) 60A
  • Desun Hospital Health Insights : Modern Approach on Angioplasty

    1. 1. Modern Approach on Angioplasty
    2. 2. <ul><li>Angiography is a diagnostic tool to produce X-ray pictures of the inside of blood vessels. When blood vessels are blocked, damaged or abnormal in any way, chest pain, heart attack, stroke or other problems may occur. Angiography helps your physician determine the source of the problem and the extent of damage to the blood vessel segments that are being examined. </li></ul><ul><li>Femoral Angiography: When the angiogram </li></ul><ul><li>procedure done through the Femoral route. </li></ul><ul><li>Radial Angiography: When the angiogram </li></ul><ul><li>procedure done through the Radial route. </li></ul>Radial artery
    3. 3. <ul><li>In our Desun Hospital We Do Radial Angiography with the same cost compared to conventional Femoral Angiogram. The advantages of Radial Angio are: </li></ul><ul><li>a time-sparing homeostasis technique </li></ul><ul><li>avoidance of post-procedural bed-rest, we do it as Day-care procedure </li></ul><ul><li>a lower incidence of local complications </li></ul><ul><li>improved quality of life for patients </li></ul>
    4. 4. <ul><li>Over time, a fatty substance called plaque can build up in your arteries, causing them to harden and narrow & this condition is called atherosclerosis. </li></ul><ul><li>Coronary angioplasty is a procedure used to open blocked or narrowed coronary (heart) arteries. </li></ul><ul><li>The procedure improves blood flow to the heart muscle. </li></ul>
    5. 5. <ul><li>Improve symptoms of CHD, such as angina and shortness of breath. (Angina is chest pain or discomfort.) </li></ul><ul><li>Reduce damage to the heart muscle caused by heart attack. A heart attack occurs if blood flow through a coronary artery is completely blocked. </li></ul><ul><li>Reduce the risk of death in some patients. </li></ul>
    6. 6. <ul><li>Percutaneous coronary intervention (PCI) </li></ul><ul><li>Percutaneous intervention </li></ul><ul><li>Percutaneous transluminal angioplasty </li></ul><ul><li>Percutaneous transluminal coronary angioplasty </li></ul><ul><li>Balloon angioplasty </li></ul><ul><li>Coronary artery angioplasty </li></ul>
    7. 11. <ul><li>Cardiologists do coronary angioplasties at hospitals. </li></ul><ul><li>Doctor will take a medical history (including the medicines you take), a physical exam , and explain the procedure . </li></ul><ul><li>some routine tests , such as blood tests, an EKG (electrocardiogram), and a CHEST X Ray. </li></ul><ul><li>Consent form </li></ul>
    8. 12. <ul><li>Coronary angioplasty is done in a special part of the hospital called the cardiac catheterization laboratory . The &quot;cath lab&quot; has special video screens and x-ray machines. </li></ul><ul><li>In the cath lab, patient lie on a table. An intravenous (IV) line will be placed in your arm to give you fluids and medicines . The medicines will relax you and prevent blood clots. </li></ul><ul><li>During angioplasty, patient will be awake but sleepy </li></ul><ul><li>(conscious sedation). </li></ul>
    9. 13. <ul><li>The doctor will use a needle to make a small hole in an artery in your arm or groin. </li></ul><ul><li>A thin, flexible guide wire will be inserted into the artery through the small hole. </li></ul><ul><li>The needle is then removed, and a tube called a sheath is placed over the guide wire and into the artery. </li></ul>
    10. 14. <ul><li>Technical innovations </li></ul><ul><li>image intensification </li></ul><ul><li>three-phase generators </li></ul><ul><li>rapid film changers </li></ul><ul><li>automatic pressure injectors </li></ul><ul><li>advanced catheter technology </li></ul><ul><li>all helped to establish angiography as an essential diagnostic tool by the 1960s </li></ul>
    11. 15. <ul><li>Vascular studies usually require a room or suite of rooms </li></ul><ul><li>specifically designed to accommodate the sophisticated and accessory equipment needed to perform angiography and interventional procedures </li></ul>Angiographic Equipment & Room Design
    12. 16. <ul><li>The procedure room should be large enough to accommodate all of the equipment as well as radiologic and ancillary staff </li></ul><ul><li>Special procedures sometimes require a general anesthetic that necessitates extra equipment and staff. </li></ul><ul><li>These procedures are also more hazardous to the patient and each room must be equipped to deal with emergencies that may occur </li></ul>
    13. 17. <ul><li>Remote computerized equipment should also be housed adjacent to the special room. </li></ul><ul><li>Although there must be adequate protection for all operators and staff, there must at all times be clear access and view of the patient being examined </li></ul>
    14. 18. <ul><li>Biplane C-arm digital imaging  </li></ul><ul><li>Autoinjector </li></ul><ul><li>syringes, a heating device, </li></ul><ul><li>a high-pressure mechanism </li></ul><ul><li>a control panel    </li></ul><ul><li>Image Intensifying screen  </li></ul><ul><li>  Sliding table </li></ul><ul><li>Rapid film changer (NOW DIGITAL*) </li></ul><ul><li>   Cut film 6 & Cassette changer/magazine </li></ul>
    15. 19. <ul><li>1 . Puncture Needle </li></ul><ul><li>      Stylet and  Cannula </li></ul><ul><li>large cannula size (1.6mm) </li></ul><ul><li>2. Guide Wire Soft flexible wire with the strength to pass through curved vessels </li></ul><ul><li>(.6 – 1.0) </li></ul>
    16. 20.
    17. 21. (having 2 tubes simultaneously)
    18. 22. <ul><li>A C-arm or U-arm device is preferable </li></ul><ul><li>the equipment can be rotated rather than the patient when visualization of the catheter is critical </li></ul><ul><li>simultaneous biplane visualization exposures are needed to reduce the number of injections of contrast required </li></ul>
    19. 23. <ul><li>Generator: </li></ul><ul><li>This must be a three-phase or high-frequency 12-pulse machine and at least 1000 mA to accommodate the rapid, short, and high exposure values required in angiography </li></ul>
    20. 24. <ul><li>X-ray tube: </li></ul><ul><li>High-speed rotating anode tubes. The object of an angiogram is to produce the highest quality radiographs in the shortest time possible </li></ul><ul><li>a 0.3 mm small focal spot will produce the best detail </li></ul><ul><li>tube rating can be exceeded because of the rapid succession of exposures needed </li></ul><ul><li>usual to have a 0.6-mm focal spot tube </li></ul>
    21. 25.
    22. 26. <ul><li>In most angiographic studies </li></ul><ul><li>contrast must be administered at a consistent speed </li></ul><ul><li>either faster </li></ul><ul><li>as in abdominal angiography </li></ul><ul><li>or slower as in lymphangiography </li></ul><ul><ul><li>SAFETY MEASURES: P 638 </li></ul></ul><ul><ul><li>LIGHT / ALARM / </li></ul></ul>
    23. 27.
    24. 28. <ul><li>Warms contrast – improve viscosity </li></ul><ul><li>Piston – motor driven plunger </li></ul><ul><li>SAFETY MEASURES (p.638) </li></ul><ul><li>Flashing light – audible tone – message </li></ul><ul><li>OPERATIONAL ERROR – OMISSION </li></ul><ul><li>PREVENTS EXESSIVE PRESSURE FLOW RATE CONTROLLED </li></ul>
    25. 29.
    26. 30. <ul><li>After coronary angioplasty, pt will be moved to a special care unit. </li></ul><ul><li>He stay there for a few hours or overnight. </li></ul><ul><li>He must lie still for a few hours to allow the blood vessel in your arm or groin (upper thigh) to seal completely. </li></ul>
    27. 31. <ul><li>Nurses will check pt heart rate and blood pressure. </li></ul><ul><li>They also will check your arm or groin for bleeding. </li></ul><ul><li>After a few hours, pt will be able to walk with help. </li></ul><ul><li>The place where the catheter (Sheath) were inserted may feel sore or tender for about a week. </li></ul>
    28. 32. <ul><li>How much activity or exercise pt can do. </li></ul><ul><li>When pt should follow up with his doctor. </li></ul><ul><li>What medicines patient should take. </li></ul><ul><li>What you should look for such as a signs of infection around the area where the sheath was inserted. </li></ul><ul><li>When pt should call his doctor. For example, you may need to call if you have shortness of breath; a fever; or signs of infection, pain, or bleeding. </li></ul>
    29. 33. <ul><li>Your doctor will prescribe medicine to prevent blood clots . </li></ul><ul><li>Taking medicine as prescribed is very important. </li></ul><ul><li>If you got a stent during angioplasty, the medicine reduces the risk that blood clots will form in the stent. </li></ul><ul><li>Blood clots in the stent can block blood flow and cause a heart attack. </li></ul>
    30. 34. <ul><li>Lifestyle changes may include: </li></ul><ul><li>Changing diet. </li></ul><ul><li>Quit smoking </li></ul><ul><li>Doing physical activity regularly. </li></ul><ul><li>Losing weight or maintaining a healthy weight. </li></ul><ul><li>Reducing stress . </li></ul>
    31. 35. <ul><li>Arterial sheaths will be removed by designated </li></ul><ul><li>personnel, or a cardiologist. </li></ul><ul><li>When: </li></ul><ul><li>No hematoma will develop at sheath site. </li></ul><ul><li>Patient will maintain adequate perfusion to affected extremity. </li></ul><ul><li>Discontinue heparin drip, as per doctor order. </li></ul>
    32. 36. <ul><li>Verify that dressing supplies are available - 4x4 elastoplasts. </li></ul><ul><li>Have 0.9% NS IV infusion set up. </li></ul><ul><li>Have Atropine available as per doctor order. </li></ul>
    33. 37. <ul><li>Monitor HR, B/P and O 2 saturation q 10 minutes x 30 minutes immediately after sheath removal. </li></ul><ul><li>Follow your hospital policy. </li></ul><ul><li>Then monitor vital signs q 15 minutes x 1 hour, then q 30 minutes x 1 hour, then q 1 hour x 2 hours. </li></ul><ul><li>Assess circulation, motion and sensation to both feet. </li></ul><ul><li>Apply PRESSURE to site not less than 30 minute and as per doctor order. ( FemoStop ). </li></ul>
    34. 38. FemoStop / Gold Compression Assist Device The FemoStop Gold Compression Assist Device includes an integrated digital manometer and transparent, inflatable dome that offer precise, hands-free femoral artery or vein compression . Compared to manual compression, FemoStop Gold has been shown to help achieve homeostasis quicker and more comfortably , while helping to improve staff efficiency .
    35. 39. <ul><li>Maintain bed rest while pressure is in place. </li></ul><ul><li>No bending of groin is permitted. May turn side to side for back care. </li></ul><ul><li>May resume diet , per doctor order. </li></ul><ul><li>Obtain 12-lead EKG . </li></ul><ul><li>Notify your doctor for: </li></ul><ul><li>a. Absent or diminished pulse in affected limb. </li></ul><ul><li>b. Presence of a hematoma . </li></ul><ul><li>c. Symptomatic bradycardia or other arrhythmia . </li></ul><ul><li>d. Bleeding at insertion site. </li></ul><ul><li>e. Recurrence of chest pain . </li></ul>
    36. 40. <ul><li>PATIENT TEACHING: </li></ul><ul><li>Reinforce need for: no bending of affected limb, frequent vital signs and pulse checks , bed rest per doctor order post sheath removal. </li></ul><ul><li>Instruct patient to report any numbness, tingling or acute pain of affected limb, or right/left lower quadrant abdominal pain. </li></ul>
    37. 42. <ul><li>Image </li></ul><ul><ul><li>IVUS brings the diagnostic process to a new level of detail. By sending, receiving and processing sound waves, IVUS creates a cross-sectional picture of an artery. This cross sectional picture can offer a tremendous amount of information: </li></ul></ul><ul><ul><ul><li>Plaque composition </li></ul></ul></ul><ul><ul><ul><li>Lumen measurements </li></ul></ul></ul><ul><ul><ul><li>Important morphologic features </li></ul></ul></ul><ul><ul><ul><li>Pre and Post-therapeutic assessment </li></ul></ul></ul>
    38. 43. <ul><li>Stenting of smaller vessels </li></ul><ul><ul><ul><ul><li>Vessels ≤ 3mm </li></ul></ul></ul></ul><ul><li>Intra-stent restenosis </li></ul><ul><ul><ul><ul><li>Visualize the stent </li></ul></ul></ul></ul><ul><li>Difficult to assess lesions </li></ul><ul><ul><ul><ul><li>More sensitive plaque detection </li></ul></ul></ul></ul>

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