Angiography basics

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  • 1. Angiography/ Interventional Basics What do we visualize with an angiographic procedure?
  • 2. Personnel in the Angio Room
    • http://www.heartsite.com/html/cardiac_cath.html
    • Radiologist/ Specialist
    • Cardiovascular nurse
    • 2-3 Radiologic Technologists (CV)
    • Sometimes Anesthesiologist
  • 3. Angiography/ Interventional/ Cardiovascular
    • Procedure Room (Suite)
      • Room size- 400-600 square feet
      • Easily cleaned
      • Why?
      • Outlets needed for O2, suction, crash cart
      • 3 means of access to the room (Bushong, p. 374)
        • What are they?
  • 4.
    • Control Room
      • 100-150 square feet
      • Easy access and communication to procedure room
      • Computers, monitors and un sterile personnel
      • Storage area- guide wires, catheters and needles
  • 5. Equipment found in all Advanced Procedure Rooms
    • X-ray generators
    • Controls
    • X-ray Tubes
    • System to record events of procedure
    • Automatic Injectors
  • 6. Generator
    • 700MA- 1500MA
    • Short exposure times
    • Able to generate 80- 100 KW power
    • Limit motion
    • Provide max. contrast
  • 7. X-Ray Tube Requirements
    • Detail
    • Withstand high heat- rapid exposure sequences
    • Tube rating charts posted
    • Need max. detail for vessels
    • Use smallest possible focal spot
    • Decrease target angle, p.13…line focus principle
  • 8. Equipment Requirements
    • High heat load tubes w/ rapid cooling
      • Series imaging, intense heat
      • SPEED UP THE ANODE RPM
    • 1-2 Track mounted tubes
    • Analog- to- Digital Conversion System
    • Programmable digital image acquisition system (rate,sequencing, processing)
    • PACS
  • 9.
    • Electromagnetic Injectors
    • Monitoring Equipment- BP & ECG
    • Island Tables- access from all sides, height adjustments, floor controls
    • Where are the cables?
    • Tables do not usually tilt
  • 10. Digital Acquisition
    • 2 types
      • 1. Analog-to-Digital
        • Radiation-pt-intensifier-light-TV-light to electrical signal- analog-to-digital converter- image processor
      • 2. Flat detectors
      • Charged coupled devices (CCD) computer chip
      • Direct digital conversion
  • 11. Charge Coupled Device (CCD)
    • Silicon computer chips
    • Converts light to digital image
    • Lower noise
    • Better contrast
    • Lower patient dose
    • Advantage to this type system- images produced in low light w/o loss of resolution
  • 12. Digital Imaging- Analog VS Digital Concepts
    • Analog- image seen after chemical process
    • Digital- image manipulated by software
      • Relates to numbers
      • Number table called an array
      • Information changed through use of computer algorithm
    • Advantages of Digital Angiography, p.30
  • 13. Digital Subtraction Angiography (DSA)
    • Computer “ subtracts” out all anatomy except contrast-filled vessels
    • Looks like a reverse image
    • Can be more diagnostic for vessels ( clots, constrictions)
    • Imaging systems below now mostly replaced by digital
      • Cut Film Changer
      • Cine Fluoro( Cardiac Cath Camera)
  • 14. Electromechanical Injector
    • Used in Angio, CT, MRI
    • Overcome arterial pressure + maintains bolus
    • Maintains flow rate
    • Flow rate affected by
      • Viscosity
      • Length + diameter catheter
      • Injection pressure
      • Vessel selected
  • 15.
    • Components
      • Control panel
      • Syringe
      • Heating Device
      • High- pressure mechanism
    • Safety Devices
      • Acceleration regulators
      • Pressure- limiting devices
      • MRI- non- ferrous material
  • 16. Vocabulary Terms
    • Arteriosclerosis- vessels hardened
    • Atherosclerosis- plaque like cholesterol
    • Thrombus
    • Embolus
    • Occlusion
    • Tumor
    • Stenosis
    • Angioplasty-angio procedure dilates stenosed vessel
  • 17.
    • Lithotripsy
    • Stent- cage like metal device placed in vessel to maintain blood flow
    • Thrombolysis
    • Filter
    • Embolization- stop bleeding, cease blood flow to site of pathology
    • Ante grade
    • Retrograde
  • 18. Seldinger Technique
    • Method for catheterization of vessels
    • Developed 1950’s still popular today
    • Percutaneous (through the skin)
    • 3 vessels considered:
      • Femoral –preferred site for arterial (size + accessibility)
      • Brachial
      • Axillary
  • 19.  
  • 20.
    • Selection based on strong pulse w/ absence of disease
    • Site cleaned, area draped, local given
  • 21. Seldinger Technique ( step-by-step)
    • Insertion of needle
    • Placement of needle in lumen
    • Insertion Guide wire- thru needle, advance 10 cm
    • Removal of Needle- guide wire in position
    • Threading of catheter to area of Interest- fluoro used
    • Removal of guide wire- catheter remains in place
  • 22. SELDINGER TECHNIQUE
  • 23.
    • Two less common methods used
      • Cut down- minor surgical procedure to expose vessel of interest
      • Translumbar- patient prone, long needle passed thru T12- L2 into aorta
  • 24. Contents of Procedure Tray
    • Variety items 3 basic groups of equipment
      • Prep Group
      • Anesthetic Group
      • Insertion and removal Contrast
    • Accessories
      • Adaptors
      • Connectors
      • Manifolds, Stopcocks
  • 25. Let’s Look at Needles, Guide wires and Catheters
    • Cannula
    • stilette
    • connecting hub (luer lock)
    • baseplate
    • two or three-way stopcock
    • transparent tubing
  • 26. Guidewires
    • Guide catheter for placement in vessel
    • Diameter large enough so blood can not flow back for too long a time
    • Tips at the end of GW
      • Straight
      • J- tipped
    • longer G.W. for selective angio vessels
    • Short used for shorter direct vascular approach
  • 27. CATHETERS
      • Straight
      • Pigtail
      • Sidewinder
      • Cobra
  • 28.
    • The more holes at the end / the more contrast / large vessels
    • Catheter with only end hole/ smaller vessels/ carotid
    • Combo end and side holes reduce risk of trauma to vessel, enhances contrast
  • 29. Vascular/ Non- Vascular Studies
    • Embolization pg 711, Bontrager
    • Stent Placements
    • PTA pg 712 , Bontrager
    • Vena Cava Filters
    • Thrombolysis
    • Biopsies
    • Fluid Drainage
    • Injection of Medicines
    • Tube Placement in Organs or Cavities
      • Bontrager, pg 716
  • 30. Interventional Imaging Procedures
    • Intervene w/ disease, provide therapeutic outcome
    • Purpose/ benefits
      • Lower risk compared to surgery
      • Less $
      • Shorter hospital stay and recovery
      • Alternative for non surgical patient
  • 31. Post Procedure Care
    • Catheter removed – compression
    • Bed rest- min 4 hrs/ head up 30 degrees
    • Vital signs
    • Extremity watch
    • Some angiographic procedures: angioplasty, venography, angiocardiography, lymphography
  • 32. Radiation Protection
    • Proximity to patient
    • Radiation protection devices
    • Leaded glasses pulled into place
    • Minimal fluoro use
    • Collimation
    • Wear badges and ring monitors
  • 33. Risks/ Complications
    • Bleeding at puncture site
    • Thrombus formation
    • Embolus formation –plaque dislodged
    • Dissection of vessel
    • Puncture site infection ( contaminated sterile field)
    • Contrast reaction