6. Personnel in the Angio Room
Radiologist ( or other specialist)
Cardiovascular nurse
2-3 Radiologic Technologists (CV)
Sometimes Anesthesiologist depending
on the procedure
7. Technologist Responsibilities
Prepare Room/ consent forms
Provide radiographic positioning / Dr Assistance
Knowledge of exam, anatomy, pathology
Prepare sterile tray, prep patient
Knowledge of catheters and guide wires
Know sterile technique/ safe clean up
Monitor ECG + pressure
Patient care skills and pharmacology
8. Angiography/ Interventional/
Cardiovascular
Procedure Room
(Suite)
Room size- 400-
600 square feet
Easily cleaned
(floors, wall, etc.)
Outlets needed for
O2, suction.
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
9. Equipment found in all
Advanced Procedure Rooms
X-ray generators
Controls
X-ray Tubes
System to record events of procedure
Automatic Injectors
10. X-Ray Tube Requirements
Detail
Withstand high heat- rapid exposure
sequences
Use smallest possible focal spot
11. Equipment Requirements
High heat load tubes w/ rapid cooling
Series imaging (up to 3-4 films/sec),
intense heat
Analog- to- Digital Conversion System
Programmable digital image acquisition
system
PACS
12. Electromagnetic Injectors
Monitoring Equipment- BP & ECG
Island Tables- access from all sides,
height adjustments, floor controls
Tables do not usually tilt
13. Digital Imaging- Analog VS
Digital Concepts
Analog- image seen after chemical
process
Digital- image manipulated by software
Information changed through use of
computer algorithm
14. 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)
16. Seldinger Technique
Method for catheterization of vessels
Developed 1950’s still popular today
Percutaneous (through the skin)
technique for arterial and venous access
3 vessels considered:
Femoral –preferred site for arterial (size +
accessibility)
Brachial
Axillary
17. Selection based on
strong pulse w/
absence of disease
Site cleaned, area
draped, local given
18. 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
20. 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
22. Guidewires
Guide catheter for placement in vessel
Guide wire diameter be 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
24. CATHETERS
Straight- end hole only
Pigtail- circular tip w/ multiple side
holes to reduce whiplash and control
contrast
Sidewinder- curved to facilitate vessel
selection
Cobra- variation in curvature to facilitate
selection of vessels
25. The more holes at the end / the more
contrast used/ large vessels
Catheter with only end hole/ smaller
vessels/ carotid
Combo end and side holes reduce risk of
trauma to vessel, enhances contrast
27. 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
28. Preparation to procedure
Anti coagulants- what do these do?
Consent form
NPO 8 hours
Lab tests to test kidney function?
29. Post Procedure Care
Catheter removed – compression
applied
Bed rest- min 4 hrs/ head elevated 30
degrees
Vital signs
Extremity watch
30. Radiation Protection
> radiation dose to angio team- fluoro
Proximity to patient
Radiation protection devices
Leaded glasses pulled into place
Minimal fluoro use as possible
Collimation
Angio personnel wear badges and ring
monitors
31. Contra Indications
Contrast allergy
Impaired renal function
Blood- clotting disorders
Anti coagulant medication
Unstable cardio pulmonary/ neurological
status
32. Risks/ Complications
Bleeding at puncture site
Thrombus formation
Embolus formation –plaque dislodged
from vessel wall by catheter
Dissection of vessel
Puncture site infection ( contaminated
sterile field)
Contrast reaction