A catheter is a hollow flexible tube that can be inserted into a body
cavity, duct or vessel. Catheters thereby allow drainage or injection of fluids
, distend a passageway or provide access by surgical instruments.
The process of inserting a catheter is catheterization.
In most uses a catheter is a thin,
flexible tube: a "soft" catheter;
in some uses,
it is a larger, solid tube: a "hard" catheter.
The first curve is called primary curve for
The second curve is called secondary curve
to give support to that Catheter against the
What is a Catheter made up of ?
A range of polymers are used for the construction of
catheters, including silicone rubber latex and
Silicone is one of the most common choices because it is
inert and unreactive to body fluids and a range of medical
fluids with which it might come into contact.
Fluoropolomers (PTFE) (TEFLON)
PARTS OF A CATHETER
FRENCH CATHETER SCALE:
The French catheter scale (most correctly abbreviated as Fr, but also often
abbreviated as FR or F) is commonly used to measure the outer diameter of
cylindrical medical instruments including catheters ,needles etc.
In the French Gauge system as it is also known, the diameter in millimeters of the
catheter can be determined by dividing the French size by 3, thus an increasing
French size corresponds with a larger diameter catheter. The following equations
summarize the relationships:
D(mm) = Fr/3
Fr = D(mm)*3
Most commonly in adult Diagnostic Catheters of 5 – 7 Fr is used.
TYPES OF CATHETERS:
Catheters can be classified depending on
SIDE HOLES :
-: Single Hole
-:End Hole with side holes.
-:Blocked end with side holes only.
Abdominal – 6-80 cm
Thoracic or Carotid Arteries – 100-120 cm
NOTE: Size depends on :
> age of the patient
> selective or super selective study
> size of the vessels.
NOTE: Ideal practice is to use the smallest diameter catheter feasible for
any particular study to minimize the risk of arterial damage by the
Some Other Types of Catheters:
Hydrophilic Catheters :
Hydrophilic-coated catheters have a layer of polymer
coating that is bound to the catheter surface.
The polymer absorbs and binds water to the catheter,
resulting in a thick, smooth and slippery surface.
Intermittent catheters are hollow tubes used to drain
urine from the bladder.
Usually its around 80cm.
Different Catheter Curves
For Different Purposes:
> Judkins Left (JL)
> Judkins Right ( JR)
> Judkins Left Short Tip
> Judkins Right Short Tip
> Amplatz Left ( AL)
> Amplatz Right ( AR)
> Left Coronary Bypass
> Right Coronary Bypass
> Cardiac Pigtail
CATHETERS CAN BE BROADLY CLASSIFIED
UNDER THESE GROUPS:
Used for Angiographs .
Used for Angioplasty.
• Guiding catheters are like angiography catheters only difference is that
guiding catheters are more stiffer & firm as it carries Balloon catheters,
PTCA wires and stent delivery system.
• Mild stiffness comes due to the wire braided design.
• Good Push ability .
• Good Tractability.
Used to cannulate or puncture the artery.
Usual Sizes include
18 ga, 19 ga , 20ga, 21 ga.
The selection of the Size depends on
the guide wire going to be inserted
through that needle port.
Diagnostic guide wires are used to traverse vascular anatomy to aid in
placing catheters and other devices. Guide wires are used for both
Cardiology and Radiology angiographic procedures.
• Guide wires are relatively simple spring type wires that
provides necessary firmness and the control to the site where
Angiogram will be taken.
• A the name suggests it ‘ Guides’ the catheter.
• PTFE coated Soft tip for the smoothness during the insertion
• Less trauma to the intimal wall of the artery
In 1929 Werner
demonstrated that a simple
Rubber catheter could be passed to
the pulmonary artery through the
Anti- Cubital Vein and
An angiographic film could be
obtained using radiographic
In 1953 ,
Sven –Ivar Seldinger invented
The technique of gaining access
Percutaneusly into an artery
without An arteriotomy.
Sven- Ivar Seldinger
TECHNIQUE OF INSERTING A CATHETER
The technique of catheter insertion via
double-wall needle puncture and guide-wire is known as
The SELDINGER TECHNIQUE.
Double Wall Puncture:
Compression to prevent Hematoma of the other wall.
Rotatory movement to get the needle into the lumen.
Single Wall Puncture:
Usually done for patients co-agulation time is less.
COMMON CORONARY CATHETERS
USED FOR ANGIOGRAPHY
1. HEAD HUNTER
2. JUDKINS LEFT CORONARY
3. JUKINS LEFT AND RIGHT
CORONARY CATHETERS IN
CATHETERS USED FOR
2. PIGTAIL CATHETER
GUIDEWIRES USED IN
1. TEREMO WIRE
2. TIGER CATHETER
BOTH LEFT AND
3. CATHETER FOR
OF RT CORONARY
AND IN PDA
INTERVENTION THERAPIES FOR
BENIGN BILIARY OBSTRUCTION
MALIGNANT BILIARY OBSTRUCTION
PERCUTANEOUS MANAGEMENT OF
PERCUTANEOUS MANAGEMENT OF
Regional arterial infusion and
chemoembolisation is the most common
technique used in hepatic malignancies
Chemoembolisation agents should have
characters of rapid first pass clearence, steep
dose response curve
Temporary agents commonly used are gelfoam
cause recanalisation in 4-6 weeks
Permanent are polyvinyl alcohol cause
Lipiodol is agent used for diagnostic imaging
The arterial supply of the liver is mapped out and portal vein
patency is established, catheterization of the hepatic arteries is
undertaken. With the new lubricious coatings, this usually can be
accomplished with 5.0-5.5 French catheters
cirrhosis and hepatocellular carcinoma coexist frequently in
patients with chronic hepatitis, the portal circulation should also be
assessed for hepatofugal flow.
Because the hepatic artery is to be embolized intentionally,
confirmation of portal vein patency is essential. This can be
accomplished with superior mesenteric or splenic artery
angiography to rule out thrombosis
repeated chemoembolizations, the blood supply of the liver must
be reassessed continuously because different flow patterns will
emerge over time this is mainly due to collateral formation from the
“culprit vessels” from peripheral arteries
CELIAC ANGIOGRAPHY IN
WITH PORTAL VIEN
METASTATIC OCULAR MELANOMA WITH SELECTIVE CATHETERISATION AND
OCCLUSION OF COLLATERAL FROM SUPERIOR MESENTERIC ARTERY
SELECTIVE EMBOLISATION OF RIGHT GASTRIC
R LIVER TUMOUR
TO RIGHT SHUNT
HEPATIC METASTASIS FROM COLORECTAL CA
RT LOBE OF LIVER WITH HYPEREMIC BORDER
underlying principle is the local creation of heat, via a percutaneously or
surgically placed probe, that destroys tumor tissue while insulating and
sparing adjacent normal liver.
using probes as small as 15-gauge to 17-gauge needles, alternating
current causes tissue coagulation by frictional heating. Tumor tissue is
ablated as temperatures reach 50-100 C, and yet, noncancerous tissue
as close as 0.5 cm away is spared
Complete and accurate demonstration of the bile duct
obstruction and of the bile ducts above and below the lesion is
a key element in the management of bile duct stenoses and
obstructions. This will usually require opacification of the bile
ducts by percutaneous transhepatic cholangiography
(PTC), endoscopic retrograde cholangiopancreatography
(ERCP), or injection of contrast through any indwelling
catheters such as T tubes.
Procedures performed are:
percutaneous biliary dilatation using balloon dilation catheters include
those of Burhenne (1975) via a T-tube tract and of Molnar and Stockum
(1978) via the transhepatic route.
The balloon size should match the estimated caliber of the duct on
either side of the stricture and is usually in the 4- to 8-mm range. Duct
rupture is most unusual with correctly sized balloons even though high
pressures (up to 16 atm) are not infrequently needed to dilate the
stricture. Progress in balloon manufacture now provides balloons that
can be used at up to 20 atmospheres in pressure. Stricture dilatation
can be very painful, and adequate sedation and pain control are
A drainage catheter, of 10-12 French and occasionally 14 French, is left
across the stricture for 6 weeks and then exchanged for a new selfretaining catheter positioned in the biliary tree above the stricture.
POSITION OF PATIENT FOR PTBD AND THE OPACIFICATION
OF BILIARY RADICLE AS SHOWN IN THE SECOND IMAGE
WITH DILATION OF CBD
PATIENT WITH OPEN CHOLECYSTECTOMY AND DAMAGE TO
RIGHT HEPATIC DUCT WHICH WAS REPAIRED BY ROUX EN Y
FUTHER SUFFERED CHOLANGITIS DUE TO STRICTURE TREATED
BY BALLON DILATATION
ALL SURGICAL OPTIONS ARE EXHAUSTED AND
DILATATION HAVE FAILED
Gianturco stent appears to provide reasonable palliation
GIANTURCO STENT NO 8, 10, 12 MM IS USED
VIA PERCUTANEOUS TRANSHEPATIC ROUTE VIA
EXISTING T- TUBE
CATHETER PLACED OVER WIRE AND CONTRAST
INJECTED VIA SIDE ADAPTER
DILATOR PASSED ALONG THE STRICTURE AND
FOLLOWED BY SMALL PEEL AWAY INTRODUCER
INTRODUCER PEELED AWAY WITH THE SELF
RETAINING STENT IN PLACE
PLACEMENT IN A
PATIENT WITH BEIGN
ROLE OF RADIOLOGIST
PERFORM CECT OR MRCP TO PROPERLY DELINEATE
THE LIVER AND BILIARY TRACT ANATOMY
FUTHER DEFINE THE ANATOMY USING PTC AND
PERFORM A PTBD
IMPROVE METABOLIC STATUS OF THE PATIENT
PERFORM A HEPATIC ARTERIOGRAPHY TO RULE
OUT AND TUMOUR OR MASS ENCASING THE LIVER
AND FOR MARKING THE LIVER ANATOMY
the general location of the puncture site within the
biliary tree (i.e., peripherally or centrally); (2) the
angle formed by the junction of the needle and
the specific duct entered; and (3) the therapeutic
objectives of future biliary interventions. After the
diagnostic PTC is performed using a 21- to 23gauge “skinny needle” (Chiba needle or trocar
needle), a percutaneous biliary drainage (PBD) is
Eventual placement of an 8-10F multi-side-hole
locking pigtail catheter across the obstruction
PERCUTANEOUS MANAGEMENT OF BILE DUCT
STONE EXTRACTION THROUGH T -TUBE TRACT
1. a 21- or 22-gauge needle is used to access the duct of interest. A 0.018-inch guide
wire is advanced through the needle, maneuvered into the common bile duct, and
exchanged for a standard 0.035-inch guide wire over an intermediary exchange
2. an appropriate catheter and guide wire may be manipulated through the distal duct
and bowel. It would be traumatic to extract large calculi through the transhepatic
3. Therefore, a technique that will
allow expulsion of stones or stone
fragments through the duct into
the duodenum must be used.
TRANS JEJUNAL CHOLEDOCHOLITHOTOMY
IN DISEASES ASSOCIATED WITH RECURRENT CALCULI AND BILE
FREE ASSESMENT OF HEPATIC DUCT AND FOR LONG TERM LINE
TO ENSURE COLON IS NOT PUNCTURED IT IS PRE OPACIFIED BY
BARIUM ONE DAY PRIOR HEPATIC FLEXURE
METALLIC ANCHOR DEVICE IS PLACED IN SMALL BOWEL FOR
DRAIN CAN BE EASILY REINSERTED IF IT FALLS OFF
A 3-5 MM ENDOSCOPE CAN BE PASSED THROUGH THE T TUBE
TRACT FOR ASSESSMENT AND REMOVAL OF THE STONES
ANGIOPLASTY BALLON CATHETERS
PERCUTANEOUS CHOLECYSTOLITHOTOMY (PCCL)
EXTRACTION OF STONE
REMOVAL OF STONE
IT INCLUDES THE FOLLOWING PROCEDURES
TRANSHEPATIC VARICEAL EMBOLIZATION
TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC
PERCUTANEOUS REVISION OF SURGICAL
CHECK SHUNT PATENCY
TRANS HEPATIC VARICEAL EMBOLISATION IN A
PATIENT WITH UNCONTROLLED BLEEDING VARIECES
TREATMENT OF PORTAL
1. TRANS HEPATIC
2. SPLENIC PORTOGRAM
SHOWS LEFT GASTRIC
3. WALLENT,S STENT
4. SPLENIC PORTOGRAM
SHOWS NORMAL FLOW
TIPS PLACEMENT IN DISTAL PORTAL VEIN AND SPLENIC VEIN THROMBOSIS