Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Angiography basics

32,394 views

Published on

  • Be the first to comment

Angiography basics

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

×