The document discusses angiography procedures and equipment. It describes the personnel involved including radiologists, nurses, and technologists. It outlines the angiography room setup and various equipment used, including x-ray generators, tubes, injectors, and digital imaging systems. Key steps of the Seldinger technique for vascular catheter insertion are provided. Post-procedure care and risks are also summarized.

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

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