Cardiac catheterization involves inserting a catheter into the heart to view coronary artery anatomy and function. A contrast agent is injected to visualize the arteries under fluoroscopy. The procedure assesses coronary artery disease and collects data on heart structures and pressures. It begins with patient preparation and sterile technique before puncturing an artery to insert the catheter for imaging coronary arteries and ventricles. The procedure provides diagnostic information and is completed when the cardiologist has the needed views, after which the patient must rest.
Cardiac catheterization (kath-uh-tur-ih-ZAY-shun) is a procedure used to diagnose and treat cardiovascular conditions. During cardiac catheterization, a long thin tube called a catheter is inserted in an artery or vein in your groin, neck or arm and threaded through your blood vessels to your heart.
Using this catheter, doctors can then do diagnostic tests as part of a cardiac catheterization. Some heart disease treatments, such as coronary angioplasty, also are done using cardiac catheterization.
Usually, you'll be awake during cardiac catheterization, but given medications to help you relax. Recovery time for a cardiac catheterization is quick, and there's a low risk of complications.
Cardiac catheterization (kath-uh-tur-ih-ZAY-shun) is a procedure used to diagnose and treat cardiovascular conditions. During cardiac catheterization, a long thin tube called a catheter is inserted in an artery or vein in your groin, neck or arm and threaded through your blood vessels to your heart.
Using this catheter, doctors can then do diagnostic tests as part of a cardiac catheterization. Some heart disease treatments, such as coronary angioplasty, also are done using cardiac catheterization.
Usually, you'll be awake during cardiac catheterization, but given medications to help you relax. Recovery time for a cardiac catheterization is quick, and there's a low risk of complications.
A cardiac event monitor is a device that you control to record the electrical activity of your heart (ECG). This device is about the size of a pager. It records your heart rate and rhythm. Cardiac event monitors are used when you need long-term monitoring of symptoms that occur less than daily
indications, uses and types of cardiac catheterization, about intra cardiac pressure, about angiography and its technique, digital substraction angiography and its technique.
Angioplasty uses imaging guidance to insert a balloon-tipped catheter into a narrow or blocked blood vessel where the balloon is inflated to open the vessel and improve blood flow. It may be done with vascular stenting – the placement of a small wire mesh tube within the blood vessel to help keep it open. The procedure is much less invasive than other surgical interventions and usually does not require general anesthesia.
A cardiac event monitor is a device that you control to record the electrical activity of your heart (ECG). This device is about the size of a pager. It records your heart rate and rhythm. Cardiac event monitors are used when you need long-term monitoring of symptoms that occur less than daily
indications, uses and types of cardiac catheterization, about intra cardiac pressure, about angiography and its technique, digital substraction angiography and its technique.
Angioplasty uses imaging guidance to insert a balloon-tipped catheter into a narrow or blocked blood vessel where the balloon is inflated to open the vessel and improve blood flow. It may be done with vascular stenting – the placement of a small wire mesh tube within the blood vessel to help keep it open. The procedure is much less invasive than other surgical interventions and usually does not require general anesthesia.
In medical field, a catheter is a thin tube made from biomaterial material that
has wide range of uses. Catheters are medical devices that can be inserted in the
body to treat diseases or perform a surgical procedure. Catheters are mainly used
in cardiovascular, urological, gastrointestinal, neurovascular, and ophthalmic
surgical applications.
Catheters can be inserted into a body cavity, duct, or vessel. Functionally, they
allow drainage, administration of fluids or gases, access by surgical instruments,
and also perform a wide variety of other tasks depending on the type of catheter.
The process of inserting a catheter is catheterization. In most uses, catheter is a
thin, flexible tube though catheters are available in varying levels of stiffness
depending on the application. A catheter left inside the body, either temporarily or permanently, may be referred to as an indwelling catheter.
This slide will provide illustrative information regarding coronary angioplasty . It also focus on practical area knowledge of cardiac catheterization which one should focus while caring patient with coronary angioplasty.
MI ( blockage of blood flow to heart muscle)
Acute angina (type of chest pain)
Aneurysms
AVM( Arterio-venous Malformations) abnormal connection between artery and vein.
eg. In spine and brain.
AVF (Arterio-venous Fistulas), LCA ,RCA EQUIPMENT
RUKAMANEE YADAV
Angiography is a general term
that describes the radiologic examination
of vascular structures within the body
after the introduction of an iodinated contrast
media or gas.
3. Assess the severity Data collection
and extent of
coronary artery
disease (CAD)
Cardiomyopathies
Valvular or
myocardial disorders
Determine CAD in
patient with chest
pain of unknown Genetic disorders
origin
4. Uncontrolled Uncompensated
hypertension congestive failure
Severe anemia Active infection or
Ventricular febrile illness
fibrillations Electrolyte
Acute stroke abnormalities
GI bleeds Severe
Allergy to contrast coagulopathy
Renal failure
5. After patient is properly identified, the
procedure must be explained before
consent can be signed
Baseline vital signs will be done and as
long as these are within the doctor’s
interest, can proceed with the
procedure
Blood tests must be done including BUN,
creatnine, PTT, INR, insulin/sugar levels
6. After patient is put on table, the area
being puncture must be free from hair
Hair removal done by disposable electric
razor and removed by sticky side of cloth
tape
Patient must be surgically cleaned with
hospital approved sterile surgical prep
solution
7. The technologist working with the
cardiologist must be scrubbed in
following basic sterile surgical technique
The patient is then draped from neck
down with sterile drapes
All equipment (radiation shields, image
intensifier, equipment used to
manipulate machine) must be prepped
with sterile covers
8. Procedure tray should
include:
-sterile gowns and gloves
for scrub tech and doctor
-sterile towels and drapes
for procedure
-equipment covers
-gauze
-scalpel, needles, scissors,
hemostats
-syringes for
heparin/saline flush,
lidocaine, and blood
draw
-labels with marking pen
for any item filled with a
solution
-basin for heparin/saline
mixture, basin for waste
fluids, small cup for
lidocaine
-skin prep solution
-high power manifold
-connection tubing
Fig. 2
9. Fig. 3
-Three catheters are used: JR4 (advances to right coronary arters, JL4 (advances
to left coronary arteries), and 145 degree pigtail catheter (to advance into
ventricles
-One 135cm wire
-Sheath corresponds with catheter size (5F cath gets 5F sheath etc.)
-Size of catheter depends on doctor’s preference but generallly 6F is used
10. Patient relaxed with Versed or Fentanyl,
sometimes both
Two 500mL bags of saline infused with
2,000 units (2cc) heparin each for
flushing all tubing, catheters, sheaths
Lidocaine for tissue numbing
Visipaque contrast unless otherwise
specified
11. When doctor and tech are
scrubbed and all equipment
and supplies are ready, the
procedure may begin
12. Access is easiest from right side of
patient due to aortic bend
Puncture is generally done via the
femoral artery
Alternative sites include the radial and
brachial arteries of the arm
13. After puncture of femoral, radial or brachial artery (primarily on right side of
patient), a catheter is advanced into the aorta and then the coronary arteries
14. After numbing the groin area, the
femoral artery is palpated and a needle
is inserted in that direction
When blood comes out of needle, the
artery has been accessed
A small, flexible guidewire is then inserted
into the lumen of the needle
The needle can then be removed but
the wire must maintain position
15. After removing the needle, a flexible
plastic tube can be placed over the wire
and introduced into the artery. This is
called a one-way sheath (allows
insertion of catheters and wires without
blood escaping)
The catheter is then inserted over the
guidewire but through the sheet and
advanced into placement via the
inferior vena cava to the aorta
16. Movement of catheter is monitored
under fluoroscopy (x-ray movies) with the
cardiologist manipulating its movements
The fluoroscopic machine is manipulated
by a qualified, scrubbed in, radiologic
technologist
When catheter is in place, wire can be
removed and contrast administered
17. Catheter in place to view left
coronary arteries
Catheter in place to view
right coronary arteries
18. Pigtail catheter in left
ventricle to measure
ventricular pressure
Aortagram used to assess
ascending and descending
aorta
20. The x-ray machine is suspended from the
ceiling. It can be manipulated in multiple
angles and views to achieve a desired
picture. The x-ray comes from the
bottom of the machine and the image
intensifier that transmits the image is
above the patient. Lead shielding and a
radiation badge is required for all
personnel in the room during the
procedure.
21. The procedure is complete when the
cardiologist has seen all the views and
anatomy desired and all pressures
recorded
The catheter can be removed and
manual pressure must be applied to
entry site for 15 minutes
22. The patient must lie flat and supine for a
minimum of two hours to ensure the
artery does not reopen
After two hours, the patient can be
released to person driving the patient
home
Dressing must remain dry, no lifting over
five pounds for three days
No shower for 24 hours
23. No bathing or swimming for one to two
weeks
Drink plenty of fluids
If severe pain, swelling or discoloration of
limb occurs, doctor must be notified
immediately
24. 1. Abdulla, Abdulla M. Cardiac
Catheterization. Ed. Dr. Abdulla M.
Abdulla. 18 February 2012. HeartSite. 24
Oct. 2012.
http://www.heartsite.com/html/cardiac_c
ath.html
2. Olade, Roger B. “Cardiac Catheterization
of the Left Heart”. Medscape Reference.
Ed.Karlheinz Peter. 10 Jan. 2012.
Medscape Reference. 24 Oct. 2012.
<http://emedicine.medscape.com/article/
1819224-overview#aw2aab6b2b3>