Percutaneous_Catheterization_Presentation

1. Percutaneous Catheterization
• Site, Asepsis, Guide Wire, Catheter, Pressure
Injector & Accessories
• Presented by: Dr Prashant, Dr Anamika
• Moderator: Dr Mohit

2. Objectives
• 1. Understand site selection and asepsis in
percutaneous catheterization
• 2. Explore guide wires and catheters
• 3. Learn about pressure injectors
• 4. Review accessories involved

3. Definition & Indications
• Percutaneous catheterization: insertion of a
catheter through the skin into a vessel or body
cavity.
• Indications: vascular access, drainage,
angiography.

4. Common Clinical Applications
• 1. Central venous catheter placement
• 2. Interventional radiology
• 3. Drainage of abscesses or fluids
• 4. Angiographic procedures

5. Vascular Access Sites
• Common sites:
• - Femoral vein/artery
• - Radial artery
• - Jugular vein
• - Brachial vein

6. Anatomical Considerations
• Key anatomical landmarks:
• - Inguinal ligament for femoral
access
• - Radial styloid for radial access
• - Sternocleidomastoid for jugular
access

7. Choosing the Right Site
• Factors influencing site:
• - Patient anatomy
• - Procedure type
• - Risk of infection
• - Urgency of access

8. Importance of Asepsis
• Prevents infections such as:
• - Catheter-related bloodstream infections
• - Local site infections
• - Sepsis

9. Patient Preparation
• Steps:
• 1. Skin cleaning with antiseptic
• 2. Draping with sterile materials
• 3. Local anesthesia if required

10. Operator Preparation
• Includes:
• - Surgical hand scrub
• - Sterile gloves and gown
• - Mask and cap

11. Sterile Field Setup
• Includes:
• - Sterile drapes
• - Sterile tray with instruments
• - Maintaining sterile technique throughout

12. Steps in Aseptic Technique
• 1. Donning PPE
• 2. Preparing site
• 3. Using sterile tools
• 4. Avoiding contamination

13. Wires
Wires have three main properties: diameter, stiffness, and
hydrophilic or nonhydrophilic composition.
There are three basic types of wire categorized according to the
above properties:
• Access wire: simple short wire; used for access and
often quickly exchanged
• Maneuver wire: often floppier body; tip is often curved,
floppy, and hydrophilic; commonly used to subselect
vessels
• Rail wire: stiff; provides a stable platform for exchanges,
balloons, stents, and maintaining access

14. • Hydrophilic wires: useful in a fluid environment and when a
narrow area must be traversed and less resistance is desired
{eg, in small vessels, in the pylorus for percutaneous
gastrostomy).
■ Hydrophilic wires are slippery when wet and sticky when
dry {flush them and keep them wet).
• Nonhydrophilic wires: easier to grip, do not become sticky,
may offer more resistance when traversing narrow areas.

16. 0.018"
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Wires Commonly Used at Our
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Hydrophilic Nonhydropbilic

17. Wires
Hydrophilic 0.018-inch

21. Shearing(arrow)

22. Guide Wire Properties
• Important properties:
• - Flexibility
• - Torque control
• - Radiopacity
• - Coating

23. Insertion Technique
• Seldinger technique:
• 1. Puncture vessel
• 2. Insert guide wire
• 3. Remove needle
• 4. Advance catheter

24. Complications of Guide Wires
• Potential issues:
• - Vessel trauma
• - Kinking
• - Wire embolism
• - Misplacement

25. Catheters
General (Nonselective)
• Pigtail or Omniflush (Angiodynamics,
Latham, NY): pigtail end; multiple side
holes on the straight and curved portions
of the catheter; used for venography and
arteriography.

27. • Mikaelson (Angiodynamics): shape helps
anchor the catheter in place by increasing
opposition against the aortic wall.
• Cobra (Cordis; Fremont, Calif): similar uses
to those of SOS and Mikaelson; decreased
curve allows easier advancement over a
wire.

28. Catheter Materials
• Common materials:
• - Polyurethane
• - Silicone
• - Teflon
• Designs vary by flexibility and lumen
configuration

29. Insertion Techniques
• Techniques:
• - Over-the-wire
• - Peel-away sheath
• - Direct puncture (less common)

30. Catheter-Related
Complications
• Includes:
• - Malposition
• - Thrombosis
• - Infection
• - Mechanical failure

31. What is a Pressure Injector?
• Device used to deliver contrast agents at high pressure for imaging.
• Used in: CT, MRI, angiography.

32. Injector Parameters
• Controlled parameters:
• - Flow rate (mL/sec)
• - Total volume
• - PSI (pressure)
• - Delay time

33. Safety with Injectors
• Risks:
• - Extravasation
• - Over-pressurization
• - Air embolism
• Ensure proper setup and monitoring.

34. Sheaths and Dilators
• Used to facilitate catheter entry.
• Dilators enlarge the puncture tract.
• Sheaths protect vessels and guide devices.

37. Needles and Syringes
• Access needles: for vessel entry.
• Syringes: for flushing, aspiration, contrast
injection.

38. Contrast Media
• Types:
• - Iodinated (CT)
• - Gadolinium-based (MRI)
• Consider allergies and renal function.

39. Monitoring Equipment
• Essential during procedures:
• - ECG
• - Blood pressure cuff
• - Pulse oximetry

40. Basic Conversions and
Measurements
Needle diameter is measured in gauges.
□The lower the gauge, the larger the needle.
Catheter and sheath diameters are measured in French (F)
units.
□1F=l/3mm
□1 F = 0.013 inch
Wire diameter is measured in inches.
□0.018 and 0.035 wires are 0.018 and 0.035 inch in diameter,
respectively.

41. Conclusio
n
• Needles: 18-, 19·, and 21-gauge needles are most often used for vascular
work; 18-gauge and larger bores are used for abscess drainage or
biopsy.
Wires: selected according to size, shape, hydrophilic or nonhydrophilic
property, and strength.
0.018-inch wires need a 22-gauge or larger bore needle for
introduction.
0.035-inch wires need at least an 18-gauge needle or 5-F catheter
•
(placed with a 21- or 22-gauge needle and exchanged over an 0.018-
inch wire) for introduction.
Select maneuvering wires for small vessels, tight spaces, or difficult
curves. Select rail wires for stability.
• Sheath diameter is based on the internal diameter of the sheath.
• Always adv,rnce a catheter or sheath over a wire or dilator to avoid
vessel
injury.