08 technical Gilchrist aimradial20170922 Right heart
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Right heart catheterization by transradial approach - Ian C Gilchrist
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08 technical Gilchrist aimradial20170922 Right heart
- 1. Right Heart Access by Radial Ian C Gilchrist, MD, FACC, FSCAI Professor of Medicine Penn State’s Hershey Medical Center Heart & Vascular Institute Hershey, PA Dorsal Radial Artery/Vein Access icg2017
- 2. Disclosure Statement Nothing involve in this presentation icg 2017
- 3. Arm Veins: Original Cardiac Access Forssmann Klinische Wochenschrift 1929;8(45)2085-7. Werner Forssmann icg 2017
- 4. Why Bother? Safety & Convenience icg 2017
- 5. Case & Point Icg/HMC cath lab Access: Radial artery RIJ vein Complication: Pneumothorax There is room for a safer way to the right heart & central venous system This is no longer paid for in the United States icg 2017
- 6. An Enlightened Radial Operator Brachial Artery Cutdown Percutaneous Femoral Access Transradial Arterial Access Complete Forearm Vascular Access Transradial Cutdown icg 2017
- 7. Venous System Access Before entering the cath lab Nurse Heparin LockIV Catheter (20 g) + + Nurse places heparin lock in forearm for use in the catheterization lab for venous sheath access. • saves time • improves cath lab efficiency • fosters team building icg 2017
- 8. Heparin Locks, Needles & Wires Heparin lock on angiocath Micropuncture needle Micropuncture needle impaled in Heparin Lock (remove both in block off field for sterility) Wire holder icg 2017
- 9. Try in cath lab ± tourniquet Inspect arm carefully Don’t forget the other arm Floor nurses unable to get access? °C Christen, et al. J Cardiovasc Pharmacol. 2004;44:659–664 Trouble Shooting icg 2017
- 10. No Touch Technology Use non-invasive (no touch) technology to localize vein and its path for superficial vessels Uses absorption of hemoglobin to localize vessels AccuVein Device icg 2017
- 11. V Photo’s by Mauricio Cohn, MD Miami, Fl Ultrasound for deep vessels Photo’s by Mauricio Cohn, MD Miami, Fl Photo’s by Mauricio Cohn, MD Miami, Fl Pressure Everyone has veins! Trouble Shooting- No Veins icg 2017
- 12. Sheath in But No Return Flow Source: Hadaway LC. Nursing 2005;35(8):54-61 Vein: low pressure system that collapses easily As long as everything flushes & perforation is not otherwise a concern, it is probably in the lumen Trouble Shooting Veins also have valves icg 2017
- 13. Venous System: Typical Patterns Radial (lateral) veins lead equally to either Cephalic or Basilic veins Ulnar (medial) veins usually continue as Basilic vein Chun et al. Radiology. 2003;226:918-920. icg 2017
- 14. Upper Venous Junction Cephalic vein joins the Axillary vein at a T-Junction. – Defines start of the subclavian & central venous system – Location most likely to cause technical issues icg 2017
- 15. Navigating a Sticky RA 10cc H2O Credit: Samir B. Pancholy, MD icg 2017
- 16. Jetting Across the RA Initial approach to tricuspid valve 10cc of flush via lumen Video Credit: Samir B. Pancholy, MD icg 2017
- 17. http://assets.families.com/Encyclopedias/gea2_02_img0132.jpg Arm Trauma EPS Devices Breast Cancer Lymphodemia Contraindications/Cautions icg 2017
- 18. Summary Finish with hemostasis just like removing an IV Can replace sheath with large angiocath if needed It is simple & extends the potential arm access Learning both arterial and venous techniques will make you a better cardiologist icg 2017
- 19. Thank you icg1@psu.edu icg 2017