Transcript Cardiac Cath and Angiocardiography

Cardiac Cath and
Angiocardiography
SPRING 2009
FINAL
3-23-09
Definition of Cardiac Catherization
• Comprehensive term to describe minor surgical
procedure for diagnostic evaluation or
interventional (therapeutic) purposes
• Diagnostic
– Collects data to evaluate PT’s condition
• Therapeutic
– To intervene by mechanical means to treat disorders
of the vascular and conduction systems within the
heart
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Principles of Cardiac
Catheterization
• Suspected or known coronary
• heart disease
Indications
• Myodcardial infarction
• Sudden cardiovascular death
• Valvular heart disease
• Congenital heart disease
• Aortic dissection
• Pericardial constriction
• Cardiomyopathy
• Initial and follow up
assessment for heart
transplant
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Contraindications
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Active GI bleed
Renal failure
Recent stroke
Fever from infection
Electrolyte imbalance
Anemia
Short life expectancy
Digitalis intoxication
• PT refusal
• Uncontrolled
hypertension
• Bleeding disorders
• Pulmonary edema
• Uncontrolled ventricular
arrhythmias
• Aortic valve endocarditiis
• Allergic to contrast
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Complications and Risks
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Death
Myocardial infarction
CVA
Arrhythmia
Hemorrhage
Contrast
Hemodynamic
Perforation
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Angiographic Supplies
and Equipment
•Catheters
•Contrast Media
•Pressure Injector
Catheters
• For LT cardiac cath
similar to those for
angio
• RT cath requires
specialized catheters
– Typically flow directed
catheters
– With manifolds
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Contrast Media
• High Osmolar Ionic
– Sometimes causes ECG changes
• Widely used
– Non-ionic
– Ionic low osmolar
• Restricted costs causes limited use of low
osmolar contrast agents.
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Pressure injector
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Imaging
•Image chain
•Digital Angiography imaging
equipment
Image chain
• Similar to angio suites
• High resolution imaging and recording
• C-arms must be able to be on for extended
periods of time
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Withstand great heat load
Multi focal-spot
High speed rotating fluoro tubes
Short exposure times
15-30 frames per second
• Often have a video camera
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Digital Angiography
Imaging equipment
• Long term storage of large amounts of
digital files has benefited from advances in
computer technology
• DICOM (digital communications
committee)
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Ancillary Equipment
and Supplies
•Physiologic Equipment
•Other equipment
Physiologic Equipment
• Equipment to monitor
– ECG
– Hemodynamic pressures
• Vital signs to
• record PT function
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Other Equipment
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Crash cart
Oxygen and suction
Defibrillator
Temporary pacemaker
Pulse oximeter
Blood pressure cuff
Equipment to perform cardiac output studies
Activated clotting time (ACT) equipment
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Patient Positioning for
Cardiac Catheterization
• PT must be positioning so that they will not
have to be moved during procedure
• Must be positioned so anatomic structures
of interest are demonstrated
• PT is supine with shielding as appropriate
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Catheterization Methods
and Techniques
Pre-Catheterization Care
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Informed consent obtained
PT history
Physical exam
CXR
Blood work
ECG
Echocardiogram
Exercise stress test
Nuclear Medicine cardiac perfusion studies
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Pre-Catheterization Care
• IV started
– Sedation and nausea
• Nothing to eat 4-6 hours before procedure
• Records of procedure
– PT hemodynamic data
– Fluoro times
– Medications administered
– Supplies used
– Other pertinent information
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Catheter Introduction
• Prepare catheter introduction
site with aseptic technique
– Shaved and cleaned
• Can be at femoral (most
common), brachial, radial,
axillary, jugular and
subclavian areas
• Selinger technique used
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Selinger Technique
Needle with cannula
inserted
Needle withdrawn
until there is blood flow
Catheter over guidewire
Needle removed
Inner cannula removed
& guidewire inserted
Guidewire removed
leaving catheter in
artery
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Data Collection
• Physiologic data unusually collected
– Hemodynamic parameters
• Includes blood pressure
• Cardiac output
• Vascular pressures (inside & outside the heart)
– ECG
– Oximetry readings
– Cardiac output
– Blood samples to measure oxygen
saturations levels in various parts of the heart
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