Transcript Coronary Angioplasty Balloon Catheter in Medical Applications

Coronary Angioplasty Balloon
Catheter in Medical Applications
Jagvir Singh
MTech. Clinical Engg.
History of Coronary Angioplasty
• In 1711, Stephen Hales conducted the first cardiac
catheterisation of a horse using brass pipes, a glass tube
and the trachea of a goose.
• WERNER FORSSMAN – First Human Catheterization –
1929
• In the early 1940's, Andre F Cournand, working in New
York, began utilizing right heart catheterisation for
investigation of cardiac function in both normal and
diseased patients.
• Andreas Gruentzig – First Coronary Angioplasty - 1977
COMPLETE APPARATUS:
> Needle
 Guide Wire
 Sheath
 Catheter
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PUNCTURE NEEDLES:
Used to cannulate or puncture the artery.
Usual Sizes include
18 ga, 19 ga , 20ga, 21 ga.
The selection of the Size depends on
the guide wire going to be inserted
through that needle port.
Seldinger Needle
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GUIDE WIRE:
Guide-wire structure :
Available in 35-260 cm length; should be at
least 20 cm longer than the catheter to be
used
• Majority - stainless steel (Majority coated
with PTFE (Teflon)
• Inner core – Mandrel
• Shaft
- Coiled wire Safety ribbon / wire
– Extends the whole length of coil
• All wires have a bead at the tip - soldered.
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DEFINITION:
A catheter is a hollow flexible tube that can be inserted into a body cavity,
duct or vessel. Catheters thereby allow drainage or injection of fluids ,
distend a passageway or provide access by surgical instruments.
The process of inserting a catheter is catheterization.
In most uses a catheter is a thin,
flexible tube: a "soft" catheter;
in some uses,
it is a larger, solid tube: a "hard" catheter.
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Ideal characteristics of catheters

Better Torque Control
 Strength
 Radiopacity
 Flexible
 Atraumatic Tip
 Low Surface frictional resistance for good trackability
over guide wire.
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PARTS OF A CATHETER
BODY
 HUB
 BODY
HUB
TIP
 TIP
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FRENCH CATHETER SCALE:
The French catheter scale (most correctly abbreviated as Fr, but also often
abbreviated as FR or F) is commonly used to measure the outer diameter of
cylindrical medical instruments including catheters ,needles etc.
D(mm) = Fr/3
or
Fr = D(mm)*3
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CATHETERS CAN BE BROADLY CLASSIFIED
UNDER THESE GROUPS:
 DIAGNOSTIC CATHETERS
Used for Angiographs .
 GUIDING CATHETERS
Used for Angioplasty.
• Guiding catheters are like angiography catheters only difference is that
guiding catheters are more stiffer & firm as it carries Balloon catheters,
PTCA wires and stent delivery system.
• Mild stiffness comes due to the wire braided design.
• Good Push ability .
• Good Tractability.
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TYPES OF CATHETERS:
CLASSIFICATION :
Catheters can be classified depending on
 SIDE HOLES :
-: Single Hole
-:End Hole with side holes.
-:Blocked end with side holes only.
 SIZES :
Abdominal – 6-80 cm
 Thoracic or Carotid Arteries – 100-120 cm
 NOTE: Size depends on :
> age of the patient
> selective or super selective study
> size of the vessels.
NOTE: Ideal practice is to use the smallest diameter catheter feasible for any
particular study to minimize the risk of arterial damage by the procedure.
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TYPES OF CATHETERS
 SHAPES
 Straight Catheter
 Pigtailed Catheter
 Cobra Shaped Catheter
 Side Winder Catheters (Shepherd)
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Different Catheter Curves
For Different Purposes:
> Judkins Left (JL)
> Judkins Right ( JR)
> Judkins Left Short Tip
> Judkins Right Short Tip
> Amplatz Left ( AL)
> Amplatz Right ( AR)
> Left Coronary Bypass
> Right Coronary Bypass
> Cardiac Pigtail
> Multipurpose
Judkins Left
Amplatz Left
Judkins Right
Amplatz Right
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Butterfly Catheters
Foleys Catheter (1way,
2way or 3way)
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Shape of the Tip :
J Tip / Straight Tip
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Some Other Types of Catheters:
 Hydrophilic Catheters :
Hydrophilic-coated catheters have a layer of polymer
coating that is bound to the catheter surface.
The polymer absorbs and binds water to the catheter,
resulting in a thick, smooth and slippery surface.
 Intermittent Catheters:
Intermittent catheters are hollow tubes used to drain
urine from the bladder.
 Pediatric Catheters:
Usually its around 80cm.
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Catheter
construction :
Single layered/Multi layered
Multi layered :
Inner tube - of Teflon / Polyurethane
Middle layer - tube of nylon, woven Dacron, or stainless steel braiding.
External layer - A tube of polyethylene or polyurethane is then heated and
extruded over the two inner layers to bond firmly . Radio- opaque material is
incorporated by impregnating with barium or bismuth
Ba, Bi soften the catheter ,may produce fine pitting of surface thereby
increasing thrombogenicity
Thrombogenicity is reduced by coating with Silicone or any antithrmbogenic
materaial
Catheters Materials
Dacron ,Polyurethane, Poly ethylene, Teflon,
Polyvinylchloride (PVC)
Dacron
•Eg. GL - Goodale Lubin, NIH.
Woven Dacron
•Most covered with polyurethane coating to increase surface
stiffness and reduce vascular trauma.
•Some angiographic catheters are reinforced with a nylon core.
Polyurethane and Poly ethylene(e.g. Judkins
Coronary catheters, Pigtail catheters )
•PE is relatively resistant to softening by barium/bismuth and is
more easily extruded
•can be easily softened by heating for reshaping/special tip
configurations
•has to be gas sterilized
• PU has an excellent memory. This is a desirable feature of
super selective catheters whose tip design may be altered
during insertion and manipulation.
•Softer - which reduces the risk of vascular trauma or
perforation.
•can be reshaped by immersing in boiling water/or steam
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Teflon
•Stiffest vascular catheters.
•Teflon has poor catheter memory - more
appropriate for non-selective catheterization.
Eg. Mullins for septal puncture / all sheaths
Polyvinyl chloride
• PVC
catheters are the softest among the catheters available.
• Very flexible and therefore ideal for flow directed catheters.
• PVC has a high friction coefficient which may reduce the ease of
catheter passage and increase the incidence of venous spasm.
• They have increased thrombogenicity and very poor memory
and high moisture absorbtion – drugs may get absorbed Eg Atropine.
Examples: Swan-Ganz catheters, Berman angiographic catheter.
Two types of medical balloons
• High pressure balloons
Moulded to their inflated geometry
from non-compliant or low
compliant materials that retain their
designed size and shape even under
high pressure
•Low pressure balloons
Moulded in a tubular shape which is
then expanded to several times its
original size in use. Used primarily
for fixation or occlusion.
Balloon Materials
Manufacturing Balloons
• Angioplasty balloons are made by extruding
material into a tube shape and then forming
the tube into a balloon through a process
known as blow moulding. The balloon should
have:
– The smallest possible wall thickness
– Burst pressure of more than 15 bar
– Defined pressure and diameter characteristics
USES & APPLICATION s OF CATHETERS:
Placement of a catheter into a particular part of the body may allow:
 Draining urine
from the urinary bladder as in urinary
catheterization, e.g., the Foley catheter.
 Catheter balloon Valvuloplasty
 Drainage of fluid collections, e.g. an abdominal abscess.
 Administration of intravenous fluids, medication or
parenteral nutrition with a peripheral venous catheter.
 Angioplasty , angiography , balloon septostomy, balloon
angioplasty.
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CONTD…
 Direct measurement of blood pressure in an artery or vein.
 Direct measurement of intracranial pressure.
 Administration of anesthetic medication into the epidural
space, the subarachnoid space, or around a major nerve bundle
such as the brachial plexus.
 Subcutaneous administration of insulin or other medications.
 A central venous catheter is a conduit for giving drugs or
fluids into a large-bore catheter positioned either in a vein near
the heart or just inside the atrium.
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REFERENCES:
Websites:
Wikipedia
 Google
Books:
 Diagnostic and therapeutic Cardiac Catheterization :
Carl J.Pepine
Cardiac Catheterization Angiograhy and Instruments:
W. Grossman, Donald Baim
 Cardiac Catheterization methods diagnostic and therapeutic:
Peterson ,Nicod
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