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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 2 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 4 Contraindications • • • • • • • • 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 5 Complications and Risks • • • • • • • • Death Myocardial infarction CVA Arrhythmia Hemorrhage Contrast Hemodynamic Perforation 6 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 8 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. 9 Pressure injector 10 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 – – – – – 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 12 Digital Angiography Imaging equipment • Long term storage of large amounts of digital files has benefited from advances in computer technology • DICOM (digital communications committee) 13 Ancillary Equipment and Supplies •Physiologic Equipment •Other equipment Physiologic Equipment • Equipment to monitor – ECG – Hemodynamic pressures • Vital signs to • record PT function 15 Other Equipment • • • • • • • • Crash cart Oxygen and suction Defibrillator Temporary pacemaker Pulse oximeter Blood pressure cuff Equipment to perform cardiac output studies Activated clotting time (ACT) equipment 16 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 17 Catheterization Methods and Techniques Pre-Catheterization Care • • • • • • • • • Informed consent obtained PT history Physical exam CXR Blood work ECG Echocardiogram Exercise stress test Nuclear Medicine cardiac perfusion studies 19 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 20 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 21 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 22 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 23