Cardiac Cath and Angiocardiography

SPRING 2009

FINAL

3-23-09

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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

Principles of Cardiac Catheterization

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Indications• Suspected or known coronary • heart disease

• 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

• 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

• Death• Myocardial infarction• CVA• Arrhythmia• Hemorrhage• Contrast• Hemodynamic• Perforation

Angiographic Supplies and Equipment

•Catheters

•Contrast Media

•Pressure Injector

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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

Imaging

•Image chain

•Digital Angiography imaging equipment

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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

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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)

Ancillary Equipment and Supplies

•Physiologic Equipment

•Other equipment

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Physiologic Equipment

• Equipment to monitor– ECG – Hemodynamic pressures

• Vital signs to

• record PT function

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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

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Patient Positioning forCardiac 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

Catheterization Methods and Techniques

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Pre-Catheterization Care

• 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 withdrawnuntil there is blood flow

Inner cannula removed& guidewire inserted

Needle removedCatheter over guidewire 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