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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

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Cardiac Cath and Angiocardiography

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  1. Cardiac Cath and Angiocardiography SPRING 2009 FINAL 3-23-09

  2. 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

  3. Principles of Cardiac Catheterization

  4. 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

  5. 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 Contraindications

  6. Complications and Risks • Death • Myocardial infarction • CVA • Arrhythmia • Hemorrhage • Contrast • Hemodynamic • Perforation

  7. Angiographic Supplies and Equipment Catheters Contrast Media Pressure Injector

  8. Catheters • For LT cardiac cath similar to those for angio • RT cath requires specialized catheters • Typically flow directed catheters • With manifolds

  9. 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.

  10. Pressure injector

  11. Imaging Image chain Digital Angiography imaging equipment

  12. 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

  13. Digital Angiography Imaging equipment • Long term storage of large amounts of digital files has benefited from advances in computer technology • DICOM (digital communications committee)

  14. Ancillary Equipment and Supplies Physiologic Equipment Other equipment

  15. Physiologic Equipment • Equipment to monitor • ECG • Hemodynamic pressures • Vital signs to • record PT function

  16. 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

  17. 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

  18. Catheterization Methods and Techniques

  19. Pre-Catheterization Care • Informed consent obtained • PT history • Physical exam • CXR • Blood work • ECG • Echocardiogram • Exercise stress test • Nuclear Medicine cardiac perfusion studies

  20. 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

  21. 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

  22. Selinger Technique Inner cannula removed & guidewire inserted Needle withdrawn until there is blood flow Needle with cannula inserted Guidewire removed leaving catheter in artery Catheter over guidewire Needle removed

  23. 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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