Cardiac Catheterization Studies. Claire Winters Chief Cardiac Clinical Physiologist TCH. Aims + outcome of lecture. Role of the CCP. Check + use defib, temp pacing + resus equipment Connect up for continuous ECG + sat monitoring
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Chief Cardiac Clinical Physiologist TCH
1) RFA – easy access, low complications
Palpate RFA - once obtained clean site with Betadine and surgically drape
Infiltrate 1 -2% lignocaine subcutaneous about 2 – 4 cm below the inguinal ligament using an angle needle 45o to skin – (see diagram)
Insert access needle 16 – 18 gauge Cook needle – aim in same direction to puncture artery – access gained by observing a brisk ‘spurt’ of red blood – sluggish backflow venous access.
Insert 0.035inch J tipped guidewire to the abdominal ao, needle is then withdrawn.
Arterial sheath with dilator, arterial sheath has a haemostatic device and side port is placed over the wire. Wire and dilator is then removed
Sheath is then flushed with saline.
6F or 5F sheath generally used.
2) Brachial / radial approach
- Artery palpated medially in the antecubital fossa
Approach similar to cut down technique for the RFA approach.
Left arm approach Judkins catheter is adequate
R. arm approach Amplatz or MP catheter
- Stiffness – floppy, intermediate, standard
-Allows a cross-sectional image of the lumen and vessel wall – greater accuracy in measurement due to better spatial resolution.
- Has 3 – 4 razor atherotomes which cut into plaque and vessel wall and allow vessel dilation at a low balloon pressure.
- X - Atrial relaxation with decline in pressure.
Tricuspid closure –upright deflection i.e. c wave – follows PR interval
V wave – near end of T wave – atrial filling
Y wave descent – opening of tricuspid valve with emptying of the atrium.
Normally a wave is greater than peak v
RV - peak systolic and end diastolic wave are used for RV pressure
PA – peak systolic, end diastolic and mean pressure are measured
PCWP – i.e. LA pressure – wave similar to the RA pressure
V wave is greater than the a wave
Mean PCW, a wave and v wave are recordedPressure wave forms
i.e. Stroke vol (ejection/ beat) x hr
Art – ven O2 sat Vols %
The O2 capacity = 13.5x1.34=18.09 vols% (for O2 sat)
PA sat in vols%=72x18.09 ÷100 = 13.03
AO 96x18.09 ÷100 = 17.30
CO is Oxygen consumption ÷ 10 l /min
Art – ven O2 sat Vols %
180 ÷10 vols% 180 ÷ 10 = 4.14 l/min
Normal cardiac output - 4 – 8 L
(mean PAP–PCWP) x 80 N=100-250 dyne.s cm
(arterial saturation – mixed venous saturation)
(pulmonary vein sat – pulmonary artery sat)
Mixed venous – 3 x SVC + 1 x IVC
e.g. IVC 78%, SVC 74%, RA 76%, PA 89%, LV 96%, AO 96% what is the shunt?
SA 96 – (3x74 + 78 / 4) 75 = 21
PV 96 – PA 89 = 7 Shunt =3
Ratio greater than 2 generally means pt would benefit from surgery.