Cardiac CatheterizationBy

JenniferPeterson

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Cardiac catheterization views the anatomy of the heart using a contrast material injected into the coronary arteries under fluoroscopic imaging.

Fig. 1

Indications for Procedure

Assess the severity and extent of coronary artery disease (CAD)

Valvular or myocardial disorders

Determine CAD in patient with chest pain of unknown origin

Data collection

Cardiomyopathies

Genetic disorders

Contraindications

Uncontrolled hypertension

Severe anemia Ventricular

fibrillations Acute stroke GI bleeds Allergy to contrast Renal failure

Uncompensated congestive failure

Active infection or febrile illness

Electrolyte abnormalities

Severe coagulopathy

Before the Procedure

After patient is properly identified, the procedure must be explained before consent can be signed

Baseline vital signs will be done and as long as these are within the doctor’s interest, can proceed with the procedure

Blood tests must be done including BUN, creatnine, PTT, INR, insulin/sugar levels

Patient Prep

After patient is put on table, the area being puncture must be free from hair

Hair removal done by disposable electric razor and removed by sticky side of cloth tape

Patient must be surgically cleaned with hospital approved sterile surgical prep solution

Sterile Field and Patient

The technologist working with the cardiologist must be scrubbed in following basic sterile surgical technique

The patient is then draped from neck down with sterile drapes

All equipment (radiation shields, image intensifier, equipment used to manipulate machine) must be prepped with sterile covers

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Procedure tray should include:-sterile gowns and gloves for scrub tech and doctor-sterile towels and drapes for procedure-equipment covers-gauze-scalpel, needles, scissors, hemostats-syringes for heparin/saline flush, lidocaine, and blood draw-labels with marking pen for any item filled with a solution-basin for heparin/saline mixture, basin for waste fluids, small cup for lidocaine-skin prep solution-high power manifold-connection tubing Fig. 2

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Fig. 3-Three catheters are used: JR4 (advances to right coronary arters, JL4 (advances to left coronary arteries), and 145 degree pigtail catheter (to advance into ventricles-One 135cm wire-Sheath corresponds with catheter size (5F cath gets 5F sheath etc.)-Size of catheter depends on doctor’s preference but generallly 6F is used

Medications Used

Patient relaxed with Versed or Fentanyl, sometimes both

Two 500mL bags of saline infused with 2,000 units (2cc) heparin each for flushing all tubing, catheters, sheaths

Lidocaine for tissue numbing Visipaque contrast unless otherwise

specified

Start Procedure

When doctor and tech are scrubbed and all equipment and supplies are ready, the procedure may begin

Arterial Puncture

Access is easiest from right side of patient due to aortic bend

Puncture is generally done via the femoral artery

Alternative sites include the radial and brachial arteries of the arm

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N After puncture of femoral, radial or brachial artery (primarily on right side of patient), a catheter is advanced into the aorta and then the coronary arteries

Steps to Insert Catheter

After numbing the groin area, the femoral artery is palpated and a needle is inserted in that direction

When blood comes out of needle, the artery has been accessed

A small, flexible guidewire is then inserted into the lumen of the needle

The needle can then be removed but the wire must maintain position

Inserting Catheter

After removing the needle, a flexible plastic tube can be placed over the wire and introduced into the artery. This is called a one-way sheath (allows insertion of catheters and wires without blood escaping)

The catheter is then inserted over the guidewire but through the sheet and advanced into placement via the inferior vena cava to the aorta

Catheter Placement

Movement of catheter is monitored under fluoroscopy (x-ray movies) with the cardiologist manipulating its movements

The fluoroscopic machine is manipulated by a qualified, scrubbed in, radiologic technologist

When catheter is in place, wire can be removed and contrast administered

Fluoroscopic Views

Catheter in place to view left coronary arteries

Catheter in place to view right coronary arteries

Fluoroscopic Views

Pigtail catheter in left ventricle to measure ventricular pressure

Aortagram used to assess ascending and descending

aorta

Fluoroscopic Views

Right coronaary arteries shown with contrast

Left coronary arteries shown with contrast

Fluoroscopic Machine

The x-ray machine is suspended from the ceiling. It can be manipulated in multiple angles and views to achieve a desired picture. The x-ray comes from the bottom of the machine and the image intensifier that transmits the image is above the patient. Lead shielding and a radiation badge is required for all personnel in the room during the procedure.

Finished Procedure

The procedure is complete when the cardiologist has seen all the views and anatomy desired and all pressures recorded

The catheter can be removed and manual pressure must be applied to entry site for 15 minutes

Post Procedure Instructions

The patient must lie flat and supine for a minimum of two hours to ensure the artery does not reopen

After two hours, the patient can be released to person driving the patient home

Dressing must remain dry, no lifting over five pounds for three days

No shower for 24 hours

Post Procedure Instructions

No bathing or swimming for one to two weeks

Drink plenty of fluids If severe pain, swelling or discoloration

of limb occurs, doctor must be notified immediately

References1. Abdulla, Abdulla M. Cardiac

Catheterization. Ed. Dr. Abdulla M. Abdulla. 18 February 2012. HeartSite. 24 Oct. 2012. http://www.heartsite.com/html/cardiac_cath.html

2. Olade, Roger B. “Cardiac Catheterization of the Left Heart”. Medscape Reference. Ed.Karlheinz Peter. 10 Jan. 2012. Medscape Reference. 24 Oct. 2012. <http://emedicine.medscape.com/article/1819224-overview#aw2aab6b2b3>

Picture Credits* Figure 1. Hale, Jane. Untitled. 2008. The

Flint Journal. http://blog.mlive.com/flintjournal/newsnow/2008/02/mclaren_opens_new_cardiac_cath.html

Figure 2. AliMed. Medline Cardiac Catheterization Procedure Tray. Alimed. 24 Oct 2012. http://www.alimed.com/medline-cardiac-catheterization-procedure-tray.html

Figure 3. Merit Medical. Performa Multipack Angiographic Cardiology Catheters. Merit Medical. 24 Oct 2012. http://www.merit.com/products/default.aspx?code=performamcath