Term
| Procedure in which the vein or artery is exposed surgically and then a cannula or sheath is inserted into the vessel under direct vision |
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Definition
| Cutdown procedure (Sones) |
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Term
| Any medical procedure where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using an "open" approach where inner organs or tissue are exposed |
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Definition
Percutaneous procedure (Seldinger)
-Commonly used in vascular procedures |
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Term
| This involves a needle catheter getting access to a blood vessel, followed by the introduction of a wire through the lumen (pathway) of the needle. It is over this wire that other catheters or sheaths can be placed into the blood vessel. |
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Definition
Percutaneous procedure (Seldinger)
-This technique is known as the Modified Seldinger Technique. |
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Term
| The technique of mechanically widening a narrowed or obstructed blood vessel, typically as a result of atherosclerosis |
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Definition
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Term
| an X-ray examination of the blood vessels or chambers of the heart. |
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Definition
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Term
| Is a slight decrease in systolic pressures, but a large decrease in diastolic pressures. At a first glance, the waveform looks like a left ventricular or ‘LV’ waveform |
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Definition
Ventricularization
-Ventricularization is most commonly seen when the catheter tip passes through a tight lesion on a left main. While this is a common example, damping and ventricularization can be seen interchangeably in any setting. |
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Term
| Indications for heart cath |
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Definition
-Failed EKG or Stress testing
-Heart Attack
-Significant family history & symptoms of atypical chest pain or discomfort
-Shortness of breath
-Inability to exert yourself
* The combination of any or all of the above |
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Term
| Goals of a diagnostic angiogram |
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Definition
-Create a roadmap of the patients coronary vasculature
-Full visualization of the coronary arteries and all their branches
-Assess Left Ventricular function
-Determine stenosis site & significance along with an ability to treat |
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Term
| Indications for a diagnostic LHC |
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Definition
-Suspected or known Coronary Artery
-Disease (CAD)
-Myocardial Infarction (Acute and Post)
-Sudden cardiovascular failure
-Valvular disease
-Congenital Heart Disease (CHD)
-Aortic dissection
-Variant angina
-Positive ETT
-Pre-op diagnosis
-Post-op CABG
Balloon valvuloplasty of Aortic or Mitral valve
-Eval of LV function
-Aortography |
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Term
| Indications for Right Heart Cath |
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Definition
-Congenital heart disease
-Pulmonary thromboembolic disease
-Suspected pericardial tamponade or constriction
-In conjunction with left heart disease
-Transeptal catheterization of LA
-Endomyocardial biopsy
-Evaluation of valvular heart disease
-Cardiac output determinaton
-Intracardiac shunt determination
-E.P. Study |
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Term
| Absolute Contraindications of Heart Cath |
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Definition
-Patient refuses the procedure (absolute)
-Inadequate Cath. Facility
--These will delay the procedure until brought under control or corrected
--These situations carry increased risk to an already risky procedure |
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Term
| Relative contraindications of Heart Cath |
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Definition
Digitalis toxicity
Febrile illness
CHF with acute pulmonary edema
Uncontrolled ventricular irritability
Uncontrolled Hypokalemia
Clotting disorder
Severe allergy to contrast media
Severe renal failure |
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Term
| Most common site for catheterization |
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Definition
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Term
| Percutaneous: (Seldinger technique) |
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Definition
| Direct puncture of the vessel through the skin |
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Term
| First catheter designed for the heart |
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Definition
Cournand
--Used for right heart catheterization, pressure measurements (RA, RV, PA, PCWP) and blood samples
--Sizes 5-8 Fr, 100-124 cm long |
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Term
| What are the different catheter materials? (Made of what) |
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Definition
-Dacron
-Polyurethane
-Polyethylene
-Teflon
-Polyvinylchloride (PVC) |
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Term
| Which material has a higher risk of thrombus formation and can be reshaped in boiling water |
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Definition
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Term
Which catheter material does not soften much at body temp, maintains shape and is very popular for selective procedures?
More thrombogenic |
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Definition
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Term
| THE STIFFEST VASCULAR CATHETER |
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Definition
Teflon
-Increases the ease of insertion
-Poor curve memory |
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Term
| Which catheter material is ideal for flow directed catheters? |
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Definition
Polyvinylchloride (PVC)
-Soft
-Supple and flexible
(poor memory curve) |
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Term
| The right tool for the right job |
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Definition
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Term
| PVC has what kind of hydro propery? |
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Definition
| Hydrophilic property- has a high rate of moisture absorption (NTG, Isosorbide, Insulin, Diazepam, Thiopental) |
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Term
| Ability to finely control the rotation or torque of the catheter tip by manipulation of the hub is an essential feature for successful selective catheterization |
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Definition
Torqueability
-Relationship between torque delivered and transmitted (ratio) |
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Term
| Ability of the catheter to resume or keep its original preformed shape |
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Definition
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Term
| Ability of the catheter to remain in position despite resistance |
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Definition
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Term
| How should the catheter tip be shaped |
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Definition
Slightly tapered tip produces the least amount of trauma
--Should not be blunt or sharp
--Should be soft and flexible |
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Term
| What does the catheter end hole allow? |
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Definition
| The end hole allows for more complete flushing of the catheter which reduces thrombus formation |
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Term
| The absence of a catheter end hole reduces what? |
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Definition
| Absence of an end hole reduces the risk of intramural injection of contrast media and catheter recoil during high volume angiography |
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Term
| What is the advantage of catheter side holes? |
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Definition
| Side holes, staggered near the distal portion is advantageous in that they permit rapid delivery of large boluses of contrast media |
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Term
| What is 1 french equivalent to? |
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Definition
(Fr) 1 Fr = 0.335 mm = 0.013 in
--Inside diameter of catheters is measured in inches |
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Term
| How can you determine the outside diameter of a catheter in mm? |
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Definition
| Divide the French gauge by 3 |
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Term
| What is the average catheter size for most adults? |
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Definition
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Term
| What size catheters are used for brachial cath? |
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Definition
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Term
| For a Right Heart Cath how long should the catheter be? |
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Definition
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Term
| For a Left Heart Cath how long should the catheter be? |
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Definition
90 - 110 cm
(Most are 100 cm) |
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Term
Describe the Cournand Catheter.
(General Purpose) |
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Definition
-Woven Dacron, polyurethane coated, open hole, with a very gradual distal curve
-Used for right heart catheterization, pressure measurements (RA, RV, PA, PCWP) and blood samples
-Sizes 5-8 Fr, 100-124 cm long |
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Term
Describe the Balloon flotation (Swan-Ganz) Catheter.
(General Purpose) |
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Definition
-Polyvinyl chloride
-Open end hole, multi-lumened right heart catheter with a latex balloon at the distal tip
-Used for continuous bedside hemodynamic monitoring of the CVP, PA, PCWP, RV, RA, and Cardiac Output |
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Term
Describe the Pigtail Catheter.
(Angiographic Catheter) |
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Definition
-Polyurethane or Polyethylene
-Tapered tip, the terminal tip is coiled back on itself in a tight loop with open or closed end hole
-4-12 non-laterally opposed side holes
-Most common catheter for LV, AO ,PA grams
-5-8 Fr, 100-110cm long |
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Term
Describe the Grollman Pigtail Catheter.
(Angiographic Catheter) |
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Definition
-Soft polyethylene
-End hole with 4 spiral side holes, angle is similar to the Van Tassel except the coil is on the opposite side
-Used for RV and PA angiographic
-6-8 Fr, 110cm long |
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Term
Describe the Judkins Left and Right Catheters.
(Coronary Catheter) |
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Definition
-Polyurethane/Polyethylene
-End hole, no side hole, preformed tip
-Used for selective coronary angiography via the percutaneous femoral approach
-“JL” refers to Judkins Left and is used for the cannulation of the Left Coronary System
-“JR” refers to Judkins Right and is used for the cannulation of the Right Coronary System
-Both the right and left have unique 90° curved tips that facilitates placement in each coronary ostia with very little manipulation
-Secondary curves are: 30° and 180°
-The number that follows the JL or JR (i.e. JL4 , JR4) refers to the distance between the primary and secondary curves of the catheter.
-Sizes 4.5, 5, 7, 8 Fr at 100cm long |
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Term
| What catheter material is very maneuverable and flexible? |
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Definition
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Term
| Which catheter material has a higher risk of thrombus formation? |
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Definition
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Term
| Which catheter material has poor curve memory, increases the ease of insertion? |
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Definition
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Term
| Which catheter material is more thrombogenic? |
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Definition
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Term
| Which catheter material is soft, supple and flexible and is ideal for flow directed catheters? |
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Definition
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Term
| Which catheter material maintains shape and is very popular for the selective procedures? Some have inner stainless steel mesh braids to improve rotational control. |
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Definition
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Term
| What was the first catheter designed for the heart? |
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Definition
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Term
| What was the first catheter used with a ballon on it? |
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Definition
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Term
| Describe the Fogarty catheter. |
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Definition
-Vinyl
-Balloon at the distal end, on lumen
-Used for vascular embolectomy via surgical cut down or post cut down
-2 - 7 Fr, 40, 60, 80, 100 cm long |
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Term
| Used in cardiac cath to straighten out catheters, transverse vessels and permit percutaneous introduction of sheaths |
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Definition
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Term
| What is the standard size of a guidewire? |
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Definition
Diameter - 0.035"
Length - 145cm
(Exchange)- 260cm |
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Term
| Provides enhanced tip flexibility which promotes exceptional maneuverability through tortuous anatomy |
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Definition
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Term
| The _______ core adds kink resistance and pushability, and the tip transition facilitates smooth catheter placement. |
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Definition
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Term
| The standard j-tip size on a guidewire is? |
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Definition
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Term
| Cutdown procedure is also known as |
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Definition
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Term
| What are the sites for the sones procedure and what is the most common? |
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Definition
| -brachial and radial -brachial is the most common |
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Term
| It is the through the skin approach to left and right heart catheterization involving vascular access via needle puncture into a vessel (femoral or brachial) |
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Definition
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Term
| What equipment is needed to perform diagnostic procedures? |
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Definition
-Percutaneous tray
-Sterile gowns and gloves
-Local anesthetic (1% lidocaine without Epi)
-Arterial and Venous manifolds |
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Term
| What is the most common site for catheterization? |
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Definition
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Term
| What is a Left Ventriculogram used for? |
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Definition
Used to asses the function of the left ventricle.
(Pigtail catheter used) |
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Term
| Why do we do a Left heart cath? |
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Definition
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Term
| Sheaths may be left in place for what? |
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Definition
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Term
| Procedure where a needle or catheter is placed in the pericardial space to allow drainage of fluid or blood |
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Definition
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Term
| Indications for Pericardiocentesis |
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Definition
-Cardiac tamponade
-Infective pericarditis
-Neoplastic pericardial disease
-Effusive/constrictive pericarditis |
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Term
| Contraindications for Pericardiocentesis |
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Definition
-Restless/uncooperative patient
-Anticoagulation therapy
-Bleeding disorder/thrombocytopenia |
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Term
| Complications with Pericardiocentesis |
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Definition
-Cardiac puncture of the RA or RV
-Hemopericardium
-Air embolism
-Arrhythmias
-Death |
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Term
| Signs and symptoms that a patient may need pericardiocentesis |
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Definition
-Chest pain or fullness in chest
-Dyspnea
-Pericardial friction rub and/or muffled heart sounds
-Rhythm: sinus rhythm, sinus tachycardia, A-fib
-RA, PCWP or LA hemodynamics – elevated pressure with “x” descent greater than the “y” descent.
-Systolic and diastolic pressures begin to meet.
-Pulsus paradoxus
-An abnormally large decrease in the systolic blood pressure and pulse wave amplitude during inspiration, the normal fall in pressure is less than 10 mm Hg |
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Term
| A recurrence of stenosis. Often stenosis that has been previously corrected and then comes back. |
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Definition
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Term
| The formation of a blood clot inside of blood vessel, obstructing the flow of blood through the circulatory system. |
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Definition
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Term
| If clotting is too severe and the clot breaks free, the traveling clot is now know as a what? |
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Definition
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Term
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Definition
Decreasing of the systolic pressure that will generally become a lower and lower pressure.
--Occurs when there is a mismatch between the catheter and the vessel ostium. |
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Term
| Reasons for a diagnostic procedure |
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Definition
-Failed EKG or stress test
-heart attack
-significant family history or symptoms of atypical chest pain or discomfort
-shortness of breath
-inability to exert yourself
*the combination of any of the above |
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Term
| Sones (Cutdown procedure) is typically used on what types of patients? |
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Definition
Used on patients with peripheral vascular disease (PVD) of the abdominal aorta, iliac and femoral vessels
-Obese patients in which a percutaneous procedure may be technically difficult |
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