CC2: Equipment Flashcards

1
Q

System components of pressure management systems

A

-X ray (single or biplane)
-Physiological recording system
=> ECG
=> Transducer
=> Pressure line
=> Catheter
=> Blood gas and O2 saturation analyser
=> CO analyser
-Contrast power injector
-Crash trolley: defibrillator, temporary pacing, intra-aortic balloon pump

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2
Q

Definitions of stability, sensitivity and frequency response

A

Stability - faithfully transmitting each of the necessary components of the wave form without distortion

Sensitivity - ratio of the amplitude of the recording signal to the amplitude of the input signal

Frequency response - the range of frequencies that something can record at enabling accurate reproduction of wave form

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3
Q

Describe the flushing system

A

-Ensures a fluid to blood connection to the transducer, preventing air entering system

-Most common system is a bag of heparinised-saline enclosed in a pressure bag

-Pump up to 300mmHg (higher than pressure of patient)

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4
Q

What is a transducer?

A

-Electronic device that that converts energy from one form (physiological) into another form (electrical)

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5
Q

Are transducers 100% efficient?

A

-No transducer is 100% efficient
-Some power is always lost in conversion (heat)

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6
Q

What type of transducer is used in cath lab?

A

-Strain Gauge
-measures small displacement and the forces that cause them

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7
Q

What are the 2 types of transducer?

A

Disposable
-Use a special arrangement of resistors (Wheatstone bridge) to detect movement of diaphragm

Non-disposable
-Use a capacitor to detect movement of diaphragm (not used in cath lab anymore)

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8
Q

How does pressure transducer work?

A

-Transducer is connected to patient with fluid filled manometer line
-Column of fluid inside manometer line moves in response to changes in blood pressure
-Fluid movement displaces tranducer’s diaphragm
-This displacement is amplified and converted to an electrical signal to display the pressure

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9
Q

What is the resonant frequency (natural frequency) of the system?

A

-The rate at which the fluid column will oscillate

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10
Q

What 3 properties determine the resonant frequency?

A

-Transducer diaphragm (how much movement is required for stated pressure - pressure volume coefficient)
-Manometer line (length, diameter, rigidity)
-Air bubbles/leaks

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11
Q

What position is the transducer in?

A

-Levelled against the mid-point of the chest (V5/V6)

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12
Q

Why is transducer position more important for right side?

A

-Systolic pressure on right side is <30mmHg
-Variation in position will have more of an impact

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13
Q

List 5 sources of error in pressure transducer

A

-Zero setting
-Calibration
-Transducer height
-Under damping
-Over damping

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14
Q

Explain zero setting in pressure transducer

A

-Even when no pressure is applied, a transducer will display a certain offset voltage
-Transducer must be exposed to atmospheric pressure and balanced
-Monitor then applies an equal and opposite voltage to the transducer, so the display reads zero

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15
Q

Why should Transducer be balanced every few hours?

A

-Zero level may drift with changes in room temp

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16
Q

Explain transducer height in pressure transducer

A

-If transducer is above heart, lower pressure recorded
-If transducer is below heart, higher pressure recorded

17
Q

Explain calibration in pressure transducer

A

-Some transducers require adjustment of the output voltage or gauge factor
-A known pressure is applied to the transducer using a mercury manometer
-Gauge factor is adjusted until the measured pressure is equal to applied external pressure
-Gauge factor may also change with room temp so check regularly

18
Q

Explain overdamping in pressure tranducer

A

-Results from friction as fluid moves inside tube
-Transducer oscillations are removed and decrease in frequency response
-Excess damping causes loss of detail in waveform and underestimation of pressures

19
Q

Explain underdamping in pressure transducer

A

-If diaphragm and fluid oscillate at a frequency > the resonant frequency, sine wave oscillation can be super-imposed on to the trace and lead to distortion of up to 40% overshoot

20
Q

List 6 causes of overdamping

A

-Blood clot/air in the line
-Contract media
-Small lumen
-Loose catheter connection
-Kink in catheter
-Soft/compliant tubing

21
Q

List 3 causes of underdamping

A

-Tubing too stiff
-Tubing too long
-Catheter positioned in turbulent jet

22
Q

What is a manometer line?

A

-Length of plastic tubing used to connect the sheath or catheter to the transducer

23
Q

What is a catheter?

A

-Long hollow tube that supplies avenue for contrast media, embolising materials or therapeutic medications/instruments

24
Q

What are the 2 types of catheter?

A

-Diagnostic
-Guide

25
Q

What are most catheters made out of?

A

Silicone
-inert - unreactive to body/medical fluids

26
Q

Purpose of side holes in catheters

A

-Improve delivery/dispersion of contrast by reducing the resistance/recoil (whipping)

27
Q

Why are right heart catheters usually longer?

A

-They need to travel further
-IVC->RA->RV->Pulmonary artery->Wedge

28
Q

Why are catheters with side holes used in LV/RV grams?

A

-Large amount of contrast needs to be delivered in a short time
-End-hole catheters would recoil during contrast delivery
-This causes VEs, perforation and inadequate ventricular opacifaction

29
Q

List 4 complications of contrast injection

A

-Arrhythmias - mechanical stimulation of ventricular endocardium by catheter/contrast
-Endocardial staining - Deposition of contrast within endocardium due to improper positioning of catheter
-Fascicular block - Anterior fascicle is close to LVOT
-Embolism - Injection of air or thrombus

30
Q

What do you need to be aware of when injecting the RCA?

A

-Don’t inject in Conus branch
-RCA supplies SA/AV node
-Patient will go into VF

31
Q

Examples of right heart catheters

A

-Cournand (MPA1)
-Balloon flotation catheters (Swan Ganz)

32
Q

What catheter is used in the Brockenborough technique?

A

-Transeptal catheter

33
Q

Explain guide wires

A

-Used to provide rigidity while advancing the catheter
-Usually 110cm long
-Tip is flexible to avoid damage
-Coated in Teflon for smooth passage

34
Q

What are the different types of arterial closure?

A

-Collagen plugs (Vasoseal/Angioseal)
-Percutaneous vascular suture delivery system (Perclose)
-Mechanical clamps (Femo-stop)
-Liquid delivered to arterial puncture site through special sheath

35
Q

What are the properties of catheters?

A

-Type of catheter
-French size (outer diameter
-Lumen
-Length
-Guide wire
-Flow
-Radio-opaque?