Invasive procedures ASYNC Flashcards
What is pericardiocentesis?
Invasive procedure in which the physician removes (aspirates) a build up of fluid from the pericardium
Why would we use pericardiocentesis?
- Diagnostic purpose
- Therapeutic purpose
What is the diagnostic purpose behind pericardiocentesis?
Identify the types of fluid for things like
1. Hemopericardium
2. Infection vs cancer
When would we use pericardiocentesis?
Can be scheduled or emergent based on purpose
The pericardium normally contains how much fluid?
20-50cc of straw colored fluid
Color of pericardial fluid can be what?
What is the role of echo for pericardiocentesis? 4
- Confirm location and size of pericardial fluid
- Identify view with largest pocket, closest to the chest wall
- Confirm needle placement
- Reassess fluid post procedure
In terms of pericardiocentesis, when identifying view with the largest pocket, what views are best?
- Usually apical is best
- May include off axis views
What needs to be considered when confirming needle placement with pericardiocentesis?2
- Needle may be seen in all patients on the echo
- agitated saline can be injected to view needle positions
What does this image represent?
Air bubbles injected to confirm needle locations
What does this image represent?
Pericardiocentesis
What can be associated with Pericardiocentesis?
Tumors
What does this image represent?
Pericarditis with constriction
What are risks of pericardiocentesis? 6
- Cardiac arrest
- Arrhythmias
- Air embolism
- Infection of the puncture site
- Infection of the pericardium
- Perforation
What are some arrhythmias heard with pericardiocentesis?
SVT, AF, VT, ventricular fibrillation
What is air embolism with pericardiocentesis?
RT heart perforation
Where do we see perforation with pericardiocentesis?
- Lung
- Liver
- Coronary artery
- Heart (RV or LV)
What does this image represent?
Large pericardial effusion
What is a reliable diagnosis for heart transplant rejection?
Myocardial biopsy
What is the level of risk for myocardial biopsy?
Low risk
How invasive is Myocardial biopsy?
Invasive, May cause some patient discomfort
Non-invasive diagnostic methods have reduced the need for biopsies, what are some? 3
- Nuclear scans
- RV strain
- Cardiac MRI
Myocardial biopsy is performed with what?
Local anesthesia
In terms of myocardial biopsy, venous sheath is placed where?
In the RT IJV
In terms of myocardial biopsy, how many specimens are obtained?
Multiple specimens are obtained from different sites within the RV, Tissues samples are then sent to the lab for analysis of tissue
What are pacemakers?
Small electronic device that regulates the heart rate by sending electrical signals to the heart
How many leads are in pacemakers?
1 or 2 lead systems
What are the two parts of a pacemaker?
- Battery unit
- Wire
What is part of the battery unit of the pacemaker?
Small metal case that contains the power source and regulates how often signals are sent
What is part of the wire system of the pacemaker?
Carries electrical message back and forth between the heart and the pacemaker
What is the size of the pacemaker?
Device is about the size of 2 toonies put together and weighs a bit more than an ounce
When is a pacemeaker required?
- Symptomatic bradycardia (Most common)
- Patients with serious, uncontrollable arrhythmias
Intra cardiac defibrillators (ICD) uses what?
Leads (wires threaded into the heart’s chambers) to monitor every heart beat
If a lethal rhythm appears with ICDs what happens?
The defibrillator shocks the heart back to a normal rhythm
1. V-tach
2. V-flutter
3. V-fib
Who has a defibrillator?
- Heart attack survivors with low ejection fraction
- Patients at high risk for sudden cardiac death (SCD)
- Patients post MI
Lead perforation can affect what?
- Pacemakers and defibrillators
- Wire migration
What does this image demonstrate?
Implantable defibrillator lead perforation of the RV apex
