RCIS Cardiac Catheters

Question 1

Hub of a diagnostic catheter

Answer 1

A plastic or metal connector attached to the body of a catheter for syringe or manifold attachment. Hubs usually have the french size and other information stamped on them.

Question 2

Heat shrink of a diagnostic catheter

Answer 2

reinforcing sleeve that strengthens the proximal end against kinking or pressure bursting.

Question 3

Secondary bend of catheter

Answer 3

the second bend from the tip end

Question 4

Primary bend of a cardiac catheter.

Answer 4

the bend nearest the tip end

Question 5

Side holes of cardiac catheter

Answer 5

round holes punched into the side of the catheter to allow broader and safer dye dispersion. They reduce catheter kickback during the injection. They need to be symmetrical so the dye injection doesn’t kick the tip to one side.

Question 6

End hole of cardiac catheter

Answer 6

Hole at distal tip of catheter allows a guide wire to pass through the catheter to provide tip guidance and to stiffen the catheter for more support.

Question 7

Tip of the catheter

Answer 7

this part of the catheter is often tapered to allow catheter insertion over a guidewire directly through the skin. catheters designed for insertion through a sheath or cutdown may have blunt ends or no end hole at all, these are less traumatic and safer during selective angiography.

Question 8

Interventional guiding catheters with large side holes are sometimes used in order to

A. Disperse angiographic contrast more evenly
B. Utilize a second guidewire (kissing wire technique)
C. Prevent occlusion of the coronary ostium and resulting ischemia
D. Reduce guider trauma and dissection at the coronary ostium

Answer 8

C. Prevent occlusion of the coronary ostium and resulting ischemia

Explanation:

Side holes prevent occlusion of the coronary ostium by the catheter tip, because the side holes allow blood flow through the catheter tip into the coronary system, Side holes in a guider allows you to monitor the aortic pressure accurately. Since the side hole will admit aortic pressure, it will no appear dampened. BUT, it can be a false sense of security. The guider can still occlude the ostium, you wont see it on the pressure monitor.

Question 9

Catheters with side-holes (pigtails, etc) provide better injection dynamics and pressure measurement than single end hole catheters. The chief DISADVANTAGE of multiple side-holes in angiographic flood catheters is that they

A. Hang up on guide wires and valves
B. Traumatize the vessel wall
C. Tend to clot unless flushed frequently
D. Cannot be used with a leading guidewire

Answer 9

C. Tend to clot unless flushed frequently

Catheters with side holes provide better injection dynamics and pressure measurement than single end hole catheters. BUT, pigtail catheters are especially prone to clotting, because of their many holes. A normal hand flush only exits the proximal holes and the distal holes remain full of blood.

Question 10

Teflon

Answer 10

smooth slippery plastic that forms the inner lumen or core of the catheter. It makes it easier to slide the balloon catheter through the lumen

Question 11

polyurethane

Answer 11

a polymer that forms the body of the catheter in which the wire or fiber braid is embedded. many new guiders include nylon within the thermoplastic

Question 12

braid

Answer 12

stainless steel embedded within the plastic jacket makes the catheter strong and torqueable

Question 13

coating

Answer 13

the slipper hypothrombogenic surface that coats many catheters. these may include silicone, heparin, hydrophilic polymer, etc.

Question 14

Which type of plastic has the least memory and torque control, and is so soft that it is used in construction of most balloon flotation catheters?

A. Polyurthane (PU)
B. Teflon
C. Polyethylene (PE)
D. Poly Vinyl Chloride (PVC)

Answer 14

D. Poly Vinyl Chloride (PVC)

Balloon flotation catheters need to be soft and float with the current. The standard construction plastic is PVC. PVC is like a “wet noodle” in the warm blood stream. Although, it has almost no torque control or memory, so it easily conforms to the vasculature.

Edwards makes a PU non-latex hypoallergenic swan that has torque control. Some Swan-Ganz catheters will also admit a guidewire to stiffen them if necessary.

Since PVC’s bursting pressure is much lower than other plastics (250 PSI), they are never pressure injected.

Question 15

Which type of plastic is stiffest, autoclavable, slipperiest, and has the GREATEST torque control?

A. Polyurethane (PU)
B. Polyethylene (PE)
C. Poly vinyl chloride (PVC)
D. Teflon

Answer 15

D. Teflon

Teflon catheters are useful for midstream high pressure flood injections. They are strong, slippery, have a high melting point (and are therefore autoclavable). Its memory is good, so it holds its shape. Temperatures as high as 350-750 deg C are required to form it.

Use caution advancing teflon tipped catheters because these tapered tips are hard and needle sharp. Nylon is also very stiff with good torque control, and is often used in catheter.construction

Question 16

Teflon is often used in the construction of sheathes and dilators. One danger with Teflon is that these dilators

A. Are difficult to sterilize in high temperature autoclaves
B. have a rough surface which traumatize vessels
C. Are more thrombogenic
D. Have dangerously hard and sharp tips

Answer 16

D. Have dangerously hard and sharp tips

Use caution advancing Teflon tipped catheters because these tapered tips are hard and needle sharp. The sharp tips require a leading guide wire when advanced. They are often used in midstream high-pressure high-flow flood angiography catheters because they can have thinner walls and a higher bursting pressure,

Teflon is NOT rough. It is slippery, and therefore ATRAUMATIC and NONTHROMBOGENIC. It makes an excellent inner lining for the guide catheters, sheath, and dilator material. But, being this strong and thin walled, it tends to pierce and kink easily. This material can withstand high temperature autoclaves

Question 17

Polyurethane (PU) catheters should be used with a _______ guide wire.

A. Stainless steel
B. Teflon coated
C. Heparin coated
D. Platinum coated

Answer 17

B. Teflon coated

Polyurethane (PU) catheter surfaces feel “rubbery.” Stainless steel wires often “stick” within their lumen. Teflon coated or lubricious wires are now commonly used with all Polyurethane catheters. Use of coated guides is an integral part of the “ no compromise for safety approach” of this technique.

Question 18

The ability to twist a catheter hub resulting in a corresponding twist at the catheter tip is termed:

A. Memory
B. Torque control
C. Extrusion
D. Lamination process

Answer 18

B. Torque control

Most catheters require twisting to direct the bend into the desired anatomic structures. the test of good torque control is to twist the catheter after it is bent completely in half. A 90deg twist at the hub should produce a 90deg twist at the tip.

Guide catheters and steel braided catheters generally have the most torque control.

Question 19

Which are the following catheters does NOT have a braided steel mesh laminated within the plastic?

A. Pigtail & Grollman
B. Swan-Ganz & Foley
C. Judkins & Amplatz
D. Multipurpose guider

Answer 19

B. Swan- Ganz & Foley

Swan- Ganz & Foley are not braided. Wire braiding is so effective at increasing strength and torque control that most arterial catheters now use this construction process, including the pigtail catheters. However, right heart catheters and urologic catheters need to be soft. Almost all arterial catheters contain a laminated wire braid for torque control. Some arterial nylon catheters do not contain a braid.

Question 20

Pushability

Answer 20

Ability to directly transmit push-pull forces from the end of the catheter to the tip. This is important in pushing a balloon catheter to the tip. This is important in pushing a balloon catheter through a guider or through tortuous anatomy.

Question 21

Torque Control

Answer 21

The ability to directly transmits rotational forces from the end of the catheter to the tip.

Question 22

Memory

Answer 22

Ability to recover and maintain a specific configuration after insertion and guidewire removal. When the bend is opened with a guidewire or during passage up the aorta, a catheter with good memory will return to its original shape. This allows it to seek the vessel for which it was designed.

Question 23

Backup support

Answer 23

Ability to remain in position despite resistance. This is essential in a good angioplasty guider catheter. When a balloon catheter is advanced through a guider catheter against resistance, it may buckle and back the guider out of the orifice.

Question 24

Trackability

Answer 24

ability to follow a guidewire along its course through the vascular anatomy. This is especially important in balloon PTCA catheters that must pass through tortuous bends and tight stenosis. it depends on proper size, flexibility, and pushability.

Question 25

Soft tips

Answer 25

ability to easily bend and to be shaped. Many diagnostic and guider catheters are capped with a soft rubber end-hole tip. When force is applied to this catheter tip, the soft tip distributers the pressure over a wider surface. This helps prevent dissection of the intima.

Question 26

Most diagnostic catheters cannot be reused. After being used in a patient, what type of “single use devices” may be re-sterilized by 3rd party reprocessed companies and then reused in other patients?

A PTCA balloon catheters
B. Polyurethane (PU) catheters
C. Teflon guider catheters
D. Diagnostic EP electrodes

Answer 26

D. Diagnostic EP electrodes

Question 27

If a 1mm ID Catheter will transmit contrast at a rate of 1ml/sec at 500 PSI, how much will a 2mm ID catheter transmit at the same pressure according to the Poiseuille’s law?

A. 2ml/sec
B. 4 ml/sec
C. 8 ml/sec
D. 16 ml/sec

Answer 27

D. 16 ml/sec

Flow through tubes are regulated according to Poiseuille’s law. As the radius of the tube is doubled, the flow increases as the fourth power of this change.

2_4th is 2 x 2 x 2 x 2 = 16

Question 28

Femoral pigtail catheters for LV angiography are usually _____ cm long.

A. 80
B. 100
C. 110
D. 140

Answer 28

C. 110

In tall patients, the LV may not be reached by the standard 100cm diagnostic catheter. Consequently, most manufactures have added 10 cm to the standard femoral LV Pigtail length.

Question 29

How is the curve of the Judkins Right coronary catheters measured?

A. From tip to hub
B. From tip to primary bend
C. From Primary to secondary curves
D. From secondary to tertiary curves

Answer 29

C. From primary to secondary curves

The Judkins coronary catheter bend size is measured between the steepest portions of the primary and secondary curves.

The longer the bends are for more dilated aortas or more inferiorly directed coronary ostia.

Question 30

What is the normal LEFT Judkins femoral coronary diagnostic catheter for an average sized adult?

A. JR 3.5
B. JR 4
C. JL 3.5
D. JL 4
E. JL 5

Answer 30

D. JL 4

The normal LEFT judkins femoral coronary diagnostic catheter for an average sized adult with an average sized aorta is the 4 cm bend diameter. Smaller bends are for smaller aortas or for superior angulation of the tip.

Question 31

In sizing catheter outer diameter, 1 french size is equal to

A. 0.25 mm
B. 0.33 mm
C. 0.40 mm
D. 0.50 mm
E. 0.66 mm

Answer 31

B. 0.33 mm

0.33 mm = 1/3 mm = 1 Fr,

This has been standardized due to the importance of catheter diameter in PTCA. Cardiologists size the coronary lesions in reference to the catheter diameter.

Question 32

What French size is a catheter with a diameter of 2.66 mm?

A, 5 Fr
B. 6 Fr
C. 7 Fr
D. 8 Fr

Answer 32

D. 8 Fr

2.66/ 0.33 = 8

Question 33

The outside diameter of a 5.5 Fr catheter is:

A. 1.5 mm
B. 1.66 mm
C. 1.83 mm
D. 2.00 mm
E. 2.17 mm

Answer 33

C. 1.83 mm

5.5 x 0.33 = 1.83

Question 34

The TIP inner diameter on standard diagnostic coronary catheters is

A. Fr size/ 3 mm
B. Fr. size x 0.013 in
C. 0.038 inch
D. 0.063 inch
E. depends on wall thickness

Answer 34

C. 0.038 inch

All coronary diagnostic catheters are designed to be used with the standard 0.035 - 0.038 inch guide wires that make a snug fit through the catheter tip. Tip ID does NOT depend on the catheter French size or wall thickness. Large PTCA guider catheters (non-diagnostic) are designed to be used with a 0.063 inch guide wires.

Question 35

Disadvantages of using guiding catheters, as compared to long sheathes in vascular interventions include:

Answer 35

• Larger arteriotomy required for guiders

- No hemostatic side valve in guiders

Question 36

When using a 5 Fr selective catheter through a 90 cm 5 Fr sheath in vascular procedures

A. It will not be possible to pass a 5 Fr catheter because its too tight
B. It will not be possible to flush fluids through the sheath because its too tight
C. a Touhy borst adapter is required to prevent bleedback
D. A 0.38 guidewire must be kept in place to prevent bleedback.

Answer 36

B. It will not be possible to flush fluids through the sheath because its too tight

A 5 Fr catheter in a 5 Fr sheath is too tight to flush. It will not be possible to administer contrast or heparinized saline through the sidearm since the catheter completely fills the sheath.

Question 37

Balloon port on Swan-Ganz

Answer 37

an air filled rubber balloon (usually 1.5 cc). This is a female LL with a plastic open closed stopcock or slider switch. Open to inflated, closed to lock in the air and keep balloon inflated

Question 38

Proximal RA Port on Swan-Ganz

Answer 38

this catheter is for additional central IV Lines

Question 39

Distal Port on Swan-Ganz

Answer 39

This port is used for measuring pressure. It is yellow tailed and marked distal.

Attach a 3way stopcock and connect to pressure transducer. Flush with heparinized saline to keep it from clotting when not in use. This port accepts a 0.025 Teflon coated guide wire to stiffen the catheter if needed.

Question 40

Proximal port on Swan-Ganz

Answer 40

for cool injectate, is colored blue for the cold color of ICE. Iced saline is flushed into the RA to measure thermodilution Cardiac Output.

Attach a 3way stopcock and flush with heparinized saline to keep it from clotting when not in use. This port is usually placed in the RA, so the iced saline must flow through the RV into the PA where the thermistor tip rests, Most labs have switched from iced saline to room temperature saline,

Question 41

Thermistor connector on Swan-Ganz

Answer 41

goes to CO computer. Usually a white, 3 pin computer connector covered with a red cap. The thermistor measures the temperature of the blood in the PA. When the cold saline is injected through the proximal port, it flows with the blood into the PA which cools the thermistor. This senses the blood flow and CO.

Question 42

Which type of catheter is necessary for optimal WEDGE pressures?

A. End-hole only
B. 4 side holes
C. 4 side holes + end hole
D. 6 side holes + distal balloon

Answer 42

A. End-hole only

A wedge pressure is taken when the catheter is pushed all the way into a capillary bed. This blocks off the proximal pressure and measures the distal pressure.

End hole only catheters are the best wedge catheters. The one end hole then looks through the capillary bed and only measures distal pressure ( Pulmonary capillary wedge = LA Pressure)

Most wedge pressures are now taken with balloon flotation catheter with the balloon inflated. but a balloon in not necessary. A PA end hole catheters can be pushed out as far as it will go until it ends “wedged” into the “capillary bed.”

Question 43

Your bilateral heart cath patient has a LBBB on the ECG. which type of catheter should you insert first?

A. Pigtail catheter in RFA
B. JR4 catheter in RFA
C. Temporary pacing electrode in RFV
D. Swan-Ganz pacing and wedge catheter in RFV
E. Thermodilution swan-ganz in subclavian vein

Answer 43

D. Swan Ganz pacing and wedge catheter in RFV allows both wedge pressure measurement and RV pacing when needed. LBBB can deteriorate into complete heart block if the RBB is irritated with your right heart catheter.

Question 44

Which catheter below would be the usual first choice to catheterize the right heart of an infant

A. 4 Fr. Swan-Ganz
B. 6 Fr. Swan Ganz
C. 4 Fr Berman Pigtail
D. 5 Fr. Multipurpose pigtail

Answer 44

A. 4 Fr. Swan-Ganz

In infant catheterization the first catheter of choice is a small 4 fr swan-ganz. It is soft and enters easily into the child’s small veins. Then the balloon will be inflated in the RA and floated into the RV and PA while recording pressures.

It lets the blood stream do the work of advancing within the right heart. If there is a shunt, the left side may often be catheterized through the shunt defect.

Question 45

Which of the following is a flow directed, balloon tipped, pediatric flood angiographic catheter that can also measure wedge pressure?

A. Berman
B. Fogarty
C. Swan Ganz
D. Dotter

Answer 45

A. Berman

Pediatric angiography is commonly done with the berman catheter. It is a flow directed, balloon tipped, pediatric flood angiographic catheter. It is a balloon flotation catheter made from PVC with side holes proximal to the balloon tip. It is usually the RT. HT. angiographic catheter of choice in infants and children.