Vascular Access and Catheters Flashcards
Procedure that provides hemodynamic data from the Ao and LV
Left Heart Catheterization (LHC)
Procedure in which a catheter is inserted into a vein and transversed through the right sided chambers of the heart and into pulmonary vasculature to measure pressures and visualize structures
Right Heart Catheterization (RHC)
Where is RHC accessed in?
Via body’s venous system through the internal jugular, brachial or femoral vein.
A catheter for the delivery of contrast media to a vessel or structure for the purpose of performing an angiogram
Diagnostic Catheter (Swan-Ganz Catheter)
A balloon-tipped catheter that passes through the venous system to navigate anatomy of the right side of the heart
Swan-Ganz Catheter
Where is LHC accessed through?
Aterial system via femoral artery and radial artery
What heart catheterization is in retrograde
Left hearted catheterization
Catheters have to be shaped within the aorta to engage with the?
Coronary Ostium
A plastic tube, often with a hemostatic valve that protects the vessel puncture sit from multiple device insertions during a percutaneous procedure
Sheath
Percutaneous procedure using a needle, wire and sheath
Seldinger technique
Indications of invasive cardiovascular laboratory
-Acute coronary syndrome
-Sudden cardiovascular arrest
-Coronary artery disease
-Valvular heart disease
-Congenital Heart disease
-Aortic dissection or aneurysm
-Pericardial constriction/tamponade
-Cardiomyopathy
-Follow up assessment on heart transplantations
Contraindications of interventional procedures
-Inadequate equipment or catheterization facility
-Patient refusal
-GI bleeding or anemia
-Electrolyte imbalance
-Infection and fever
-Medication toxicity
-Pregnancy
-Stroke within last month
-Renal Failure
-uncontrolled CHF, hypertension and arrhythmias
-Uncooperative patient
-Unknown uncontrolled bleeding
Complications of interventional procedures
-Cardiac Arrest
-Cardiogenic Shock
-Stroke
-CHF
-Contrast reaction
-Myocardial infarction
-Respiratory arrest
-Ventricular tachycardia, fibrillation or serious arrhythmia
What are the three team members not including the physician in the cath lab
Monitor, circulator and scrub assistant
What is the common practice to premedication in a diagnostic procedure
No premedication unless needed. Patients may be pre-medicated an hour before the procedure
What is given to prevent contrast medium related allergic reaction in patients with known allergies
-Prednisone 60 mg every 8 hours for 2 days prior to the procedure
-Diphenhydramine 50 mg IV prior to contrast medium administration
-Hydrocortisone 100 mg IV with 50 mg IV diphenhydramine in lab prior to the procedure
To alleviate anxiety, a common sedation is?
50 micrograms of fentanyl and 0.5 mg of Versed
What is used for local anesthesia before the sheath insertion
1-2% lidocaine with a 25g needle
Local anesthetic should be administered how long before sheath insertion
2-3 minutes
Where is the femoral vein to the femoral artery
Distal to the femoral artery
A plastic tube, that protects the vessel puncture site during a percutaneous procedure from multiple device insertions
Introducer sheath
Test of patency of both arteries supplying the hand. A negative test is a contraindication for transradial access
Allen Test
What is injected in the radial artery to prevent vasospasm and thrombotic complications
Heparin, Verapamil and Nitrates (Nitroglycerin)
What is the usually the highest french size that can be safely placed in the radial artery
6F
What should all diagnostic catheterization have
Sterile, undamaged, within expiration and readily accessible
What needles do most operators prefer?
Single piece, thin wall 18 gauge
What cm length is the introducer sheath
10 to 11 cm
What is the most used coronary angiography catheters?
JL4 and JR4 (Judkins)
What is the 2nd choice in catheters after Judkins catheters
Amplatz left or right (AL and AR)
What is the catheter of choice for ventriculography and aortography?
Pigtail Catheters
What catheter is used in Right heart catheterization
Balloon tipped Swan-Ganz Catheter
What is in the diagnostic multipacks?
JR4, JL4, Pigtail, Sheath, and Guidewire
If there is difficulty floating a balloon tipped catheter through the right atrium, right ventricle, and pulmonary artery, what catheter is a good 2nd choice?
Multipurpose or End hole Cournand catheter
