1. The Procedure and Procedural Care
Tortorici Chapter 19
Pre-procedure
* Interview patient, take Hx
* Signed informed consent
* 4-8 hour fast with water
* Stop anticoagulant therapy
* Start heparin 4 hours prior and continue 6-24 hrs. after
Protomine Sulfate (coagulant) for heparin OD
Lab tests
* BUN/Creatinine
* Clotting factors: Prothrombin time (PT)
Partial Thromboplastin time (PTT)

2. Pre-procedure sedation
Conscious sedation
* Valium (diazepam): a benzodiazepine
* Demerol: a synthetic opioid
* Narcan: for opioid OD

3. Procedure
* Establish rapport with patient
* Review chart
* Baseline vitals/neurologic tests
Vitals
Adult BP =
Elderly BP =
Pulse =
(rate, rhythm, volume)
Respiration =
Temp =
90/ /90
140/92 – 170/100
55-90
¼ pulse or 12-20
97.6, 98.6, 99.6

4. Procedure
* Establish rapport with patient
* Review chart
* Baseline vitals/neurologic tests
* Vitals/neurologic tests
* Take scouts
* Prep injection site
* Drape
* Needle puncture and catheter placement

5. Introducing the Catheter

6. Lumen
Arterial Anatomy
Tunica Adventitia
Tunica Media
(muscular)
Elastic,
fibrous
tissue
See Chapter 10
Tunica
Intima
(Endothelium)

7. The Judkins Technique of Catheterization
Utilizing the Seldinger Technique of Arterial Puncture
Cecum of colon
Ala (wing)
of ilium
Coronal MRI demonstrating
the femoral artery pulse
point, where arterial puncture
is most commonly performed
Uterus
Thigh muscle
Bladder
Adipose of
thigh (white
on MRI)
Original

8. Cannula Stylet Seldinger Needle Stylet, with beveled point
down, is inserted into cannula
for puncture

9. Disposable needle used for femoral puncture
Cannula
Disposable needle used for femoral puncture
Stylet
Aids insertion of
wire into hub of
cannula
Guide wire: Teflon wrapped wire used to introduce and manipulate catheter.
This wire has a J tip to skim over the intimal lining with minimal damage. Pushing from the other end, the solid wire core is advanced to
stiffen the tip for better control.

10. Seldinger Technique of Arterial Puncture
1. Lidocaine injection
2. small incision
3. spread with misquito forceps
4. needle in incision, pulse felt
5. 45o cephalad, medial
Original method: front and back wall of the artery is punctured.
to lessen the risk of introducing the guide wire into the wall and
dissecting the vessel.
The risk hematoma forming from the hole in the back wall is minimal.

11. Seldinger Technique of Arterial Puncture
6. The stylet is removed
7. Cannula is withdrawn,
arterial return of blood

12. Judkins Technique of Arterial Catheterizaton
Guide
Wire
8. Tilt needle, insert guide wire

13. Judkins Technique of Arterial Catheterizaton
9. The cannula is removed.
Arterial bleeding
stops as the puncture site
forms a seal around the
guide wire

14. Judkins Technique of Arterial Catheterizaton
10. Dilate puncture site
with a vessel dilator
11. A sheath is inserted to protect the puncture site
during catheter changes and manipulations

15. A sheath
A vessel dilator for widening the puncture hole
to accommodate a larger catheter
Guide wire

16. Judkins Technique of Arterial Catheterizaton
12. The catheter is threaded through the sheath
The catheter is then advanced through the iliac arteries, up the abdominal and thoracic aorta.

17. Procedure
* Establish rapport with patient
* Review chart
* Baseline vitals/neurologic tests
* Vitals/neurologic tests
* Take scouts
* Prep injection site
* Drape
* Needle puncture and catheter placement
* Hook up manifold

18. Manifold connected to catheter forms a closed system
Strain gauge
transducer
Contrast
Heperinized
Saline flush
Waste fluid
Systolic pressure
measured through
the catheter in the
left ventricle.
Manifold
Syringe for hand injections of
contrast and flushing catheter

19. Procedure
* Establish rapport with patient
* Review chart
* Baseline vitals/neurologic tests
* Vitals/neurologic tests
* Take scouts
* Prep injection site
* Drape
* Needle puncture and catheter placement
* Hook up manifold
* Set filming and injector parameters
* Position patient
* Film a run

20. Intraprocedural Care
Document
* Catheter in/out time
* CM volume
* Meds
* Fluoro time
* Hemodynamic pressures
* Instruments used
Monitor
* Vitals
* ECG (EKG)
* 02 (90% saturation)

21. Postprocedural Care
* Remove catheter
* Apply pressure (direct, mechanical device, closure device)
* Final vitals/pedal pulse
If admitted
Overnight bedrest
Monitor vital, pressure dressing, pedal pulse
Hydrate

22. Complications
* Embolus/thrombus
* Internal hemorrhage
* Hematoma at puncture site
* Cardiac events
* Vessel dissection
* CM reaction