1. Cardiac Cath and Angiocardiography SPRING 2009 FINAL 3-23-09

2. 2 Definition of Cardiac Catherization Comprehensive term to describe minor surgical procedure for diagnostic evaluation or interventional (therapeutic) purposes Diagnostic –Collects data to evaluate PT’s condition Therapeutic –To intervene by mechanical means to treat disorders of the vascular and conduction systems within the heart

3. Principles of Cardiac Catheterization

4. 4 Indications Suspected or known coronary heart disease Myodcardial infarction Sudden cardiovascular death Valvular heart disease Congenital heart disease Aortic dissection Pericardial constriction Cardiomyopathy Initial and follow up assessment for heart transplant

5. 5 Contraindications Active GI bleed Renal failure Recent stroke Fever from infection Electrolyte imbalance Anemia Short life expectancy Digitalis intoxication PT refusal Uncontrolled hypertension Bleeding disorders Pulmonary edema Uncontrolled ventricular arrhythmias Aortic valve endocarditiis Allergic to contrast

6. 6 Complications and Risks Death Myocardial infarction CVA Arrhythmia Hemorrhage Contrast Hemodynamic Perforation

7. Angiographic Supplies and Equipment Catheters Contrast Media Pressure Injector

8. 8 Catheters For LT cardiac cath similar to those for angio RT cath requires specialized catheters –Typically flow directed catheters –With manifolds

9. 9 Contrast Media High Osmolar Ionic –Sometimes causes ECG changes Widely used –Non-ionic –Ionic low osmolar Restricted costs causes limited use of low osmolar contrast agents.

10. 10 Pressure injector

11. Imaging Image chain Digital Angiography imaging equipment

12. 12 Image chain Similar to angio suites High resolution imaging and recording C-arms must be able to be on for extended periods of time –Withstand great heat load –Multi focal-spot –High speed rotating fluoro tubes –Short exposure times –15-30 frames per second Often have a video camera

13. 13 Digital Angiography Imaging equipment Long term storage of large amounts of digital files has benefited from advances in computer technology DICOM (digital communications committee)

14. Ancillary Equipment and Supplies Physiologic Equipment Other equipment

15. 15 Physiologic Equipment Equipment to monitor –ECG –Hemodynamic pressures Vital signs to record PT function

16. 16 Other Equipment Crash cart Oxygen and suction Defibrillator Temporary pacemaker Pulse oximeter Blood pressure cuff Equipment to perform cardiac output studies Activated clotting time (ACT) equipment

17. 17 Patient Positioning for Cardiac Catheterization PT must be positioning so that they will not have to be moved during procedure Must be positioned so anatomic structures of interest are demonstrated PT is supine with shielding as appropriate

18. Catheterization Methods and Techniques

19. 19 Pre-Catheterization Care Informed consent obtained PT history Physical exam CXR Blood work ECG Echocardiogram Exercise stress test Nuclear Medicine cardiac perfusion studies

20. 20 Pre-Catheterization Care IV started –Sedation and nausea Nothing to eat 4-6 hours before procedure Records of procedure –PT hemodynamic data –Fluoro times –Medications administered –Supplies used –Other pertinent information

21. 21 Catheter Introduction Prepare catheter introduction site with aseptic technique –Shaved and cleaned Can be at femoral (most common), brachial, radial, axillary, jugular and subclavian areas Selinger technique used

22. 22 Selinger Technique Needle with cannula inserted Needle withdrawn until there is blood flow Inner cannula removed & guidewire inserted Needle removed Catheter over guidewire Guidewire removed leaving catheter in artery

23. 23 Data Collection Physiologic data unusually collected –Hemodynamic parameters Includes blood pressure Cardiac output Vascular pressures (inside & outside the heart) –ECG –Oximetry readings –Cardiac output –Blood samples to measure oxygen saturations levels in various parts of the heart