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35 Cards in this Set
- Front
- Back
percardiocentesis |
s/s: chest px, fullness in chest, dyspnea, muffled heart sounds. rhythm:sinus rhythm/tach, Afib Pulsus paradoxus: abnormally large drop in systolic pressure & pulse wave amplitude during inspiration. |
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cutdown procedure (Sones) |
vein/artery is exposed surgically, then sheath is inserted. Brachial & radial used (mostly radial) |
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percutaneous procedure (Seldinger) |
access to inner organs/tissue via needle-puncture of skin. Most commonly used! Femoral or brachial. |
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damping |
decreasing of they systolic pressure that generally becomes lower & lower pressure. Ventricular ectopy/fibrillation can occur |
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ventricularization |
slight decrease in systolic pressure, but large decrease in diastolic pressure. |
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1844 |
1st cath. Done on a horse |
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1929 |
1st documented R heart cath by Werner Forssmann |
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1940s-50s |
early development of cariac angiography & intracardiac hemodynamic studies |
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1950 |
retrograde L heart cath |
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1953 |
percutaneous method introduced by Seldinger |
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1959 |
selective coronary angiography by Mason Sones |
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1962-67 |
percutaneous femoral approach |
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Indications for Left heart cath |
CAD, MI (acute/post), sudden cardiovascular failure, valvular disease, CHD, aortic dissection, CABG, balloon valvuloplasty of Aortic/Mitral, eval of LV function |
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Indications for Right heart cath |
CHD, pulmonary thromboembolic disease, pericardial tamponade/constriction w/ L heart disease, transseptal cath of LA, endomyocardial biopsy, valvular heart disease, C.O determintation, intracardiac shunt, EP study |
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Complications from cath |
death, heart attack, stroke, arhythmias, vascular injury, infection. <2% comlication rate |
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Prevention of complications |
heparin, restrict time wire is inside body to 2 minutes, protamine sulfate post cath to reverse heparin |
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Choices of approach |
Percutaneous (Seldinger): most common advantages: no repair needed, less chance of infection, no surgical closure, less skill, faster access |
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Cutdown procedure (Sones) |
direct exposure to vessel, typically brachial site, radial can be used but very rare advantages: used in patient w/ damaged femoral, iliac, & abdominal aortic vessels, less chance of bleeding, less chance of clot, greater cath control |
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Diagnostic equipment |
caths, guidewires, needles, sheaths, transduer. |
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Catheter |
"Key in the lock". Characteristics: material, design, size, and length |
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Dacron |
woven, flexible, covered w/ polyurethane for smoothness & decreased vascular trauma. |
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Polyurethane |
tensile property, memory, softer (reduces trauma), higher risk of thrombus formation, reshaped in boiling water. |
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Polyethylene |
preformed & custom made, doesn't soften at body temp, maintains shape, very popular, more thrombogenic |
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Teflon |
*stiffest vascular cath*, low friction, increase ease of insertion, poor curve memory |
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Polyvinylchloride (PVC) |
soft, supple, & flexible, ideal for flow directed, poor memory curve, can't be preformed, increase rate of moisture absorption |
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Cath size: French |
Diameter measured in French (Fr) 1 Fr=0.335mm=0.013in inside diameter: Fr/3 5-8 Fr-most adults 5-6 Fr-brachial caths |
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Cath size: Length |
R heart cath: 100-125 cm L heart cath: 90-110 cm *Most are 100 cm* |
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Diagnostic procedures |
PTCA, Transseptal cath, Septostomy, Direct LV puncture, Pericardiocentesis, Thrombolytic therapy, Atharectomy, Laser, Stents, IABP, Rotoblader, Bypass |
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C-clamp and Fem-stop |
2 people needed. Long set up for this device |
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Angioseal |
6 & 8 Fr. Collagen sponge attached by a suture. ANchor is absorbable inside the artery. Sutures completely absorbed after 10 days. Collagen sponge absorbed over 60-90 days. |
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Vasoseal |
Collagen plug, nothing left in artery. Insert collagen while another person applies pressure to vessel. Collagen & blood will co-mingle to create hemostatic plug. |
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Percutaneous Arteriotomy Closure (perclose) |
suture device emplys sutures w/ 2 nitinol needles. Purse sting method, pulling the sides of the arteriotomy together. |
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Star close (nickel & titanium) |
Similar to Perclose & Angioseal, instead of collagen or sutures a nitinol clip is used. |
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Removal percedure |
1) adjust bed for max pressure to be held 2) ensure vital signs are stable 3) have ACLS meds ready 4) before removing sheath ensure Heperain is stopped 5) check ACT (activated clotting time) & distal pulses. ACT > 180msec, wait to remove 6) hold pressure 20-5 minutes depending on sheath size |
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Pressure hold time |
3 minutes per French. Ex: 5 Fr=15 min Then split that into 4 phases by dividing the minutes by 4. Ex: 15 min/4: 1) 100% pressure 2) 75% pressure 3) 50% pressure 4) 25% pressure
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