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35 Cards in this Set

  • Front
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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.

cutdown procedure (Sones)

vein/artery is exposed surgically, then sheath is inserted. Brachial & radial used (mostly radial)

percutaneous procedure (Seldinger)

access to inner organs/tissue via needle-puncture of skin. Most commonly used! Femoral or brachial.

damping

decreasing of they systolic pressure that generally becomes lower & lower pressure.


Ventricular ectopy/fibrillation can occur

ventricularization

slight decrease in systolic pressure, but large decrease in diastolic pressure.

1844

1st cath. Done on a horse

1929

1st documented R heart cath by Werner Forssmann

1940s-50s

early development of cariac angiography & intracardiac hemodynamic studies

1950

retrograde L heart cath

1953

percutaneous method introduced by Seldinger

1959

selective coronary angiography by Mason Sones

1962-67

percutaneous femoral approach

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

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

Complications from cath

death, heart attack, stroke, arhythmias, vascular injury, infection.


<2% comlication rate

Prevention of complications

heparin, restrict time wire is inside body to 2 minutes, protamine sulfate post cath to reverse heparin

Choices of approach

Percutaneous (Seldinger): most common


advantages: no repair needed, less chance of infection, no surgical closure, less skill, faster access

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

Diagnostic equipment

caths, guidewires, needles, sheaths, transduer.

Catheter

"Key in the lock". Characteristics:


material, design, size, and length

Dacron

woven, flexible, covered w/ polyurethane for smoothness & decreased vascular trauma.

Polyurethane

tensile property, memory, softer (reduces trauma), higher risk of thrombus formation, reshaped in boiling water.

Polyethylene

preformed & custom made, doesn't soften at body temp, maintains shape, very popular, more thrombogenic

Teflon

*stiffest vascular cath*, low friction, increase ease of insertion, poor curve memory. Brockenbrough Transseptal cath made of teflon.

Polyvinylchloride (PVC)

soft, supple, & flexible, ideal for flow directed, poor memory curve, can't be preformed, increase rate of moisture absorption. Balloon flotation (Swan-Ganz) only cath made of PVC.

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

Cath size: Length

R heart cath: 100-125 cm


L heart cath: 90-110 cm


*Most are 100 cm*

Diagnostic procedures

PTCA, Transseptal cath, Septostomy, Direct LV puncture, Pericardiocentesis, Thrombolytic therapy, Atharectomy, Laser, Stents, IABP, Rotoblader, Bypass

C-clamp and Fem-stop

2 people needed. Long set up for this device

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.

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.

Percutaneous Arteriotomy Closure (perclose)

suture device emplys sutures w/ 2 nitinol needles. Purse sting method, pulling the sides of the arteriotomy together.

Star close (nickel & titanium)

Similar to Perclose & Angioseal, instead of collagen or sutures a nitinol clip is used.

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

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