Wires, Catheters & Supplimentary EquipmentTortorici Chapter 16 & 17

Guidewires

* Stainless steel

* Solid, or wrapped in teflon for lower coeficient of friction.

* Heparin coated

Guidewire tips

* Tapered tip

* Rigid or flexible (floppy)

* “J” measured in radii

3cm ave.floppy ends

3mm-3cm

Guide Wires

2 in 1 wires

* movable core in teflon wrap allows stiffening of floppy end

* Allows for 10-15 cm flop

* Handle is called a mandril

* Added versitility but increased risk of: unraveling clotting abrasion flaring of end hole in catheter

Guide Wires

Length of wires

* 30-50 cm for direct vascular puncture

* 100-150 average

* 100-260 for catheter exchange

Diameters

* Common diameters .035” - .038” .89mm - .97mm

* Range from .014”-.52” (.35-1.32mm)

Guide Wires

Wires are matched to

* Vessel size (not obstruct)

* Needle gauge (no leaking of heme, no sticking)

* Catheter lumen

On opening package scrub tech inspects:

* Visually

* Tactily

* Bend tip 180o for flexibility

Catheters

Types

* Multipurpose (for flush studies)

* Selective

* Super selective

* Deflecting

Made of

* Teflon* Polyethylene, or* Polyurethane * Braided or not* Radiopaque or lucent

Characteristics

* Memory

* Torque

Measured in: French

* Outer diameter

* 1 French = .33mm (4-5 French ave.)

Catheters

Tips

* Tapered and shaped

* End hole only for selective studies, or

* End and side holes for large vessels, recoil control

* Side holes only for pulmonary and ventriculograms

Pigtail

One of the Judkinsright coronary series.

One of the Judkinsleft coronary series

To prevent clots, cathetersare flushed with heparinizedsaline

Heparin is an anticoagulantProtamine Sulfate is a coagulant

Selecting the right coronary artery

Under fluoroscopy, as the tip of the catheter probes the area of the origin of the right coronary artery, it will flip into the vessel when found. A few CCs of contrast, hand injected, verifies placement.

Contrast is black on thefluoroscopic monitor

Sterile Equipment Packs/ Tray Set-up

Disposable or Reuseable Packs

* Needles, 18 gague, (thin walled or regular) 2 1/8” – 3 ¼” * Adapters (Male & Female, Tapered, Leur Lok, Tuohy-Borst)

* Stopcocks (2 & 3 way), Manifolds

* Vessel dilator

* Blade

* Forceps

* Extension tubing

* Basins (large and small)

* Towels

* 4 x 4 gauze (sponges)

* Gowns, gloves

Cannula

Hub

Baseplate

Stylet orobturator

Sterile Equipment Packs/ Tray Set-up

Add to Tray

* Antiseptic solution* Contrast * Heparinized saline

* Catheters

* Guide wires

* Sheath

* Drape

* Razor (not on tray)

Manifold connected to catheter forms a closed system

Contrast HeperinizedSaline flush

Strain gaugetransducer

Systolic pressuremeasured throughthe catheter in the left ventricle.

Syringe for hand injections of contrast and flushing catheter

Manifold

Waste fluid

1. Which of the following guide wires is best for maneuvering around atherosclerotic plaque?

2. Angiographic catheters are typically constructed of:

3. Coating a guide wire with Teflon will decrease its:

4. When changing from a flush to a selective study, the catheter should be twice the length of the guide wire.

5. A ”38” guide wire would have a diameter of:

6. The typical arteriography needle size used for the Seldinger technique is:

8. The sharpened, solid portion of a two-part needle is termed the:

9. A 6 F catheter would have an outer diameter of:

10. The ability of a catheter to respond to twisting manipulations is termed:

11. Thrombus formation at the catheter tip can be avoided by:

12. Guide wires are typically constructed of:

7. Guide wires are typically constructed of: