Angiography/ Interventional Basics
What do we visualize with an angiographic procedure?
Personnel in the Angio Room
http://www.heartsite.com/html/cardiac_cath.html
Radiologist/ Specialist Cardiovascular nurse 2-3 Radiologic Technologists (CV) Sometimes Anesthesiologist
Angiography/ Interventional/ Cardiovascular
Procedure Room (Suite) Room size- 400-600 square feet Easily cleaned Why? Outlets needed for O2, suction, crash cart 3 means of access to the room (Bushong,
p. 374) What are they?
Control Room 100-150 square feet Easy access and communication to
procedure room Computers, monitors and un sterile
personnel Storage area- guide wires, catheters and
needles
Equipment found in all Advanced Procedure Rooms
X-ray generators Controls X-ray Tubes System to record events of procedure Automatic Injectors
Generator
700MA- 1500MA Short exposure times Able to generate 80- 100 KW power Limit motion Provide max. contrast
X-Ray Tube Requirements
Detail Withstand high heat- rapid exposure
sequences Tube rating charts posted Need max. detail for vessels Use smallest possible focal spot Decrease target angle, p.13…line focus
principle
Equipment Requirements
High heat load tubes w/ rapid cooling Series imaging, intense heat SPEED UP THE ANODE RPM
1-2 Track mounted tubes Analog- to- Digital Conversion System Programmable digital image acquisition
system (rate,sequencing, processing) PACS
Electromagnetic Injectors Monitoring Equipment- BP & ECG Island Tables- access from all sides,
height adjustments, floor controls Where are the cables? Tables do not usually tilt
Digital Acquisition
2 types 1. Analog-to-Digital
Radiation-pt-intensifier-light-TV-light to electrical signal- analog-to-digital converter- image processor
2. Flat detectors Charged coupled devices (CCD) computer
chip Direct digital conversion
Charge Coupled Device (CCD)
Silicon computer chips Converts light to digital image Lower noise Better contrast Lower patient dose Advantage to this type system- images
produced in low light w/o loss of resolution
Digital Imaging- Analog VS Digital Concepts
Analog- image seen after chemical process
Digital- image manipulated by software Relates to numbers Number table called an array Information changed through use of
computer algorithm Advantages of Digital Angiography, p.30
Digital Subtraction Angiography (DSA) Computer “ subtracts” out all anatomy
except contrast-filled vessels Looks like a reverse image Can be more diagnostic for vessels
( clots, constrictions) Imaging systems below now mostly
replaced by digital Cut Film Changer Cine Fluoro( Cardiac Cath Camera)
Electromechanical Injector
Used in Angio, CT, MRI Overcome arterial pressure + maintains
bolus Maintains flow rate Flow rate affected by
Viscosity Length + diameter catheter Injection pressure Vessel selected
Components Control panel Syringe Heating Device High- pressure mechanism
Safety Devices Acceleration regulators Pressure- limiting devices MRI- non- ferrous material
Vocabulary Terms
Arteriosclerosis- vessels hardened Atherosclerosis- plaque like cholesterol Thrombus Embolus Occlusion Tumor Stenosis Angioplasty-angio procedure dilates stenosed
vessel
Lithotripsy Stent- cage like metal device placed in
vessel to maintain blood flow Thrombolysis Filter Embolization- stop bleeding, cease
blood flow to site of pathology Ante grade Retrograde
Seldinger Technique
Method for catheterization of vessels Developed 1950’s still popular today Percutaneous (through the skin) 3 vessels considered:
Femoral –preferred site for arterial (size + accessibility)
Brachial Axillary
Selection based on strong pulse w/ absence of disease
Site cleaned, area draped, local given
Seldinger Technique ( step-by-step) Insertion of needle Placement of needle in lumen Insertion Guide wire- thru needle, advance 10
cm Removal of Needle- guide wire in position Threading of catheter to area of Interest- fluoro
used Removal of guide wire- catheter remains in
place
SELDINGER TECHNIQUE
Two less common methods used Cut down- minor surgical procedure to
expose vessel of interest Translumbar- patient prone, long needle
passed thru T12- L2 into aorta
Contents of Procedure Tray
Variety items 3 basic groups of equipment Prep Group Anesthetic Group Insertion and removal Contrast
Accessories Adaptors Connectors Manifolds, Stopcocks
Let’s Look at Needles, Guide wires and Catheters Cannula stilette connecting hub (luer
lock) baseplate two or three-way
stopcock transparent tubing
Guidewires
Guide catheter for placement in vessel Diameter large enough so blood can
not flow back for too long a time Tips at the end of GW
Straight J- tipped
longer G.W. for selective angio vessels Short used for shorter direct vascular
approach
CATHETERS
Straight Pigtail Sidewinder Cobra
The more holes at the end / the more contrast / large vessels
Catheter with only end hole/ smaller vessels/ carotid
Combo end and side holes reduce risk of trauma to vessel, enhances contrast
Vascular/ Non- Vascular Studies Embolization pg 711,
Bontrager Stent Placements PTA pg 712 ,
Bontrager Vena Cava Filters Thrombolysis
Biopsies Fluid Drainage Injection of
Medicines Tube Placement in
Organs or Cavities Bontrager, pg 716
Interventional Imaging Procedures
Intervene w/ disease, provide therapeutic outcome
Purpose/ benefits Lower risk compared to surgery Less $ Shorter hospital stay and recovery Alternative for non surgical patient
Post Procedure Care
Catheter removed – compression Bed rest- min 4 hrs/ head up 30 degrees Vital signs Extremity watch Some angiographic procedures:
angioplasty, venography, angiocardiography, lymphography
Radiation Protection
Proximity to patient Radiation protection devices Leaded glasses pulled into place Minimal fluoro use Collimation Wear badges and ring monitors
Risks/ Complications
Bleeding at puncture site Thrombus formation Embolus formation –plaque dislodged Dissection of vessel Puncture site infection ( contaminated
sterile field) Contrast reaction
Top Related