Cardiac
catheterization
views the anatomy
of the heart using a
contrast material
injected into the
coronary arteries
under fluoroscopic
imaging.
Fig. 1
Assess the severity Data collection
and extent of
coronary artery
disease (CAD)
Cardiomyopathies
Valvular or
myocardial disorders
Determine CAD in
patient with chest
pain of unknown Genetic disorders
origin
Uncontrolled Uncompensated
hypertension congestive failure
Severe anemia Active infection or
Ventricular febrile illness
fibrillations Electrolyte
Acute stroke abnormalities
GI bleeds Severe
Allergy to contrast coagulopathy
Renal failure
After patient is properly identified, the
procedure must be explained before
consent can be signed
Baseline vital signs will be done and as
long as these are within the doctor’s
interest, can proceed with the
procedure
Blood tests must be done including BUN,
creatnine, PTT, INR, insulin/sugar levels
After patient is put on table, the area
being puncture must be free from hair
Hair removal done by disposable electric
razor and removed by sticky side of cloth
tape
Patient must be surgically cleaned with
hospital approved sterile surgical prep
solution
The technologist working with the
cardiologist must be scrubbed in
following basic sterile surgical technique
The patient is then draped from neck
down with sterile drapes
All equipment (radiation shields, image
intensifier, equipment used to
manipulate machine) must be prepped
with sterile covers
Procedure tray should
include:
-sterile gowns and gloves
for scrub tech and doctor
-sterile towels and drapes
for procedure
-equipment covers
-gauze
-scalpel, needles, scissors,
hemostats
-syringes for
heparin/saline flush,
lidocaine, and blood
draw
-labels with marking pen
for any item filled with a
solution
-basin for heparin/saline
mixture, basin for waste
fluids, small cup for
lidocaine
-skin prep solution
-high power manifold
-connection tubing
Fig. 2
Fig. 3
-Three catheters are used: JR4 (advances to right coronary arters, JL4 (advances
to left coronary arteries), and 145 degree pigtail catheter (to advance into
ventricles
-One 135cm wire
-Sheath corresponds with catheter size (5F cath gets 5F sheath etc.)
-Size of catheter depends on doctor’s preference but generallly 6F is used
Patient relaxed with Versed or Fentanyl,
sometimes both
Two 500mL bags of saline infused with
2,000 units (2cc) heparin each for
flushing all tubing, catheters, sheaths
Lidocaine for tissue numbing
Visipaque contrast unless otherwise
specified
When doctor and tech are
scrubbed and all equipment
and supplies are ready, the
procedure may begin
Access is easiest from right side of
patient due to aortic bend
Puncture is generally done via the
femoral artery
Alternative sites include the radial and
brachial arteries of the arm
After puncture of femoral, radial or brachial artery (primarily on right side of
patient), a catheter is advanced into the aorta and then the coronary arteries
After numbing the groin area, the
femoral artery is palpated and a needle
is inserted in that direction
When blood comes out of needle, the
artery has been accessed
A small, flexible guidewire is then inserted
into the lumen of the needle
The needle can then be removed but
the wire must maintain position
After removing the needle, a flexible
plastic tube can be placed over the wire
and introduced into the artery. This is
called a one-way sheath (allows
insertion of catheters and wires without
blood escaping)
The catheter is then inserted over the
guidewire but through the sheet and
advanced into placement via the
inferior vena cava to the aorta
Movement of catheter is monitored
under fluoroscopy (x-ray movies) with the
cardiologist manipulating its movements
The fluoroscopic machine is manipulated
by a qualified, scrubbed in, radiologic
technologist
When catheter is in place, wire can be
removed and contrast administered
Catheter in place to view left
coronary arteries
Catheter in place to view
right coronary arteries
Pigtail catheter in left
ventricle to measure
ventricular pressure
Aortagram used to assess
ascending and descending
aorta
Right coronaary arteries
shown with contrast
Left coronary arteries shown
with contrast
The x-ray machine is suspended from the
ceiling. It can be manipulated in multiple
angles and views to achieve a desired
picture. The x-ray comes from the
bottom of the machine and the image
intensifier that transmits the image is
above the patient. Lead shielding and a
radiation badge is required for all
personnel in the room during the
procedure.
The procedure is complete when the
cardiologist has seen all the views and
anatomy desired and all pressures
recorded
The catheter can be removed and
manual pressure must be applied to
entry site for 15 minutes
The patient must lie flat and supine for a
minimum of two hours to ensure the
artery does not reopen
After two hours, the patient can be
released to person driving the patient
home
Dressing must remain dry, no lifting over
five pounds for three days
No shower for 24 hours
No bathing or swimming for one to two
weeks
Drink plenty of fluids
If severe pain, swelling or discoloration of
limb occurs, doctor must be notified
immediately
1. Abdulla, Abdulla M. Cardiac
Catheterization. Ed. Dr. Abdulla M.
Abdulla. 18 February 2012. HeartSite. 24
Oct. 2012.
http://www.heartsite.com/html/cardiac_c
ath.html
2. Olade, Roger B. “Cardiac Catheterization
of the Left Heart”. Medscape Reference.
Ed.Karlheinz Peter. 10 Jan. 2012.
Medscape Reference. 24 Oct. 2012.
<http://emedicine.medscape.com/article/
1819224-overview#aw2aab6b2b3>
Figure 1. Hale, Jane. Untitled. 2008. The Flint
Journal.
http://blog.mlive.com/flintjournal/newsnow/20
08/02/mclaren_opens_new_cardiac_cath.html
Figure 2. AliMed. Medline Cardiac
Catheterization Procedure Tray. Alimed. 24
Oct 2012. http://www.alimed.com/medline-
cardiac-catheterization-procedure-tray.html
Figure 3. Merit Medical. Performa Multipack
Angiographic Cardiology Catheters. Merit
Medical. 24 Oct 2012.
http://www.merit.com/products/default.aspx?
code=performamcath
