INVASIVE
CARDIOL
OGY
Catheter Laboratory
Anthony Vallejo Wadiwad RN
HEART
The human heart is a muscular organ with four
chambers. The size of the heart is the size of about a
clenched fist. One of the most important organs
responsible for sustaining life.
The human heart is located between the lungs in the
thoracic cavity, slightly towards the left of the sternum
(breastbone).
FUNCTION OF THE HEART
One of the primary functions of the human heart is to pump
blood throughout the body.
Blood delivers oxygen, hormones, glucose and other components
to various parts of the body, including the human heart.
The heart also ensures that adequate blood pressure is maintained
in the body.
Controls the rhythm and speed of your heart rate.
STRUCTURE OF THE HEART WALL
Epicardium – Is the outermost layer of the heart. It is composed
of a thin-layered membrane that serves to lubricate and protect
the outer section.
Myocardium – This is a layer of muscle tissue and it constitutes
the middle layer wall of the heart. It contributes to the thickness
and is responsible for the pumping action.
Endocardium – It is the innermost layer that lines the inner heart
chambers and covers the heart valves. Furthermore, it prevents
the blood from sticking to the inner walls, thereby preventing
potentially fatal blood clots.
BLOOD FLOW
Inferior Vena Cava and Superior Vena Cava
Right Atrium
Tricuspid Valve
Right Ventricle
Pulmonary Semi-lunar Valve
Pulmonary Arteries
Lung
Pulmonary Vein
Left Atrium
Mitral Valve
Left Ventricle
Aortic Semi-lunar Valve
Aorta
System
CATHETERIZATION
LABORATORY
Commonly referred to as a CATH LAB, is an
examination room in a hospital or clinic with diagnostic
imaging equipment used to visualize the arteries of the
heart and the chambers of the heart and treat any stenosis
or abnormality found. (Wikipedia)
Also used for vascular and interventional Radiology
procedures.
CARDIOVASCULAR CATHETERIZATION
It is the insertion and passage of small plastic tubes
(catheters) into arteries and veins to the heart and other
organs of the body to obtain x-ray pictures (angiography)
and to measure pressures (hemodynamics), treat stenosis
and aneurysms, insert pacemakers and other devices.
Used for minimally invasive interventions such as PCI
(angioplasty/stenting), treatment of congenital heart
diseases and valve treatments/ replacements.
1. WHAT IS THE DIFFERENCE BETWEEN A
CATH LAB AND AN OPERATING ROOM?
Operating rooms are typically used for
open procedures requiring an incision
whereas most procedures performed in
a cath lab require only a needle stick to
feed the catheter through an artery or
vein. The only exception is with
pacemaker placement which does
require a small incision to place the
device. The same sterile techniques are
used in the cath lab to ensure patient
safety. (Bill Jennings, RN)
Source: (floridamedicalclinic.com)
2. WHAT IS THE DIFFERENCE BETWEEN NON-
INVASIVE CARDIOLOGY AND INVASIVE
CARDIOLOGY?
Non-invasive cardiology identifies heart problems without using
any needles, fluids, or other instruments which are inserted into
the body. (ex. Nuclear Cardiology, Echocardiography, Stress
Tests, Heart Monitors, CT Scans)
Invasive cardiology is a non-surgical option which uses a
catheter – a small, flexible tube – to repair damaged or weakened
vessels, narrowed arteries, or other affected parts of the heart
structure.
Source: (floridamedicalclinic.com)
C ARM MACHINE
Single Plane Bi-Plane
Single X-ray generator Dual X-ray source &
source & image image intensifier.
intensifier. Useful for pediatric and
neurovascular
interventions.
PHILIPS AZURION B20/15 (BI-PLANE)
First Bi-Plane machine in the north
CATH LAB EQUIPMENT
Monitor Defibrillator
Power Injector
Whole Blood Oximeter
ACT Machine
Anesthesia Machine
SUPPLIES / INSTRUMENTS
Radial / Femoral Sheath
Wires
Angiographic Catheters
Balloons / Stents
Closure Devices / Coils
RADIATION IN THE CATH LAB
Occupational radiation exposure is a major concern for cardiac
catheterization laboratory workers.
Radiation has no minimum safety threshold and its adverse effects
occur in a linear, dose-dependent risk.
The duration of radiation exposure, distance from the radiation
source, and physical shielding are the key facets in reducing
exposure.
RADIATION SAFETY & PROTECTION
SERVICES OFFERED
DIAGNOSTIC INTERVENTIONAL
Percutaneous Coronary Intervention
Coronary Angiography
Pericardiocentesis
Cerebral Angiography (4 Vessel) Pacemaker Insertion (Temporary/Permanent)
Hemodynamic Studies Carotid Artery Stenting
Carotid Angiography Renal Artery Stenting
Renal Angiography Coiling of Aneurysms (Cerebral, Coronary,
etc.)
Mesenteric Angiography
Peripheral Angioplasty
Peripheral Angiography Hemodialysis Access Management
Venography Central Catheter Insertion
Aortography Inferior Vena Cava Filter Insertion
Left Ventriculography Percutaneous Transmitral Commissurotomy
Fractional Flow Reserve Endovascular Stenting
Congenital Heart Disease Device Closure
Transarterial Chemoembolization
CATH LAB PERSONNEL
Angiographer
- Invasive Cardiologists (Adult / Pedia)
- Interventional Radiologist
Supervisor / Unit Head
Scrub Nurse
Circulating Nurse
Cardiovascular Technologist
Radiologic Technologist
Nursing Attendant
ANGIOGRAPHER
Invasive Cardiologist / Interventional Radiologist
Main Operators of the field
Discusses treatment plan to the patient
Uses non-surgical option which uses a catheter – a small, flexible
tube – to repair damaged or weakened vessels, narrowed arteries,
or other affected parts of the heart structure.
Uses minimally-invasive surgery to identify or treat structural or
electrical abnormalities within the heart structure.
ANGIOGRAPHER
Performs a broad range of procedures such as treating tumors,
taking organ biopsies or placing stents by inserting tiny
instruments and thin plastic tubes (catheters) into the body via
an artery or vein. The images are used to guide the catheters and
instruments to the exact area where the procedure or treatment is
to be performed. This reduces the need for traditional (open) or
keyhole (laparoscopic) surgery as treatment can be given via a
small tubes.
SCRUB NURSE
Also known as “Scrub Tech”
Member of the sterile team
Assists the angiographers during the procedure
Ensures sterility of the catheters, instruments and working table.
Prepares and anticipates the wires, catheters, balloons, stents or
devices needed by the angiographer.
Makes sure that every catheters or wires are flushed, wet during
the procedure. (some cases require heparinized soaking
solutions).
Applies direct pressure to the puncture site (radial/femoral) after
the procedure.
CIRCULATING NURSE
Receives the patient prior to the procedure
Secures consent (OPD)
Orients patient and relative/watcher about the procedure
Attachment of leads
Skin prep
Intra and post procedural patient care.
Monitor patients' comfort and safety during procedures, alerting
physicians to abnormalities or changes in patient responses.
Medications
Documentation/ charting
Watches out for any adverse events during procedure.
Prepares discharge information
CARDIOVASCULAR TECH
Also known as “CV Tech”
Technical side of the team.
Explain procedures to patient to obtain cooperation and reduce
anxiety.
Assists the circulating nurse in serving/opening catheters, wires,
balloons, stents that will be served to the sterile team (scrub nurse,
angiographers),
Monitors/ records pressures of the different chambers of the heart.
Recognizes abnormal rhythms/pressures.
Observe gauges, recorder, and video screens of data analysis
system during imaging of cardiovascular system.
RADIOLOGY TECHNOLOGIST
Operates the imaging equipment (C-arm, XpertCT, Interventional
Tools)
Implements radiation safety and protection protocols.
Guides the angiographer throughout the procedure.
Troubleshoots the imaging equipment.
Verifies contrast dye needed.
Operates the power injector and other equipment that might be
needed for a procedure.
Monitors fluoro time and radiation exposure of the whole team.
Secures patient data and images for future review or retrieval.
CORONARY ANGIOGRAM
Is a diagnostic test that uses X-ray imaging to see
your heart's blood vessels. The test is generally done
to see if there's a restriction in blood flow going to the
heart. During this test a type of dye that is visible by
an X-ray machine is injected into the blood vessels of
your heart. The X-ray machine rapidly takes a series
of images (angiograms), offering a look at your blood
vessels.
CORONARIES
INDICATION OF
CORONARY ANGIOGRAM
Known and suspected case of coronary disease.
Myocardial Infarction
Sudden Cardiovascular Death
Congenital Heart Disease
Cardiomyopathy
CONTRAINDICATION OF
CORONARY ANGIOGRAM
GI bleeding
Anemia
Electrolytes imbalance
Renal failure
Pregnant
Fever and infection
History of stroke
Drug intoxication
NORMAL CORNARY ANGIOGRAM
HEMODYNAMICS
The study of
the flow of blood in the
circulatory system, pressure
and also the oxygen saturation
in the different parts of the
heart.
PERCUTANEOUS CORONARY
INTERVENTION
Refers to the non-surgical insertion of a catheter into the
body through a small puncture site in the skin, usually into
the artery. Where in a technique of remodelling a blood
vessel will be applied through introduction of an expandable
stent/s, balloon catheter/s and other specialized tools for
treating a diseased artery.
INDICATION
Mild angina
Stable angina with ischemia
Acute myocardial infarction
Left ventricle dysfunction
Arrhythmia secondary to ischemia
Multiple lesions
Re-stenosis after successful PCI
Angina pectoris after coronary artery by pass graft
surgery
CONTRAINDICATION
Unstable and extremely high risk coronary anatomy.
Contraindication to coronary artery bypass graft.
Bleeding diathesis.
Patient who are non compliant with dual anti-platelet.
Multiple in stent re-stenosis.
Patient who did not give his / her informed consent.
COMPLICATIONS
Death
Myocardial infarction
Emergency CABG closure
Coronary artery perforation
Access bleeding
Pseudoaneurysm
AV fistula
Ischemia
Stroke
Allergic reaction
Renal failure
PERCUTANEOUS TRANSLUMINAL
ROTATIONAL ATHERECTOMY
Is a nonsurgical procedure to open blocked
coronary arteries or vein grafts by using a
device on the end of a catheter to cut or shave
away atherosclerotic plaque (a deposit of fat and other su
bstances that accumulate in
the lining of the artery wall).
INTRAVASCULAR
ULTRASOUND (IVUS)
A means of directly looking at the lumen of coronary arteries.
Transducer emits high frequency sound waves reflecting tissue
structures of different densities.
Advancing an IVUS catheter over an .014” guide wire, down
the coronary artery.
Slowly pulling the catheter back toward the guide catheter while
recording.
Reviewing what you have recorded, interpreting the images, &
conducting measurements to aid the physician.
USES
1. Pre- stenting to understand the lesion
morphology.
2. Pre- stenting to measure the length of disease
and diameter of the artery.
3. Post- stenting to check for stent to wall
apposition.
4. Hazy angiographic appearance.
5. Left main stenosis.
COMPARISSON BETWEEN CORNARY
ANGIOGRAM AND IVUS
