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4 Disadvantages of using multiple side-hole guiding catheters: Decreased contrast opacification/ backup support/ coronary pressure mon/possible kinking
Catheter plastic that has the LEAST memory and torque control, and is soft as to be used for most balloon floatation catheters? Poly Vinyl Chloride (PVC)
What type of plastic is the stiffest, autoclavable, slipperiest, and GREATEST torque control? Teflon (PTFE)
One danger with Teflon is that dilators: Have dangerously hard and sharp tips
Polyurethane (PU) catheters should be used with a _________ guide wire. Teflon coated; that way the wire doesn't stick inside the catheter (metal wires) and reduces the chance of damaging the guidewire
The ability to twist the catheter, and having the distal tip turn as well? Torque control
What catheters do not have a braided steel mesh within the plastic? Foley & Swan-Ganz
Most catheters cannot be reused. What "single use devices" may be sterilized by a 3rd party then reused? Diagnostic EP electrodes
How much will a 2 mm ID catheter transmit at 500 psi (roughly) 16 ml/sec (2 to the 4th power = 16
How long are pigtail catheters usually? 110 cm
How is the curve of the JR (Judkins Right) coronary catheters measured? From Primary bend (closest to the tip) TO Secondary bend (closest to the hub)
Normal left Left judkins formal diagnostic catheter size for adults? JL4 (meaning the distance from primary bend to secondary is 4 cm long)
One french size equals? .33 mm
What would be the french size of a catheter with a diameter of 2.66mm 8Fr
The Outside diameter of a 5.5 Fr catheter is? 1.83 mm
The tip diameter on standard diagnostic coronary catheters is? .038 inch
Disadvantages of using guiding catheters, as compared to long sheaths in vascular intervention? Larger arteriotomy required for guiders / No hemostatic side valve in guiders
Name the Five ports of a Swan-Ganz, and what they do? 1) Balloon port: inflates balloon 2)Proximal RA port(white): for additional lines 3)Distal Port(usually yellow): Pressure monitoring 4)Proximal Port(blue): Blue for the cold color of ICE 5)Thermister: goes to computer
How far up on the Swan-Ganz is the proximal injection port located? Other port locations? Blue port 30 cm / Thermister 4 cm / Yellow port (distal tip)
When properly placed, what parts of the heart is the Swan-Ganz ports located? Proximal (blue) port is in the RA, and the thermistor is in the Rt, Lt PA
What part of catheter is necessary for optimal WEDGE pressures? End hole only
Your Bilater heart cath pt. has a (LBBB) on the ECG. What catheter should be inserted first and why? Swan-Ganz PACING and WEDGE: because the pacing will help if the LBBB turns into RBB from irritation, plus the swan allows for wedge pressure as well
Right Heart catheter for an infant? 4 Fr Swan Ganz
What is a flow directed, balloon, tipped, pediatric flood angio catheter. That can also measure wedge pressure? Berman
Two angio flood catheters that will recoil the least during a high flow injection? Berman and Pigtail
Catheter that has the least chance of staining the endocardium during lV gram injection? Pigtail
When doing a flood injection with a 4 or 5 Fr catheter. The injector pressure should not exceed: 1200 PSI (side note: the highest pressure is near the hub)
the IMA catheter (Internal Mammary) looks similar to what other catheter? Judkins RIght
Catheter designed to do a complete LV and coronary angio from the femoral artery is? Multipurpose
Complex selective catheter shapes are used mainly for cannulating? Aortic side branches
The Brockenbrough transeptal catheter is designed to puncture? Fossa Ovalis
Diagnostic catheter OD _____ size: French
Inflated Balloon cath. OD: mm.
Needle OD: Gauge
Guide Wire OD measured in? Inches
All vascular needles and catheters are fitted with ______ connectors: Female luer lock
Seldinger needle that admits a .038 guide wire is? 18T gauge
Curved sheath for going over the aortic bifurcation (right leg to left) is the? Balkin Introducer sheath
Guide wire diameters are usually measured in: Thousands of inches
The core of a wrapped guide wire is termed: its mandrel
What guide wire becomes slippery when wet, and has a nitinol spring tip Termo "guide wire"
What guide wire is most kink- resistant? Nitinol Core to tip wires
What guide wire is used to straighten tortuous coronary vessels? Hint: they are stiff in the region 2-15 cm from the tip, but flexible 1-2 cm tip. Support wires
In nitinol tip guide wires the tip is? Fixed and cannot be changed
Standard micropunture sizes? 21Gauge needle, and .018 inch wire
Type of guide wire designed for cerebral use? Bentson wires (designed for selective cerebral cath) and commonly used in many peripheral procedures
Which type of guide wire is 260-300 cm long? Exchange guides
Recommended clearance allowed between catheter ID and system OD? .10-.13 cm
Standard guide wires for adult left heart cath? Length? Diameter? 145-150cm and .035-.038 diameter
7Fr unable to float past TV of a dialated right heart heart, try a? .025 guide wire
What device allows one to easily pass a wire into a catheter? Plastic sleeve tip-straightner
One reason to enlarge femoral site with scalpel is? Reduce hematoma blood accumulation
When double flushing what do you do with the first syringe? Drawn back blood forcefully into the syringe, then discard. usually 2-4 cc of blood
How does a venous puncture differ than an arterial puncture? Ventous is unique with saline filled syringe that is fitted to the needle. This is because venous just ooze's while arterial shoots out
Pericardial disease patients need both Rt. and Lt heart cath? True
With valvular heart disease such as Mitral what type of case is requried? Lt? Rt? Both
pt.s that commonly recieve myocardial biopsy? Heart transplant follow up / Cardiomyopathy
3 Common contraindications to left heart cath and coronary angiogram? Hypertension (pulmonary edema, coronary ishemia) / Hypokalemia (cause ventricular arrythmias) / Fever (causes infections at access site)
How to relieve Ventricular irritability: Lidocaine drip
How to relieve Hypertension: VasoDilator therapy
How to relieve Fever: Antibiotic therapy
How to relieve LV Failure: Digitalis & Diuretics
How to relieve Hypokalemia: KCI drip
How to relieve Allergy to contrast: Steroids and Benadryl
If a patient is allergic to seafood then they are allergic to? Protamine or Contrast
4 advantages of non-ionic contrast agent (Omnipaque) Less; vasodilation, myocardial depression, elevation of LV-EDP, and nausa/ hot flashes
If a pt. comes to the lab with a contrast allergy, what should be given to them? premedicated with 60mg Steroids(prednisone) / and Anti-histamine 50mg (Deiphenhydramine known as benadryl
Best way to prevent CVA and TIA during angiography is? Using full systemic hemparization
Blood chemistry norms Sodium: 135-145 mEq/L
Blood chemistry norms Potassium: 3.5-4.5 mEq/L
Blood chemistry norms Chloride: 95-105 mEq/L
Blood chemistry norms Total Calcium: .08-1.0 mEq/L
Blood chemistry norms Magnesium: 1.5-2.1 mEq/L
Blood chemistry norms Creatinine: .8-1.4 mg
A patient with diabetes or renal insufficiency are at risk for CIN or renal failure. What should be done to reduce this from happening? Administer .5 (1/2) normal saline drip the night before the procedure
Before the case starts, pt.'s should come to the lab with a PT (prothrombin Time): <18
Percent of death rate? Percent of complications: stroke, heart attack? Death rate .1% some say the range is .1 - .3% Stroke rate .25%
abbreviation/ acronym that refers to the worst complications of a cardiac procedure? MACE (major adverse cardiac event)
Death Rate .1% or 1 in every ______. 1000
6 types of patients with the highest risk of mortality during catheterization: Infants (<1), Valvular disease, Severe coronary obstruction, Functional class IV patients, LV dysfunction, severe cardiac disease.
Most common complication of PTCA is? Coronary artery dissection at dilation site
pseudoaneurysm (false): false aneurysmal chamber through a narrow neck.
True aneurysm: chamber protruding through the artery
How does one fix a (false) aneurysm? Ultrasound localization and application of COMPRESSOR CLAMP
Most common complication of cardiac ventriculography? Ventricular tachycardia runs
Ventricular tachycardia and fib can also happen suddenly during? Right coronary arteriography
Which type of patients is a vasovagal reaction most dangerous? Critical aortic stenosis
Pyro - Fever
Heart Complications, CVA: aka STROKE Heparin
Heart Complications, Heart perforation: Pericardial centesis
Heart Complications, Pulseless artery POST sones procedure: Fogarty embolectomy
Heart Complications, Pyrogen reaction: Morphine
Heart Complications, Phlebitis & fever POST pacemaker impl..: Antibiotic
Heart Complications, Vasovagal Reaction: Atropine
What 2 kinds of imaging is usually done for Pericardiocentesis? Fluoro & 2 dimensional echo
Allergic reations, Rash, Nausea, Urticaria: Benadryl, Prednisone, Decadron
Allergic reactions, Dyspnea, Wheezing, Syncope: or pt. going into anaphylatic shock Epinephrine, Volume infusion
Allergic reactions, Seizure, hypotension, bradycardia, dyspnea: CPR as needed
Allergic reactions, Seizure, vital signs ok: Valium
In the immune response the foreign protein that stimulates antibody production is? Antigen
T-cells are? Lymphocytes
The adrenal cortex produces glucocorticoids which may be given in large doses to treat: Inflammation and metabolic disorders
Plasma protein that plays an important role in antibody & immunity is? Gamma-globulin
Hemodynamic effects of morphine include _______ venous capacitance and _______ Peripheral Vascular Resistance. Increased capacitance, decreased PVR
Hemoptysis - Coughing up Blood
First Heart cath (on horse): Claude Bernard 1844
First Cath on Human (himself): Werner Forssman 1929
Developed Percutaneous Technique: S.I. Seldinger 1953
First Coronary arteriogram: Mason Sones 1959
First Coronary Angioplasty: Andreas Gruntzig 1977
Minimum case load necessary for a cath lab team to maintain? >200 cases/year
Minimum case load necessary for physicians? >75
Define an "ambulatory cath lab": A lab which patients do not stay overnight in the hospital.
Normal PT time: 12-15 sec
Normal ACT time: 75-100
Class of Premedication: Antihistamine Benadryl
Class of Premedication: Narcotic Morphine
Class of Premedication: short acting, (narcotic like) Pain Duller Demerol
Class of Premedication: Benzodiazapine (anti-anxiety agent) Valium or Versed
Class of Premedication: Anti-Cholinergic Atropine
PreMed common name: Demerol Meperidine
PreMed common name: Valium Diazepam
PreMed common name: Versed Midazolam
PreMed common name: Benadryl Diphenhydramine
PreMed common name: Belladonna Atropine
Which sedative wears off within 30 mins following IV infusion? Versed(midazolam) rapid onset 1-2 min with duration lasting roughly 30 min. The CNS depresent wears off 10 times faster than Valium
What platelet site does abcixamab(ReoPro) block? Glycoprotein IIb/IIIa
Premedication commonly given prior to angioplasty to avoid coronary spasm? Ca Channel Blocker called Nifedipine or Verapamil
Standard Dosage: Valium 5-10 mg IV,IM,or PO
Standard Dosage: Cimetadine (Tagamet) 50-300 mg
Standard Dosage: Benadryl (diphenhydramine) 10-50 mg IV / 25-50 mg PO
Standard Dosage: Belladonna 0.5-1.0 mg Subq, IV
Amount of cc's of heparin for complete systemic anticoagulation of average adult? 5 cc's
Amount of cc's of heparin injected directly into the brachial for a sones procedure? 3.0-5.0 cc's
Patient was given 2500 units of IV heparin. What amount of Protamine is needed to reverse 2500 units of heparin? 2.5 cc's
For a sones cutdown of the Brachial arter? First________. Cut lateral, then lateral(perpendicular to the artery)
For a IJ punture, how should the patient be positioned? Trendelenburg (Legs lifted up about 2ft)
The Syvek NT and Chito-Seal are? Topical Hemostasis Accelerators
Where is the antecubital fossa? In the Arm Pit
Suture used to repair the brachial arteriotomy is ______, and the skin suture is________. 6-0 Prolene or tevdec NON absorbable skin is 4-0 Dexon Plus absorbable
With prosthetic aortic, and Mitral valves. It may be impossible to enter the LV. another method is? Direct LV apical puncture at PMI
For IJ puntures, how many degrees is the head suppose to be turned? about 30 degrees right or left, but usually left
For a brachial cutdown, most physicians us #___ size scalpel blade? #15
The Perclose hemostatic closure device uses? Non-absorbable suture
What IV site is most difficult for hemostasis? Subclavian
IMA bypass grafts can be studied easily from the ____ approach. Ipsilateral brachial
Feeds what: LAD septals Ant. IV septal
Feeds what: Distal LAD Apex
Feeds what: LAD - diagonals Anterior
Feeds what: Circumflex - Obtuse marg Post-lateral
Feeds what: Distal RCA (post. desc.) inferior
Feeds what: Prox RCA (acute marg) RA & RV
In a Left dominant Coronary artery, what LV wall will be affected by a RCA MI? NONE, because left dominace means it feed the posterior desending so no inferior lv wall impairment
Segments seen in an RAO LV angio? Anterior, inferior, and Apical
False LV aneurysm is usually composed of buldging? pericardium and clotted hematoma
What gauge is the long needle used for transeptal catheterization? 18G to 21G
Name of the atrial septal ridge? Where the transeptal cath is pulled down over. Limbus or Limbic ledge
A pediatric heart cath usually starts with? Puncture of the Femoral vein because a pediatric cath usually does both right and left
How many units of heparin should be administered for a pediatric left heart cath? 100 units/kg
Ages of pediatric: Premature? Born before "term"
Ages of pediatric: Neonate? <6 months of age
Ages of pediatric: Infant? Between 6 months and 1 year of age
Ages of pediatric: Child? Between 1 year and puberty
Distinguish between reversible and irreversible high pulmonary vascular resistance PVR is what test? Right Cardiac cath with O2 or NO challenge
Normal adult SVR to PVR ration? 12:1 svr is 12 times greater
Abbreviations: BUN Kidney function test (Blood urea nitrogen)
Abbreviations: CFA Artery punctured for AO-gram (common femoral artery)
Abbreviations: NG Feeding tube to stomach (Nasogastric)
Abbreviations: PFA Artery supplying femor (Profunda Femoral artery)
Abbreviations: DSA Computerized Digital X-ray imaging (digital subtraction angio)
Abbreviations: DVT Thrombosis of leg veins (Deep vein thrombosis)
Abbreviations: IVP Procedure where contrast injected IV to outline renal system ( Intravenous pyelogram)
Abbreviations: DP Artery to front of foot (dorsalis pedis)
Abbreviations: SMA Artery to the intestine (Superior mesenteric artery)
Abbreviations: V/Q Radio-isotope scan of lung (Ventilation/Perfusion scan)
Abbreviations: PTA Vascular angio..(Percutaneous transluminal angioplasty)
Abbreviations: KUB X-ray of abdomen (Kidney, ureters, bladder)
Major disadvantage to multidetector CT? Large volumes of iodinated contrast
Claudication is usually due to? Atherosclerosis in the leg arteries
Moderate hyperkalemia shows what on EKG: Peaked/ tented T wave
Moderate Hyopkalemia shows what on EKG: prominent "U" wave
Hypercalcemia does what on EKG: Short Q-T interval
Hypocalcemia shows what in EKG: Prolonged Q-T interval
Most common sensor in Medtronic (VVIR) pacemaker is? Motion
DDI/R Excludes physiological VAT pacing
Where are the R2 defibrilator pads placed? LV apex to Right scapula
Who discovered X-rays in 1895? Roentgen
Who developed the fluoroscope in 1898? Edison
Materials that emit light when stimulated by X-radiation are? Phosphors
Area of the anode struck by the electron beam? Target
Negative side of tube containing focusing cup? Cathode
Heater that "boils" off electrons? Filament
Positively charged metal wheel that dissipates heat? Anode (rotating)
Metal shroud around filament cup that condenses electron beam? Focusing cup
When you increase the X-ray tube mA, you are increasing the? Filament temperature
Which part of the X-ray tube produces the X-ray photons? Target of the rotating anode
The source of the electrons within an X-ray tube is the? Filament
Why is tungsten utilized for both the filament and target? Has a high melting point anode may reach 2000C, it must rotate fast to prevent melting
What part of the X-ray is negatively charged? Cathode
One X-ray photon is generated in the X-ray tube when a high velocity: Electron is suddenly slowed
Light stimulates it to emit electrons? Photocathode
X-rays stimulate it to emit light? Input Phospher (also known as the Cesium Iodide screen)
Converts electrons to light? Output phosphor
Accelerates electrons? Anode
Focus electron beam? Electrostatic beam
The fluorescent screen of an image intensifier uses? Cesium Iodide
Modern device that replaces the image intensifier tube and converts X-rays into visible light? Flat panel detector
Ionizing radiation: Roentgen
Occupational exposure measured: REM (film badge)
Radiation absorbed in tissue: RAD
Quantity of radioactive material: Curie
Units for: RAD Gray
Units for: REM Sievert(Sv)
Units for: Roentgen R or C/kg
Units for: Curie Ci or Bq
What does RAD measure? The amount of radiation absorbed by patient
What radiation unit is 100 times larger than the others? Gray (Gy)
What radiographic view will produce the highest X-ray exposure to staff? LAO
X-ray photon strength is most affected by? Kiovoltage
Inadequate mA on x-ray results in? inadequate x-ray photons being generated
What affects both quality, and quantity of the primary x-ray beam? kVp
Decreasing mA: no change quanlity, decreases quantity
Increasing mA: no change quality, increases quantity
Increaseing kV: Hardens quality, increases quantity
Decreasing kV: softens quality, decreases quantity
Primary purpose of using a Grid in radiography is? Filter scatter radiation
Grids are between the patient and the? Image intensifier, to reduce scatter radiation fog
What does Collimate do? aka coning down Moves the lead shutters / chief function is to reduce patient absorbed dose
Aluminum Filtration of primary X-ray beams is required by law to selectivly filter out harmful? Soft-low energy X-rays
What period of pregnancy is the fetus most radiosensitive? First trimester
Created by: IdAhOmEyEr