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Diagnostics
| Question | Answer |
|---|---|
| 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 |
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IdAhOmEyEr
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