Circulatory System Cardiac Catheterization

Snopek, Fundamentals of Radiographic Procedures:

Ch.3: Injectors
Ch. 4: Contrast media
Ch. 5: Catheters

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2 Systems differ in function/
transportation of fluids
Pulmonary & Systemic Circulation: https://www.youtube.com/watch?
v=x2R0_lBr_zk&ab_channel=VisibleBody
 1

I
Cardiac Circulation Animation:
https://www.youtube.com/watch?v=dX9SAgzLwXk&ab_channel=EZmed
 AKI
LA
R PA

paly
RA

P
RY LA

we

v.v
RV
Descendff
 Effratport nutrients 302coxygel
Functions Remove waste
tempwater electroy
Maintain
– Transport nutrients and Oxygen
–
–
Remove waste EEIE.at
Maintain temp, water and electrolytes plasma H2O
Components

RBC, WBC, Platelets, Plasma, H2O

f ansportnutrient 2049
Removewaste
Maintainbody temp water electly
 Blood Vessel Structure
• Capillary bed- arteries and veins
connected here
• Where diffusion of materials take
place across walls of small vessels

Tunica Intima (internal)

– Lining blood vessel
Tunica Media
– Support for vessel
Tunica Adventitia (external)
– Responsible for strength of vessel

Blood vessels - Structure & Function: https://www.youtube.com/watch?

v=hYNcdZa_2B4&ab_channel=TeachPE
 14
Systemic Circulation
CITÉ

•
– Strong pulse (heart
i
phases)
said
Arteries- carry blood away from heart (O2)

– Vessels decrease in size to tissues

i
• Veins- blood returns
0 to heart (deoxygenated)
– __a
Vessels increase in size towards the heart
– Gradients
 Blood flow through the Heart
• SVC/IVC-
RT Atrium—Tricuspid Valve—
RT Ventricle-Pulmonary Arteries—LUNGS—
Pulmonary Veins- LT Atrium-Mitral Valve —
Left Ventricle-Ascending Aorta
 Cardiac Cycle
• G
Repeats 75x/ minute
Itsy
• Consists of 3 phases
– Atrial contraction (systole)
– Ventricular contraction (systole)
– Complete rest (diastole)
 Blood flow of Coronary Arteries
• Originated from aortic blub
a L corongark seed
• LEFT CORONARY ARTERY affta
– Feed anterior and posterior portions of heart
• RIGHT CORONARY ARTERY ( RCA) R c agr Supplieblow

– Supplies blood to Rt Atrium/ Rt Ventricle a Ate Rt

0
RV
 Blood Supply to the Brain
– RT + LT Common Carotid (

8
Bifrucate at C-4)
– RT + LT Vertebral Artery

Brain suit
Iliffe

Branches off Aortic Arch

1.Brachiocephalic Artery
Right common Carotid Artery
Right Subclavian artery
2. Lt Common Carotid Artery
3. Left Subclavian Artery
Gott are
AA

If

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 VEINS

– Inferior Vena Cava

– Common Iliac
– Femoral
– Great Saphenous
– Anterior Tibial
0
Branches off Aortic Arch
1.Brachiocephalic Artery
Right common Carotid Artery
Right Subclavian artery
2. Lt Common Carotid Artery
3. Left Subclavian Artery 0
E
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 BRANCHES OFF ABDOMINAL AORTA

• CELIAC TRUNK ( 3 branches arteries off

aorta)
– Gastric, Hepatic and Splenic
• SMASup mesatinArtery
• Renal
• IMA int mesenteric
Artery
 VENOGRAMS
•
•
0
2/3 body’s blood supply sits in venous system
Flow to heart controlled by what?
• Valves to prevent?
• DVT????
– Replaced by modality that uses echoes or sound
waves… what modality?
 LYMPHANGIOGRAPHY
I

Drains interstitial fluid and returns it to venous system

Fluid from left side of body, lower limbs, pelvis and

thwaael
live.ie
abdomen enter veins from thoracic duct

Upper right, upper limb, head and neck drain into veins
by right lymph duct
into wine duet
upper
headneck by LPlymph
 Introduction to Angiography

1929 -A surgical resident, called Forssman, catheterised himself,

then walked to the x-ray department for chest x-ray.

• Equipment
• Catheters & guide wires.
• Patient preparation for
angiography.
• Direct puncture & Seldinger
technique.
• Patient after care

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 Definition of Angiography:
The radiographic examination of Vascular structures
O
within the body after the introduction of CM.
O
Angiography demonstrates:
• _________variations.
anatomic
• ________
function e.g.cardiac
catheterisation.
2 general categories:
1. ___________
Arteriography
2. ___________
Venography

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Angiography:

There are different types of angiogram and specific names are

given e.g. Cerebral angiography = visualization of the
arteries & veins of the brain.
______________

The blood flow & therefore the

flow of CM in the vessels is
rapid. Therefore, we need
equipment that can make a rapid
series of exposures

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 Angiographic Equipment

Bi-plane:
• Advantages:
– one injection
images in 2 directions with ____ of ____
______ ___
CM
– Less CM for patient
– Less risk of kidne
______
damage y

• Disadvantage:
– Equipment is more
expensive
_____________

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 CM Injection
Methods:
• By hand
• Pressure (Automatic)
injector:(motor,
50
_____ control
_____

0000
panel,_____
barrel______ ______
(syringe), _____
collar)

0
 Pressure injector
Purpose:
To inject a specific quantity of CM during a predetermined time

by setting:
a. Injectionrate
____.
b. Injectionvolume
_______.
c. Maximumpressure
_______. (max pressure may be reached
gradually to prevent the catheter whiplash which would dislodge
the catheter.)
d. Electronically connected – linked withexposure
________ (before or
simultaneously or after exposure).

0
Automatic pressure injector (cont’d)

Motor
Barrel

control unit

viscous

temperatur
e

0
 Automatic pressure injector (cont’d)
7 factors affecting the flow rate or speed of injection;
1. Maximum pressure to be allowed.
_________________
2. Atime interval in which the pressure (max) will be
____________
reached.
3. Temperature
____________ of the CM.
4. Cathete
________ length.
rDiameter
5. __________ of the catheter.
6. Diamete
__________ of the vessel.
r C high
7. Type of _____ (concentration / viscosity; ideally ____
M
iodine concentration low viscosity)
and ____

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 Contrast media
Ideally:
• ____
High iodine concentration
• ____
Lo viscosity
w

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 Injection – Retrograde vs. Antegrade

• Retrograde- Injection of CM into vessel in the

________
opposit direction of normal blood flow.
e
• Advantage = a more satisfactory method for
visualizing the aorta because the arterial turbulence

•
80
causes the CM to _____
E
fill the lumen of the vessel.
sam
Antegrade- Injection of CM into vessel in the _____
e
direction of normal blood flow.
•
0
Antegrade causes layering of the CM in the vessel.

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 Angiographic Guidewires
• Sterile technique:
• Guide wire:
– made from _____________
. stainless
– Itsteel
is coated with _______
Teflon
to reduce friction; this
helps to slide the catheter
over the GW.
– Heparin-coated – prevent
clot formation.

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 Angiographic Catheters
Catheters:
are ____________
heparin coated to prevent clot
formation.
made from pliable _______
plastic (e.g.
polyurethane, polypropylene) to allow
them to be straightened over the GW
for insertion & to resume their shape
for easy maneuverability into the
vessel.
Made in different shaped _____
tip to
allow manoeuverability intos artery
openings for selective injections

Judkins: Reshaping Catheters 0

 Angiographic Catheters & guidewires
• volume of
Side and end holes facilitate a larger __________________ to be
delivered without catheter whiplash. CM
• Catheter size:
– from 0.05 inch (____Fr.)
4 to 0.09 inch (_____Fr.)
7 (3Fr =1mm).
– Length –commonly- ___________
100 cm.

Catheter Sizes: French Catheter Sizing

The French size of a catheter is determined by a simple multiplication of 3
(diameters in millimeters multiplied by 3 = the French size).
For example, if a catheter has a diameter of 4.7 millimeters, then the French (Fr) size
is 14

0
 Angiographic Catheters & guidewires

cate 0 05 a 0079 7

•
00
Guidewires Size: from 0.032 inch to 0.038 inch.

•
0
sterilit and non contamination due
Disposable catheters ensure ________
to poor cleaning of reusable catheters.
y

• heparinisedsaline
The catheter is continuously flushed with __________

8
blood_____.
solution to prevent formation of _____ clots

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 Injection methods
1. Direct.
2. Seldinger needle & catheterisation.
• Flus selective arteriography can be
_______ and _________
hperformed.
bolu of CM introduced to
-‘Flush’ = a large _______
s of interest. E.g in aortography
visualise the artery
the flush injection gives excellent visualisation of
all the branches of the aorta.
- Selective = CM ‘introduced directly into the
specific vessel of interest.
________

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 Advantages of Selective injection.

1. Visualisation is achieved with reduced volume of ______.

C
M
2. Therefore, it is better __________
tolerated by patient.
3. The CM is not as diluted
________ in the vessel of interest.
4. Reduces superimposition by other vessels – better
visualisatio
____________
n

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 Seldinger technique vs direct puncture.
• Seldinger technique – definition:
Percutaneous puncture of an artery remote from the required site
of CM using a Seldinger needle to facilitate the introduction of a
catheter.
• 4 advantages of the catheter technique over direct puncture
method of injecting CM:
1. extravasation
Risk of __________________ is reduced.
2. More body
_______ parts can be reached for selective
injection. positioned
3. The patient can be _____________ as needed.
radiograph
4. The catheter can be left in place while the s____________
are reviewed.

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SELDINGER TECHNIQUE
 Seldinger Technique ( step-by-step)

1. Insertion of needle
2. Placement of needle in
lumen
3. Insertion Guide wire- thru
needle, advance 10 cm
4. Removal of Needle- guide
wire in position
5. Threading of catheter to
area of Interest- fluoro used
6. Removal of guide wire-
catheter remains in place
 Other methods

• less common methods used

– Cut down- minor surgical procedure to expose
vessel of interest
 Seldinger / Catheter sites.
4 puncture sites for the catheter technique:
1. Femoral
__________ .
2. Brachia
__________.
l
3. Axillary
__________.
4. Aorta
__________.
(if others unavailable)

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 Post Procedure Care

• Catheter removed – compression

• Bed rest- min 4 hrs/ head up 30 degrees
• Vital signs
• Extremity watch
 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
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