Introduction to Cardiac Cathlab

Chiranjeevi Darsi
P G CVT,RCIS,RCES,CCDS,CEPS
Cardiac Physiologist
King’s College Hospital
London,UK
What is Cardiac Catheterization ???

➢ Cardiac Catheterization is a procedure to diagnose and treat heart conditions

➢ During the procedure a Flexible thin tube called catheter inserted via Arm/leg
Artery or Vein
 History
1929 Werner Forssmann credited with being the first person to catheterize a
living person, himself. At age 25, while receiving clinical instruction in surgery in
Berlin, he passed a catheter 65 cm through one of his left antecubital veins,
guiding it by fluoroscopy until it entered his right atrium. He then walked to the
radiology department (upstairs), where the catheter was documented with a
CXR.
1953 Seldinger develops his percutaneous technique of vascular access.
1958 Sones selective coronary arteriography.
1977 Gruntzig introduces the technique of PTCA to open blocked Heart blood
vessels
 Heart Anatomy

➢The Heart is Organ that Pumps the

blood throughout body

➢ It beats 1,00,000 times per day

➢It pumps 10,000 ltrs per day

Known or Suspected Heart Conditions for Which Diagnostic Cardiac
Catheterization May Be Performed

➢ Coronary artery disease (including heart attack)

➢ Heart valve problems
➢ Decreased heart function
➢ Congenital heart disease
➢ Elevated pressures in the heart chambers and/or great vessels
➢ Abnormal cardiac output (volume of blood flowing through the heart)
➢ Heart muscle inflammation, infection, or rejection (in the transplanted heart), for
which catheterization is performed to obtain small pieces of tissue for
microscopic examination (biopsy)
 Cathlab Room and Equipment
Procedure Room

Where Cardiac Cath Procedures

performed in a sterile environment

Control Room

The control room is used for monitoring

the patient's vital signs, hemodynamics,
and ECG tracings. Here, physicians discuss
the planned procedure and write the
final report
 X Ray machine

➢ The machine emits a heavy and

concentrated beam of electrons called
X-ray photons. The photons travel
through air, make contact with the
body and its tissues, and produce an
image that will be captured and
reviewed to diagnose and Intervene.

➢ The beam’s high-energy rays cannot be

absorbed by soft tissues like the skin
and organs. Therefore, the beam passes
through them. But, the solid bones of
the body absorb the photons.
Monitoring Station
 Procedures Performed

➢ Coronary Angiogram
➢ Percutaneous Coronary Intervention - PCI
➢ Device Implants and Explants
➢ EPS and Ablation RF/Cryo
➢ Left and Right Heart Catheterizations
➢ Valve Implants TAVI/TEER
➢ Pediatric Diagnostic and Interventions
 Different types of Equipment
➢ Defibrillator/Crash cart
➢ Temporary Pacemaker Pulse Generator (TPI)
➢ Intra Aortic Balloon Pump (IABP)
➢ LUCAS Chest Compression Device
➢ Intra Vascular Ultra Sound (IVUS)
➢ Optical Coherence Tomography (OCT)
➢ Fractional Flow Reserve (FFR)
➢ Rotablator
➢ Intra Vascular Lithotripsy (IVL)
 Procedure Preparation

➢ Consent
➢ Blood Investigations – INR,Cr,Hb,WBC
➢ ECG/NIBP/SP02
➢ Sterile Scrub
➢ Registering in Xray and Hemo system
 Patient Preparation
Sterile Patient Preparation for Cath Procedures

Standard 12 Lead Attatchment

 PressureTransducer Setup
➢ Pressure transducers converts a Mechanical pressure
into an electrical signal

Calibrating (‘zeroing’)

• ensure the transducer pressure tubing and flush solution

are correctly assembled and free of air bubbles
• place transducer at level of the right atrium
• ‘off to patient, open to air (atmosphere)’
• press ‘zero’ -> sets atmospheric pressure as zero
reference point
• whenever patient position is altered the transducer
height should be altered
 Consumables
1 Fr is equivalent to 0.33 mm
Eg : 6 Fr= 2.2mm
Puncture Needle – 18 G
Sheath- Radial,Femoral (Standard and Long) - 3 Fr – 16Fr
Catheters - Guiding and Diagnostic – 3 Fr – 8 Fr
Guide wires-Diagnostic and Interventional- 0.010”-0.038” (Hydrophilic,Teflon)
Contrast medium – Ionic and non Ionic
Balloons – Semi, Non Compliant, DEB,Cutting
Stents- DES,BMS
Valves
Pacemakers, ICD, CRTD
EP Catheters – Diagnostic and Ablation
Others –Thrombectomy, Biopsy, Filters, Physiologic Measurement and Imaging Catheters
 ➢ More comfortable than femoral catheterization
because they are able to sit up, walk, and eat
immediately
➢ This is a particular advantage for patients with back
problems
➢ More Spastic

➢ The femoral artery is usually palpable

and allows for easy access.
➢ Less Spastic
➢ More useful for Graft Angiograms and PCI
 Introduce Kit

• Puncture Needle

• Guide Wire

• Sheath
 Catheters
Diagnostic Catheters – Small internal Diameters to use for Diagnostic Purpose

Guiding Catheters – Bigger Internal Diameter to pass Balloon and Stents for Interventional
Procedures
 Hemodynamic Monitoring

➢ECG
➢Arterial Blood Pressure
➢NIBP
➢O2 Saturation
➢HR
Normal Intra Cardiac Pressures and Saturations

Left and Right Heart Cath Study

Pressures Saturation
RA – 0-4mmhg 75%
RV - 25/5 75%
PA - 25/10 75%
PCW - 7-12 98%
LA - 7-12 98%
LV - 120/10 98%
Ao – 120/80 98%
Coronary Anatomy
 CAG/PCI

CAG-Coronary Angiogram is a
Procedure to diagnose Heart Blood
vessels card coronary arteries

PCI- Percutaneous Coronary

Intervention is a Procedure to treat
Blocked Blood vessels
 PCI Guide wires and Balloons
Guidewires are essential tools, to track through the
vessel, allowing access and the ability to cross the lesion
with interventional devices

Balloon catheter will be used to help widen and improve

blood flow of blocked blood vessels of the heart
 Balloons and Stents
Stents
Stents will be placed in the blocked blood vessels to Keep the blood
vessels open permanently

Special Balloons
Drug Elluting Balloons
Cutting Balloons
Percutaneous Valve Interventions
 Heart Rhythm Catheters and Devices (EP)
Rhythm Control Devices

Multi Electrode Diagnostic and RF Pacemaker

ICD
Ablation Catheters CRT-P/D
 Congenital Heart Defects

PDA
ASD
VSD
Valve Stenosis
Atrial Septostomy
 Physiological Measurements and Imaging
OCT/IVUS
FFR is a measure of blood pressure
difference across a coronary artery Optical Coherence Tomography (OCT) is an intravascular
stenosis to determine if a stenosis is imaging modality that uses near-infrared light to provide high-
physiologically significant, which can definition, cross-sectional and three-dimensional images of
impede oxygen delivery to the heart the vessel microstructure during percutaneous coronary
muscle.1 intervention (PCI)
 Other Devices
IVL
The device uses a balloon to deliver Rotablator
sonic pressure waves that can pass
through soft arterial tissue to
Rotational Atherectomy device is used to de bulk the
“preferentially disrupt” calcified plaque
Calcified vessels for optimal stent placement
and optimize stent placement
Emergency Support Devices
LUPAS

The device is a mechanical system which can deliver high-quality cardiopulmonary

resuscitation (CPR) chest compressions consistently

TPI Pulse Generator

Abnormal Heart Rhythms During Cath Procedures

ST Elevation
Bradycardia
AV Blocks
VT/VF
Closure Devices
Manual Compression
Angioseal
TR Band
Proglide
Femstop
Complications

➢ Bleeding.
➢ Blood clots.
➢ Bruising.
➢ Damage to the artery, heart or the area where the catheter was
inserted.
➢ Heart attack.
➢ Infection.
➢ Irregular heart rhythms (arrhythmias)
➢ Kidney damage.
Case Closing and Data Saving

➢ All Events Recorded

➢ Medications and Equipment used
➢ Generating report
➢ Backup the Data as per Hospital Protocol
Take home message

➢ Cardiac Cathlab is a Sterile Procedure room to perform diagnostic and

Therapeutic procedures to diagnose and treat heart conditions
➢ Knowing Patient history, Allergies and Blood Investigations will help to improve
patient safety
➢ Check all the Cathlab Equipment daily before starting the procedures as per
Hospital protocol
➢ Maintain cathlab sterility as per Hospital infection protocol to reduce
nosocomial infection
➢ Check daily stock levels as per volume of the cases
➢ Document and store hemodynamic monitoring data and Imaging data as per
hospital policy