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
 Coronary Angiography
 Cerebral Angiography (4 Vessel)
 Hemodynamic Studies
 Carotid Angiography
 Renal Angiography
 Mesenteric Angiography
 Peripheral Angiography
 Venography
 Aortography
 Left Ventriculography
 Fractional Flow Reserve
 INTERVENTIONAL
 Percutaneous Coronary Intervention
 Pericardiocentesis
 Pacemaker Insertion (Temporary/Permanent)
 Carotid Artery Stenting
 Renal Artery Stenting
 Coiling of Aneurysms (Cerebral, Coronary,
etc.)
 Peripheral Angioplasty
 Hemodialysis Access Management
 Central Catheter Insertion
 Inferior Vena Cava Filter Insertion
 Percutaneous Transmitral Commissurotomy
 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