1. Cardiac catheters
-dr.majella

2. demonstrated that a simple Rubber catheter could be passed to
In 1929 Werner Forssmann
demonstrated that a simple
Rubber catheter could be passed to
the pulmonary artery through the
antecubital Vein and
An angiographic film could be
obtained using radiographic
contrast.

3. CARDIAC CATHETERS
“Was the key in the lock” – Andre Cournand & Dickinson Richards said in their Nobel lecture in 1956.
Certainly this key has unlocked the door to expanded diagnostic capabilities & therapeutic interventions.

4. Ideal characteristics of catheters
Better Torque Control
Strength
Radio-opacity
Flexible
Atraumatic Tip
Low Surface frictional resistance for good trackability
over guide wire.

5. PARTS OF A CATHETER
BODY
HUB
BODY
TIP
TIP
HUB

6. MEASUREMENT: FRENCH CATHETER SCALE:
The French catheter scale is commonly used to measure the outer diameter of cylindrical medical instruments including catheters, needles etc.
D(mm) = Fr/3 or Fr = D(mm)*3
Most commonly in adult Diagnostic Catheters of 5 – 7 Fr is used.

8. SIZE – wall thickness
Thick walled- Accentuates pressure waveform-systolic overshoot & diastolic dips.
Thin walled _ Improves monitoring, blood sampling & flushing abilities, decrease thrombogenicity.
Disadvantage – less torque control, not suitable high pressure injection.

9. What is a Catheter made up of ?
Materials:
A range of polymers are used for the construction of catheters, including silicone rubber latex and
thermoplastic elastomers.
Silicone is one of the most common choices because it is inert and unreactive to body fluids and a range of medical fluids with which it might come into contact.
Materials:
CATHETER:
Polyvinylchloride (PVC)
Polyethylene (PE)
Fluoropolymers (PTFE) (TEFLON)
Polyurethane (PUR)
Silicone (SI)

10. DACRON Very maneuverable & flexible.
Covered by polyurethane coating – reduce vascular trauma.
Nylon core-increase bursting pressure
Nylon – great mechanical & physical strength, reduced friction coefficient.
Eg- USCI Cournand, birds eye, eppendorf & sones.

11. POLYETHYLENE Stiffness inbetween polyurethane & Teflon.
Selective injection.
More thrombogenic than PVC, polyurethane, silicone catheters.
Stainless steel mesh braid improves rotational control & increase bursting pressure.
Eg – pigtail angiographic catheters (cook), judkins catheters, NIH & cournand.

12. POLYURETHANE Excellent memory – Superselective injection.
Softer than polyethylene or Teflon.
Increased thrombogenicity
Reshaped if immersed in boling water.
Eg – pigtail angiographic (cordis) catheters & original judkins catheters.

13. TEFLON Stiffest. Poor memory. Low friction coefficient.
Eg – Brockenbrough catheters, transducer-tip catheters & introducer sheaths.

14. POLYVINYL CHLORIDE Softest & flexible.
High friction coefficient- venous spasm.
Increased thrombogenicity.
Very poor tensile strength ( memory)
Cant be reformed.
Most hydrophilic.
Drugs absorbed- NTG, insulin, diazepam,thiopentone.
Eg- Balloon-tip flow directed catheters.

15. 0.04 0.21 1.35 2.0 +4 +3 +2 +1 Good Excellent Fair 0.015 0.9 0.75
CHARACTERISTIC
TEFLON
POLYETHYLENE
POLYURETHANE
PVC
FRICTION COEFFICIENT
0.04
0.21
1.35
2.0
STIFFNESS +4 +3 +2 +1
MEMORY
Good
Excellent
Fair
MOISTURE ABSORPTION (% 24 HRS)
0.015
0.9
0.75

16. TIP & HUB TIP: Neither blunt nor too sharp, soft & flexible.
Bullet nose tip- least trauma, Though too taper increased tip penetration.
HUB: Metal or plastic, larger than catheter, tapered hubs – easier insertion of guidewire.

17. LENGTH Rt heart catheters- 100 to 125cm.
Lt heart catheters- 100 to 110cm.
125cm for very tall person.

18. General purpose – RIGHT heart catheters
Cournand
Lehman
Goodale–lubin
Balloon floatation catheters

19. ANGIOGRAPHIC CATHETERS
Gensini
NIH
Eppendorf
Lehman ventriculography
Pigtail angiographic catheter
Flow directed angiographic catheter

20. PREFORMED CORONARY CATHETERS
Judkins
Amplatz
Schoonmaker multipurpose catheter
Coronary bypass catheter
Sones
Castillo

21. SPECIALISED CATHETERS
Shirey transvascular catheter
Brockenbrough transeptal catheter
Double lumen catheter
Multilumen catheter
Fogarty catheter
Transducer-tip catheter
Angioscopic catheter
Pacing catheter.

22. COURNAND catheter
Designer: Andre Cournand, End hole radio-opaque woven Dacron catheter with an outer coating of polyurethane.
Construction: very gradual distal curve Tapered tip.
Use : All purpose right heart catheter.
Size : 5 to 8Fr.length – 100 & 125cm.

23. Size : 7 & 8 Fr. length –100cm. SCHOOMAKER MULTIPURPOSE CATHETER
Designer : Dr.Fred W Schoomaker.
Construction: polyurethane with an inner wire braid . A-1 MP:A bend –hockey stick with straight tip 1-one end hole only A-2 MP:2side holes ,1end hole B-1 MP :B bend gradual 90 degree curve,1 end hole only B -2 MP: 2 sideholes and an end hole
Use- CAG & LV,for crossing different lesions PDA and MAPCAcoiling.
Size : 7 & 8 Fr. length –100cm.

24. NIH catheter
Construction: USCI version- woven dacron with a nylon core.Injection at high flow rates 6 sideholes COOK – polyethylene with a stainless steel braid, 4 to 6 sideholes.
Hole : No end hole , only sidehole catheter with a gentle curve.[excellent mixing of contrast ]
Use : visualizing RV.LV,arterial,pulmonary vasculature & great veins.
Size :USCI 5 to 8Fr.length –50, 80,100 cms 125cm.
COOK:6.5,7.3 & 8.2Fr, all 100cm.
Disadvantage : perforation

25. PIGTAIL CATHETER
Designed : Judkins.
Construction: woven dacron coated with polyurethane or polyethylene.
Hole : 4-12 non-laterally opposed sidehole in the terminal 5cm. Terminal 5cm coiled back.
Use : most commonly used LV, aortography & pulmonary angiography.
Size : 6.5,7,3 & 8.2Fr.length – 65,80,100 & 110cm.side holes-4,6,8 or 12.

26. Pigtail catheter
Advantage : least traumatic, less incidence of arrythmia,catheter recoil, intramyocardial injection & cardiac perforation.
Disadvantage : Thrombogenicity, & not for prolonged haemodynamic monitoring.

27. Positrol II pigtail catheter
Construction: polyurethane with stainless steel braid.
Hole : 8 nonlaterally opposed sidehole near the endhole.
Use. most commonly used LV, aortography & pulmonary angiography
Size : 7 & 8Fr. length – 110cm.

28. Nycore high-flow pigtail catheter
Construction: polyurethane over a thin nylon core.
Hole : 8 nonlaterally opposed sidehole near the endhole.
Use: LV, aortography.
Size : 7 & 8Fr. length – 65,80 & 110cm.
Advantage : flow rate equal to one Fr > than designated.

29. Ducor high-flow femoral-ventricular Pigtail catheter
Construction: polyurethane with a stainless steel braid except in tip.
Hole : 12 nonlaterally opposed sidehole near the endhole.
Use: LV, aortography.
Size : 5,7 & 8Fr. length – 65,90 & 110cm.
Advantage : can withstand upto 1000psi.

30. PIG TAIL ANGIOGRAPHIC
12 Side holes evenly disperses contrast in LV QUANTICOR [Cardiomarker pig tail] Radiopaque markers set 2 cm apart Used for quantitative angiography

32. Grollman pigtail catheter
Construction: polyethylene with for spiraled side ports near tip.
Hole : 12 nonlaterally opposed sidehole near the endhole. 60 degree bend.
Use: RV & selective PA angiography.
Size : 5,7 & 8Fr. length – 65,90 & 110cm.
Grollman pigtail catheter

33. VAN TASSEL ANGLED PIGTAIL Construction: polyurethane over a thin nylon core.
Hole : 8 nonlaterally opposed sidehole near the endhole 145˚or 155˚ angle 7cm from the tip.Use: LV, aortography.
Size : 7 & 8Fr. length – 110cm.
Advantage : can cross stenotic aortic valve

34. GOODALE-LUBIN CATHETER
Birdseye catheter.
Construction: woven dacron coated with polyurethane.
Hole : Two laterally opposed sidehole near the endhole.
Use : right heart pressure, including wedge & blood sampling.
Size : 4 to 8Fr.length – 80,100 & 125cm.
Variation :Standard wall –Cournand
Thin wall- Lehman

35. LEHMAN CATHETER;
Thin wall variation of cournand.
Shorter distal curve, increased inner diameter & decreased stiffness.
size-4 to 9Fr.length-50,80,100 &125cm.

36. GENSINI catheter Construction: woven dacron coated with polyurethane.
Hole : Three laterally opposed oval sidehole within 1.5cm of its open tip.
Use : right or left heart, pulmonary & vena cava angiographic studies.
Size : 5 to 8Fr.length – 80,100 & 125cm.
Disadvantage: More arrythmogenic

37. EPPENDORF catheter
Construction: woven dacron coated with polyurethane area 20cm proximal to hub is reinforced with nylon
Hole : closed-end, six laterally opposed sidehole catheter with a gentle curve.
Use : visualizing RV.LV,arterial,pulmonary vasculature & great veins.
Size : 7 to 8Fr.length –100 & 125cm.
Feature: less stiff, & more torque control.

38. GUIDEWIRES Three components Central core that tapers distally.
Flexible tip
Lubricious coating.

39. Fixed & movable core GW 1.spring coils 2.inner safety wire
3.mandrel core
4.flexible tip
5.proximal end

40. Guidewire
First available standard guidewire ’ contains 2 to 3cm,safety wire in the tip
Safetywire is replaced by a ribbon
steerability,trackability,torquability,kink resistence, frictional resistance.
Standard length- 175 to 190cm- usually 20cm longer than the catheter.
For exchange wire-300cm.
Thickness – inch (0.9mm).

41. CORE single or multiple segment.
Provides tensile strength, torque strength, torque transmission & blood compatibility.
Commonly composed of stainless steel.
Nitinol – increased tractability.
Disadvantage- tends to store rather than transmit torque- wire WINDING UP.
Commonly used “workhorse wire” have moderate flexibility & support.

42. Distal tip Platinum or tungsten alloy.
Radiopacity ,flexibilty & blood compatibility.
Radiopacity -2 to 3cm. Rarely 11 to 40cm.
High radiopacity is a feature of more aggressive wire,
Tip load- Amount of force required to deflect the tip into a predetermined configuration. Exp-gms of force.

43. Coating
- silicone, teflon, polytetrafluoroethylene, hydrophilic polymer.
Hydrophilic wire- crosses severe stenosis & total occlusion,

44. J-curve guidewire

45. Coreflex guidewire –solid wire body with spring coils at tip

47. Spring tip wire & Plastic wire
Spring wire:A) stainless steel tip
B) Nitinol tip jointed to stainless steel shaft
Steerability helps
Plastic wire: Little resistence, torquability lost , useful for severe stenosis with heavy calcification.

83. demonstrated that a simple Rubber catheter could be passed to
In 1929 Werner Forssmann
demonstrated that a simple
Rubber catheter could be passed to
the pulmonary artery through the
Anti- Cubital Vein and
An angiographic film could be
obtained using radiographic
contrast.