2demonstrated that a simple Rubber catheter could be passed to In 1929 Werner Forssmanndemonstrated that a simpleRubber catheter could be passed tothe pulmonary artery through theantecubital Vein andAn angiographic film could beobtained using radiographiccontrast.
3CARDIAC 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.
4Ideal characteristics of catheters Better Torque ControlStrengthRadio-opacityFlexibleAtraumatic TipLow Surface frictional resistance for good trackabilityover guide wire.
6MEASUREMENT: 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)*3Most commonly in adult Diagnostic Catheters of 5 – 7 Fr is used.
9What is a Catheter made up of ? Materials:A range of polymers are used for the construction of catheters, including silicone rubber latex andthermoplastic 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)
16TIP & 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.
17LENGTH Rt heart catheters- 100 to 125cm. Lt heart catheters- 100 to 110cm.125cm for very tall person.
18General purpose – RIGHT heart catheters CournandLehmanGoodale–lubinBalloon floatation catheters
22COURNAND catheterDesigner: 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.
23Size : 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 holeUse- CAG & LV,for crossing different lesions PDA and MAPCAcoiling.Size : 7 & 8 Fr. length –100cm.
24NIH catheterConstruction: 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
25PIGTAIL CATHETERDesigned : 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.
26Pigtail catheterAdvantage : least traumatic, less incidence of arrythmia,catheter recoil, intramyocardial injection & cardiac perforation.Disadvantage : Thrombogenicity, & not for prolonged haemodynamic monitoring.
27Positrol II pigtail catheter Construction: polyurethane with stainless steel braid.Hole : 8 nonlaterally opposed sidehole near the endhole.Use. most commonly used LV, aortography & pulmonary angiographySize : 7 & 8Fr. length – 110cm.
28Nycore 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.
29Ducor 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.
30PIG TAIL ANGIOGRAPHIC12 Side holes evenly disperses contrast in LV QUANTICOR [Cardiomarker pig tail] Radiopaque markers set 2 cm apart Used for quantitative angiography
32Grollman 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
33VAN 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
34GOODALE-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 –CournandThin wall- Lehman
35LEHMAN CATHETER;Thin wall variation of cournand.Shorter distal curve, increased inner diameter & decreased stiffness.size-4 to 9Fr.length-50,80,100 &125cm.
36GENSINI 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
37EPPENDORF catheterConstruction: woven dacron coated with polyurethane area 20cm proximal to hub is reinforced with nylonHole : 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.
38GUIDEWIRES Three components Central core that tapers distally. Flexible tipLubricious coating.
40GuidewireFirst available standard guidewire ’ contains 2 to 3cm,safety wire in the tipSafetywire is replaced by a ribbonsteerability,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).
41CORE 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.
42Distal 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.
43Coating- silicone, teflon, polytetrafluoroethylene, hydrophilic polymer.Hydrophilic wire- crosses severe stenosis & total occlusion,
47Spring tip wire & Plastic wire Spring wire:A) stainless steel tipB) Nitinol tip jointed to stainless steel shaftSteerability helpsPlastic wire: Little resistence, torquability lost , useful for severe stenosis with heavy calcification.
83demonstrated that a simple Rubber catheter could be passed to In 1929 Werner Forssmanndemonstrated that a simpleRubber catheter could be passed tothe pulmonary artery through theAnti- Cubital Vein andAn angiographic film could beobtained using radiographiccontrast.