Presentation on theme: "Cardiac catheters. 2 In 1929 Werner Forssmann demonstrated that a simple Rubber catheter could be passed to the pulmonary artery through the antecubital."— Presentation transcript:
2 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.
“Was the key in the lock” – Andre Cournand & Dickinson Richards said in their Nobel lecture in Certainly this key has unlocked the door to expanded diagnostic capabilities & therapeutic interventions. CARDIAC CATHETERS 3
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 HUB BODY TIP HUB BODY TIP
6 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 MEASUREMENT: Most commonly in adult Diagnostic Catheters of 5 – 7 Fr is used.
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)
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. TIP & HUB 16
Rt heart catheters- 100 to 125cm. Lt heart catheters- 100 to 110cm. 125cm for very tall person. LENGTH 17
Cournand Lehman Goodale–lubin Balloon floatation catheters General purpose – RIGHT heart catheters 18
COURNAND catheter Designer: Andre Cournand,1939. 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. 22
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. 23
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 24
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
Advantage : least traumatic, less incidence of arrythmia,catheter recoil, intramyocardial injection & cardiac perforation. Disadvantage : Thrombogenicity, & not for prolonged haemodynamic monitoring. Pigtail catheter 26
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. Positrol II pigtail catheter 27
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. Nycore high-flow pigtail catheter 28
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. Ducor high-flow femoral- ventricular Pigtail catheter 29
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 30
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. 32
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 33
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 34
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 36
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. 37
GUIDEWIRES Three components Central core that tapers distally. Flexible tip Lubricious coating. 38
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). 40
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. 41
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. 42
Coating - silicone, teflon, polytetrafluoroethylene, hydrophilic polymer. Hydrophilic wire- crosses severe stenosis & total occlusion, 43
J-curve guidewire 44
Coreflex guidewire –solid wire body with spring coils at tip 45
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. 47
83 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.