Cardiac catheters -dr.majella

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.

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.

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

PARTS OF A CATHETER BODY HUB BODY TIP TIP HUB

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.

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.

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)

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.

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.

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.

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

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.

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

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.

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

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

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

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

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

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.

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.

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

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.

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

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.

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.

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.

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

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

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

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

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

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

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.

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

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

Guidewire First available standard guidewire -0.018’ 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 – 0.035 inch (0.9mm).

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.

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.

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

J-curve guidewire

Coreflex guidewire –solid wire body with spring coils at tip

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.

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.