Wires, Catheters & Supplimentary Equipment Tortorici Chapter 16 & 17 Guidewires * Stainless steel * Solid, or wrapped in teflon for lower coeficient of friction. * Heparin coated Guidewire tips * Tapered tip * Rigid or flexible (floppy) * “J” measured in radii 3cm ave. floppy ends 3mm-3cm

Guide Wires 2 in 1 wires * movable core in teflon wrap allows stiffening of floppy end * Allows for 10-15 cm flop * Handle is called a mandril * Added versitility but increased risk of: unraveling clotting abrasion flaring of end hole in catheter

Guide Wires Length of wires * 30-50 cm for direct vascular puncture * 100-150 average * 100-260 for catheter exchange Diameters * Common diameters .035” - .038” .89mm - .97mm * Range from .014”-.52” (.35-1.32mm)

Guide Wires Wires are matched to * Vessel size (not obstruct) * Needle gauge (no leaking of heme, no sticking) * Catheter lumen On opening package scrub tech inspects: * Visually * Tactily * Bend tip 180o for flexibility

Catheters Characteristics * Memory * Torque Types * Multipurpose (for flush studies) * Selective * Super selective * Deflecting Made of * Teflon * Polyethylene, or * Polyurethane * Braided or not * Radiopaque or lucent Measured in: French * Outer diameter * 1 French = .33mm (4-5 French ave.)

Catheters Tips * Tapered and shaped * End hole only for selective studies, or * End and side holes for large vessels, recoil control * Side holes only for pulmonary and ventriculograms

One of the Judkins left coronary series One of the Judkins right coronary series. Pigtail To prevent clots, catheters are flushed with heparinized saline Heparin is an anticoagulant Protamine Sulfate is a coagulant

Selecting the right coronary artery Contrast is black on the fluoroscopic monitor Under fluoroscopy, as the tip of the catheter probes the area of the origin of the right coronary artery, it will flip into the vessel when found. A few CCs of contrast, hand injected, verifies placement.

Sterile Equipment Packs/ Tray Set-up Disposable or Reuseable Packs * Needles, 18 gague, (thin walled or regular) 2 1/8” – 3 ¼” * Adapters (Male & Female, Tapered, Leur Lok, Tuohy-Borst) * Stopcocks (2 & 3 way), Manifolds * Vessel dilator * Blade * Forceps * Extension tubing * Basins (large and small) * Towels * 4 x 4 gauze (sponges) * Gowns, gloves Cannula Baseplate Hub Stylet or obturator

Sterile Equipment Packs/ Tray Set-up Add to Tray * Antiseptic solution * Contrast * Heparinized saline * Catheters * Guide wires * Sheath * Drape * Razor (not on tray)

Manifold connected to catheter forms a closed system Strain gauge transducer Contrast Heperinized Saline flush Waste fluid Systolic pressure measured through the catheter in the left ventricle. Manifold Syringe for hand injections of contrast and flushing catheter

1. Which of the following guide wires is best for maneuvering around atherosclerotic plaque? 2. Angiographic catheters are typically constructed of: 3. Coating a guide wire with Teflon will decrease its: 4. When changing from a flush to a selective study, the catheter should be twice the length of the guide wire. 5. A ”38” guide wire would have a diameter of: 6. The typical arteriography needle size used for the Seldinger technique is:

7. Guide wires are typically constructed of: 8. The sharpened, solid portion of a two-part needle is termed the: 9. A 6 F catheter would have an outer diameter of: 10. The ability of a catheter to respond to twisting manipulations is termed: 11. Thrombus formation at the catheter tip can be avoided by: 12. Guide wires are typically constructed of: