Basics of Cathlab
Basics of Cathlab
Basics of Cathlab
Chiranjeevi Darsi
P G CVT,RCIS,RCES,CCDS,CEPS
Cardiac Physiologist
King’s College Hospital
London,UK
What is Cardiac Catheterization ???
➢ During the procedure a Flexible thin tube called catheter inserted via Arm/leg
Artery or Vein
History
1929 Werner Forssmann credited with being the first person to catheterize a
living person, himself. At age 25, while receiving clinical instruction in surgery in
Berlin, he passed a catheter 65 cm through one of his left antecubital veins,
guiding it by fluoroscopy until it entered his right atrium. He then walked to the
radiology department (upstairs), where the catheter was documented with a
CXR.
1953 Seldinger develops his percutaneous technique of vascular access.
1958 Sones selective coronary arteriography.
1977 Gruntzig introduces the technique of PTCA to open blocked Heart blood
vessels
Heart Anatomy
Control Room
➢ Coronary Angiogram
➢ Percutaneous Coronary Intervention - PCI
➢ Device Implants and Explants
➢ EPS and Ablation RF/Cryo
➢ Left and Right Heart Catheterizations
➢ Valve Implants TAVI/TEER
➢ Pediatric Diagnostic and Interventions
Different types of Equipment
➢ Defibrillator/Crash cart
➢ Temporary Pacemaker Pulse Generator (TPI)
➢ Intra Aortic Balloon Pump (IABP)
➢ LUCAS Chest Compression Device
➢ Intra Vascular Ultra Sound (IVUS)
➢ Optical Coherence Tomography (OCT)
➢ Fractional Flow Reserve (FFR)
➢ Rotablator
➢ Intra Vascular Lithotripsy (IVL)
Procedure Preparation
➢ Consent
➢ Blood Investigations – INR,Cr,Hb,WBC
➢ ECG/NIBP/SP02
➢ Sterile Scrub
➢ Registering in Xray and Hemo system
Patient Preparation
Sterile Patient Preparation for Cath Procedures
Calibrating (‘zeroing’)
• Puncture Needle
• Guide Wire
• Sheath
Catheters
Diagnostic Catheters – Small internal Diameters to use for Diagnostic Purpose
Guiding Catheters – Bigger Internal Diameter to pass Balloon and Stents for Interventional
Procedures
Hemodynamic Monitoring
➢ECG
➢Arterial Blood Pressure
➢NIBP
➢O2 Saturation
➢HR
Normal Intra Cardiac Pressures and Saturations
Pressures Saturation
RA – 0-4mmhg 75%
RV - 25/5 75%
PA - 25/10 75%
PCW - 7-12 98%
LA - 7-12 98%
LV - 120/10 98%
Ao – 120/80 98%
Coronary Anatomy
CAG/PCI
CAG-Coronary Angiogram is a
Procedure to diagnose Heart Blood
vessels card coronary arteries
Special Balloons
Drug Elluting Balloons
Cutting Balloons
Percutaneous Valve Interventions
Heart Rhythm Catheters and Devices (EP)
Rhythm Control Devices
PDA
ASD
VSD
Valve Stenosis
Atrial Septostomy
Physiological Measurements and Imaging
OCT/IVUS
FFR is a measure of blood pressure
difference across a coronary artery Optical Coherence Tomography (OCT) is an intravascular
stenosis to determine if a stenosis is imaging modality that uses near-infrared light to provide high-
physiologically significant, which can definition, cross-sectional and three-dimensional images of
impede oxygen delivery to the heart the vessel microstructure during percutaneous coronary
muscle.1 intervention (PCI)
Other Devices
IVL
The device uses a balloon to deliver Rotablator
sonic pressure waves that can pass
through soft arterial tissue to
Rotational Atherectomy device is used to de bulk the
“preferentially disrupt” calcified plaque
Calcified vessels for optimal stent placement
and optimize stent placement
Emergency Support Devices
LUPAS
ST Elevation
Bradycardia
AV Blocks
VT/VF
Closure Devices
Manual Compression
Angioseal
TR Band
Proglide
Femstop
Complications
➢ Bleeding.
➢ Blood clots.
➢ Bruising.
➢ Damage to the artery, heart or the area where the catheter was
inserted.
➢ Heart attack.
➢ Infection.
➢ Irregular heart rhythms (arrhythmias)
➢ Kidney damage.
Case Closing and Data Saving