Angiography basics and seldinger technique
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Transcript of Angiography basics and seldinger technique
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Angiography/ Interventional Basics
How do we perform an angiographic procedure?
Dr. ABEER FAWZY EL-SOBKYMASTER of RADIOLOGY
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© Vascular 2007 2
Types of angiographyTypes of angiography
Conventional angiography
Digital subtraction
CT angiography
MR angiography
You can see the bony skeleton
The bony skeleton is subtracted
Index
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So advanced CT, US and MRA techniques made conventional angiography limited to therapeutic purposes (Angioplasty).
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Technique of
angiography
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Personnel in the Angio Room
Radiologist ( or other specialist) Cardiovascular nurse 2-3 Radiologic Technologists (CV) Sometimes Anesthesiologist depending
on the procedure
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Technologist Responsibilities
Prepare Room/ consent forms Provide radiographic positioning / Dr Assistance Knowledge of exam, anatomy, pathology Prepare sterile tray, prep patient Knowledge of catheters and guide wires Know sterile technique/ safe clean up Monitor ECG + pressure Patient care skills and pharmacology
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Angiography/ Interventional/ Cardiovascular
Procedure Room (Suite) Room size- 400-
600 square feet Easily cleaned
(floors, wall, etc.) Outlets needed for
O2, suction.
Control Room 100-150 square feet Easy access and
communication to procedure room
Computers, monitors and un sterile personnel
Storage area- guide wires, catheters and needles
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Equipment found in all Advanced Procedure Rooms
X-ray generators Controls X-ray Tubes System to record events of procedure Automatic Injectors
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X-Ray Tube Requirements
Detail Withstand high heat- rapid exposure
sequences Use smallest possible focal spot
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Equipment Requirements
High heat load tubes w/ rapid cooling Series imaging (up to 3-4 films/sec),
intense heat Analog- to- Digital Conversion System Programmable digital image acquisition
system PACS
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Electromagnetic Injectors
Monitoring Equipment- BP & ECG
Island Tables- access from all sides,
height adjustments, floor controls
Tables do not usually tilt
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Digital Imaging- Analog VS Digital Concepts
Analog- image seen after chemical process
Digital- image manipulated by software Information changed through use of
computer algorithm
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Digital Subtraction Angiography (DSA)
Computer “ subtracts” out all anatomy
except contrast-filled vessels
Looks like a reverse image
Can be more diagnostic for vessels
( clots, constrictions)
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Electromechanical Injector
Used in Angio, CT, MRI Overcome arterial pressure + maintains
bolus Maintains flow rate Flow rate affected by
Viscosity Length + diameter catheter Injection pressure Vessel selected
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Seldinger Technique
Method for catheterization of vessels Developed 1950’s still popular today Percutaneous (through the skin)
technique for arterial and venous access 3 vessels considered:
Femoral –preferred site for arterial (size + accessibility)
Brachial Axillary
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Selection based on strong pulse w/ absence of disease
Site cleaned, area draped, local given
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Seldinger Technique ( step-by-step) Insertion of needle Placement of needle in lumen Insertion Guide wire- thru needle, advance 10
cm Removal of Needle- guide wire in position Threading of catheter to area of Interest- fluoro
used Removal of guide wire- catheter remains in
place
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SELDINGER TECHNIQUE
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Two less common methods used Cut down- minor surgical procedure to
expose vessel of interest Translumbar- patient prone, long needle
passed thru T12- L2 into aorta
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Let’s Look at Needles, Guide wires and Catheters
Cannula
connecting hub (luer
lock)
Baseplate
transparent tubing
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Guidewires
Guide catheter for placement in vessel Guide wire diameter be large enough so blood
can not flow back for too long a time Tips at the end of GW
Straight J- tipped
longer G.W. for selective angio vessels Short used for shorter direct vascular approach
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GUIDEWIRES
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CATHETERS
Straight- end hole only Pigtail- circular tip w/ multiple side
holes to reduce whiplash and control contrast
Sidewinder- curved to facilitate vessel selection
Cobra- variation in curvature to facilitate selection of vessels
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The more holes at the end / the more contrast used/ large vessels
Catheter with only end hole/ smaller vessels/ carotid
Combo end and side holes reduce risk of trauma to vessel, enhances contrast
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CATHETERS
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Interventional Imaging Procedures
Intervene w/ disease, provide therapeutic outcome
Purpose/ benefits Lower risk compared to surgery Less $ Shorter hospital stay and recovery Alternative for non surgical patient
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Preparation to procedure
Anti coagulants- what do these do?
Consent form
NPO 8 hours
Lab tests to test kidney function?
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Post Procedure Care
Catheter removed – compression
applied
Bed rest- min 4 hrs/ head elevated 30
degrees
Vital signs
Extremity watch
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Radiation Protection
> radiation dose to angio team- fluoro Proximity to patient Radiation protection devices Leaded glasses pulled into place Minimal fluoro use as possible Collimation Angio personnel wear badges and ring
monitors
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Contra Indications
Contrast allergy Impaired renal function Blood- clotting disorders Anti coagulant medication Unstable cardio pulmonary/ neurological
status
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Risks/ Complications
Bleeding at puncture site Thrombus formation Embolus formation –plaque dislodged
from vessel wall by catheter Dissection of vessel Puncture site infection ( contaminated
sterile field) Contrast reaction
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