Angiography basics

1. Angiography/
Interventional Basics
What do we visualize with an
angiographic procedure?

2. Personnel in the Angio Room
http://www.heartsite.com/html/cardiac_cath.html
Radiologist/ Specialist
Cardiovascular nurse
2-3 Radiologic Technologists (CV)
Sometimes Anesthesiologist

3. Angiography/ Interventional/
Cardiovascular
Procedure Room (Suite)
Room size- 400-600 square feet
Easily cleaned
Why?
Outlets needed for O2, suction, crash cart
3 means of access to the room (Bushong,
p. 374)
What are they?

4. 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

5. Equipment found in all
Advanced Procedure Rooms
X-ray generators
Controls
X-ray Tubes
System to record events of procedure
Automatic Injectors

6. Generator
700MA- 1500MA
Short exposure times
Able to generate 80- 100 KW power
Limit motion
Provide max. contrast

7. X-Ray Tube Requirements
Detail
Withstand high heat- rapid exposure
sequences
Tube rating charts posted
Need max. detail for vessels
Use smallest possible focal spot
Decrease target angle, p.13…line focus
principle

8. Equipment Requirements
High heat load tubes w/ rapid cooling
Series imaging, intense heat
SPEED UP THE ANODE RPM
 1-2 Track mounted tubes
Analog- to- Digital Conversion System
Programmable digital image acquisition
system (rate,sequencing, processing)
PACS

9. Electromagnetic Injectors
Monitoring Equipment- BP & ECG
Island Tables- access from all sides,
height adjustments, floor controls
Where are the cables?
Tables do not usually tilt

10. Digital Acquisition
2 types
1. Analog-to-Digital
Radiation-pt-intensifier-light-TV-light to
electrical signal- analog-to-digital converter-
image processor
2. Flat detectors
Charged coupled devices (CCD) computer
chip
Direct digital conversion

11. Charge Coupled Device (CCD)
Silicon computer chips
Converts light to digital image
Lower noise
Better contrast
Lower patient dose
Advantage to this type system- images
produced in low light w/o loss of
resolution

12. Digital Imaging- Analog VS
Digital Concepts
Analog- image seen after chemical
process
Digital- image manipulated by software
Relates to numbers
Number table called an array
Information changed through use of
computer algorithm
Advantages of Digital Angiography, p.30

13. 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)
Imaging systems below now mostly
replaced by digital
Cut Film Changer
Cine Fluoro( Cardiac Cath Camera)

14. 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

15. Components
Control panel
Syringe
Heating Device
High- pressure mechanism
Safety Devices
Acceleration regulators
Pressure- limiting devices
MRI- non- ferrous material

16. Vocabulary Terms
Arteriosclerosis- vessels hardened
Atherosclerosis- plaque like cholesterol
Thrombus
Embolus
Occlusion
Tumor
Stenosis
Angioplasty-angio procedure dilates stenosed
vessel

17. Lithotripsy
Stent- cage like metal device placed in
vessel to maintain blood flow
Thrombolysis
Filter
Embolization- stop bleeding, cease
blood flow to site of pathology
Ante grade
Retrograde

18. Seldinger Technique
Method for catheterization of vessels
Developed 1950’s still popular today
Percutaneous (through the skin)
 3 vessels considered:
Femoral –preferred site for arterial (size +
accessibility)
Brachial
Axillary

20. Selection based on
strong pulse w/
absence of disease
Site cleaned, area
draped, local given

21. 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

22. SELDINGER TECHNIQUE

23. 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

24. Contents of Procedure Tray
Variety items 3 basic groups of
equipment
Prep Group
Anesthetic Group
Insertion and removal Contrast
Accessories
Adaptors
Connectors
Manifolds, Stopcocks

25. Let’s Look at Needles, Guide
wires and Catheters
Cannula
stilette
connecting hub (luer
lock)
baseplate
two or three-way
stopcock
transparent tubing

26. Guidewires
Guide catheter for placement in vessel
 Diameter 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

27. CATHETERS
Straight
Pigtail
Sidewinder
Cobra

28. The more holes at the end / the more
contrast / large vessels
Catheter with only end hole/ smaller
vessels/ carotid
Combo end and side holes reduce risk of
trauma to vessel, enhances contrast

29. Vascular/ Non- Vascular
Studies
Embolization pg 711,
Bontrager
Stent Placements
PTA pg 712 ,
Bontrager
Vena Cava Filters
Thrombolysis
Biopsies
Fluid Drainage
Injection of
Medicines
Tube Placement in
Organs or Cavities
Bontrager, pg 716

30. 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

31. Post Procedure Care
Catheter removed – compression
Bed rest- min 4 hrs/ head up 30 degrees
Vital signs
Extremity watch
Some angiographic procedures:
angioplasty, venography,
angiocardiography, lymphography

32. Radiation Protection
Proximity to patient
Radiation protection devices
Leaded glasses pulled into place
Minimal fluoro use
Collimation
 Wear badges and ring monitors

33. Risks/ Complications
Bleeding at puncture site
Thrombus formation
Embolus formation –plaque dislodged
Dissection of vessel
Puncture site infection ( contaminated
sterile field)
Contrast reaction