wires, catheters & supplimentary equipment tortorici chapter 16 & 17 guidewires * stainless...
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Wires, Catheters & Supplimentary EquipmentTortorici 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
Types
* Multipurpose (for flush studies)
* Selective
* Super selective
* Deflecting
Made of
* Teflon* Polyethylene, or* Polyurethane * Braided or not* Radiopaque or lucent
Characteristics
* Memory
* Torque
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
Pigtail
One of the Judkinsright coronary series.
One of the Judkinsleft coronary series
To prevent clots, cathetersare flushed with heparinizedsaline
Heparin is an anticoagulantProtamine Sulfate is a coagulant
Selecting the right coronary artery
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.
Contrast is black on thefluoroscopic monitor
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
Hub
Baseplate
Stylet orobturator
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
Contrast HeperinizedSaline flush
Strain gaugetransducer
Systolic pressuremeasured throughthe catheter in the left ventricle.
Syringe for hand injections of contrast and flushing catheter
Manifold
Waste fluid
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:
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:
7. Guide wires are typically constructed of:
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