Cardiac catheters. 2 In 1929 Werner Forssmann demonstrated that a simple Rubber catheter could be...

-DR.MAJELLA

Cardiac catheters

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In 1929 Werner Forssmann demonstrated that a simple Rubber catheter could be passed to the pulmonary artery through the antecubital Vein and An angiographic film could be obtained using radiographic contrast.

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“Was the key in the lock” – Andre Cournand & Dickinson Richards said in their Nobel lecture in 1956.

Certainly this key has unlocked the door to expanded diagnostic capabilities & therapeutic interventions.

CARDIAC CATHETERS

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Ideal characteristics of catheters

Better Torque Control

Strength

Radio-opacity

Flexible

Atraumatic Tip

Low Surface frictional resistance for good trackability over guide wire.

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PARTS OF A CATHETER

HUB

BODY

TIPHUB

BODY

TIP

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FRENCH CATHETER SCALE:

The French catheter scale is commonly used to measure the outer diameter of cylindrical medical instruments including catheters, needles etc.

D(mm) = Fr/3 or Fr = D(mm)*3

MEASUREMENT:

Most commonly in adult Diagnostic Catheters of 5 – 7 Fr is used.

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Thick walled- Accentuates pressure waveform-systolic overshoot & diastolic dips.

Thin walled _ Improves monitoring, blood sampling & flushing abilities, decrease thrombogenicity.

Disadvantage – less torque control, not suitable high pressure injection.

SIZE – wall thickness

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What is a Catheter made up of ?Materials:

A range of polymers are used for the construction of catheters, including silicone rubber latex and thermoplastic elastomers. Silicone is one of the most common choices because it is inert and unreactive to body fluids and a range of medical fluids with which it might come into contact.Materials:CATHETER:Polyvinylchloride (PVC)Polyethylene (PE)Fluoropolymers (PTFE) (TEFLON)Polyurethane (PUR)Silicone (SI)

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Very maneuverable & flexible. Covered by polyurethane coating –

reduce vascular trauma. Nylon core-increase bursting

pressure Nylon – great mechanical & physical

strength, reduced friction coefficient. Eg- USCI Cournand, birds eye,

eppendorf & sones.

DACRON

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Stiffness inbetween polyurethane & Teflon.

Selective injection. More thrombogenic than PVC,

polyurethane, silicone catheters. Stainless steel mesh braid improves

rotational control & increase bursting pressure.

Eg – pigtail angiographic catheters (cook), judkins catheters, NIH & cournand.

POLYETHYLENE

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Excellent memory – Superselective injection.

Softer than polyethylene or Teflon. Increased thrombogenicity Reshaped if immersed in boling

water. Eg – pigtail angiographic (cordis)

catheters & original judkins catheters.

POLYURETHANE

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Stiffest. Poor memory. Low friction coefficient. Eg – Brockenbrough catheters,

transducer-tip catheters & introducer sheaths.

TEFLON

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Softest & flexible. High friction coefficient- venous spasm. Increased thrombogenicity. Very poor tensile strength ( memory) Cant be reformed. Most hydrophilic. Drugs absorbed- NTG, insulin,

diazepam,thiopentone. Eg- Balloon-tip flow directed catheters.

POLYVINYL CHLORIDE

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CHARACTERISTIC

TEFLON POLYETHYLENE

POLYURETHANE PVC

FRICTION COEFFICIENT

0.04 0.21 1.35 2.0

STIFFNESS +4 +3 +2 +1

MEMORY Good Excellent Excellent Fair

MOISTURE ABSORPTION (% 24 HRS)

0 0.015 0.9 0.75

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TIP: Neither blunt nor too sharp, soft & flexible.

Bullet nose tip- least trauma, Though too taper increased tip penetration.

HUB: Metal or plastic, larger than catheter, tapered hubs – easier insertion of guidewire.

TIP & HUB

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Rt heart catheters- 100 to 125cm. Lt heart catheters- 100 to 110cm. 125cm for very tall person.

LENGTH

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Cournand Lehman Goodale–lubin Balloon floatation catheters

General purpose – RIGHT heart catheters

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Gensini NIH Eppendorf Lehman ventriculography Pigtail angiographic catheter Flow directed angiographic catheter

ANGIOGRAPHIC CATHETERS

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Judkins Amplatz Schoonmaker multipurpose catheter Coronary bypass catheter Sones Castillo

PREFORMED CORONARY CATHETERS

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Shirey transvascular catheter Brockenbrough transeptal catheter Double lumen catheter Multilumen catheter Fogarty catheter Transducer-tip catheter Angioscopic catheter Pacing catheter.

SPECIALISED CATHETERS

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COURNAND catheter

Designer: Andre Cournand,1939.End hole radio-opaque woven Dacron catheter with an outer coating of polyurethane.

Construction: very gradual distal curve Tapered tip.

Use : All purpose right heart catheter. Size : 5 to 8Fr.length – 100 & 125cm.

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SCHOOMAKER MULTIPURPOSE CATHETER Designer : Dr.Fred W Schoomaker.

Construction: polyurethane with an inner wire braid

.A-1 MP:A bend –hockey stick with straight tip 1-one end hole only A-2 MP:2side holes ,1end hole

B-1 MP :B bend gradual 90 degree curve,1 end hole only

B -2 MP: 2 sideholes and an end hole Use- CAG & LV,for crossing different lesions

PDA and MAPCAcoiling.

Size : 7 & 8 Fr. length –100cm.

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NIH catheter

Construction: USCI version- woven dacron with a nylon core.Injection at high flow rates 6 sideholesCOOK – polyethylene with a stainless steel braid, 4 to 6 sideholes.

Hole : No end hole , only sidehole catheter with a gentle curve.[excellent mixing of contrast ]

Use : visualizing RV.LV,arterial,pulmonary vasculature & great veins.

Size :USCI 5 to 8Fr.length –50, 80,100 cms 125cm.

COOK:6.5,7.3 & 8.2Fr, all 100cm. Disadvantage : perforation

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PIGTAIL CATHETER Designed : Judkins. Construction: woven dacron coated

with polyurethane or polyethylene. Hole : 4-12 non-laterally opposed

sidehole in the terminal 5cm. Terminal 5cm coiled back.

Use : most commonly used LV, aortography & pulmonary angiography.

Size : 6.5,7,3 & 8.2Fr.length – 65,80,100 & 110cm.side holes-4,6,8 or 12.

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Advantage : least traumatic, less incidence of arrythmia,catheter recoil, intramyocardial injection & cardiac perforation.

Disadvantage : Thrombogenicity, & not for prolonged haemodynamic monitoring.

Pigtail catheter

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Construction: polyurethane with stainless steel braid.

Hole : 8 nonlaterally opposed sidehole near the endhole.

Use. most commonly used LV, aortography & pulmonary angiography

Size : 7 & 8Fr. length – 110cm.

Positrol II pigtail catheter

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Construction: polyurethane over a thin nylon core.

Hole : 8 nonlaterally opposed sidehole near the endhole.

Use: LV, aortography. Size : 7 & 8Fr. length – 65,80 &

110cm. Advantage : flow rate equal to one

Fr > than designated.

Nycore high-flow pigtail catheter

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Construction: polyurethane with a stainless steel braid except in tip.

Hole : 12 nonlaterally opposed sidehole near the endhole.

Use: LV, aortography. Size : 5,7 & 8Fr. length – 65,90 &

110cm. Advantage : can withstand upto

1000psi.

Ducor high-flow femoral-ventricular Pigtail catheter

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PIG TAIL ANGIOGRAPHIC

12 Side holes evenly disperses contrast in LV

QUANTICOR [Cardiomarker pig tail] Radiopaque markers set 2 cm apartUsed for quantitative angiography

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Grollman pigtail catheter Construction: polyethylene with for

spiraled side ports near tip. Hole : 12 nonlaterally opposed

sidehole near the endhole. 60 degree bend.

Use: RV & selective PA angiography. Size : 5,7 & 8Fr. length – 65,90 &

110cm.

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VAN TASSEL ANGLED PIGTAIL Construction: polyurethane over a thin nylon core.

Hole : 8 nonlaterally opposed sidehole near the endhole 145˚or 155˚ angle 7cm from the tip.Use: LV, aortography.

Size : 7 & 8Fr. length – 110cm. Advantage : can cross stenotic

aortic valve

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GOODALE-LUBIN CATHETER Birdseye catheter. Construction: woven dacron coated with

polyurethane. Hole : Two laterally opposed sidehole

near the endhole. Use : right heart pressure, including

wedge & blood sampling. Size : 4 to 8Fr.length – 80,100 & 125cm. Variation :Standard wall –Cournand Thin wall- Lehman

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LEHMAN CATHETER; Thin wall variation of cournand. Shorter distal curve, increased

inner diameter & decreased stiffness.

size-4 to 9Fr.length-50,80,100 &125cm.

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GENSINI catheter

Construction: woven dacron coated with polyurethane.

Hole : Three laterally opposed oval sidehole within 1.5cm of its open tip.

Use : right or left heart, pulmonary & vena cava angiographic studies.

Size : 5 to 8Fr.length – 80,100 & 125cm.

Disadvantage: More arrythmogenic

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EPPENDORF catheter

Construction: woven dacron coated with polyurethane area 20cm proximal to hub is reinforced with nylon

Hole : closed-end, six laterally opposed sidehole catheter with a gentle curve.

Use : visualizing RV.LV,arterial,pulmonary vasculature & great veins.

Size : 7 to 8Fr.length –100 & 125cm. Feature: less stiff, & more torque control.

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GUIDEWIRES

Three components Central core that tapers distally.

Flexible tip Lubricious coating.

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Fixed & movable core GW 1.spring coils 2.inner safety

wire 3.mandrel

core 4.flexible tip 5.proximal

end

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Guidewire

First available standard guidewire -0.018’ contains 2 to 3cm,safety wire in the tip

Safetywire is replaced by a ribbon steerability,trackability,torquability,kink

resistence, frictional resistance. Standard length- 175 to 190cm- usually

20cm longer than the catheter. For exchange wire-300cm. Thickness – 0.035 inch (0.9mm).

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CORE

single or multiple segment. Provides tensile strength, torque strength,

torque transmission & blood compatibility. Commonly composed of stainless steel. Nitinol – increased tractability. Disadvantage- tends to store

rather than transmit torque- wire WINDING UP.

Commonly used “workhorse wire” have moderate flexibility & support.

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Distal tip

Platinum or tungsten alloy. Radiopacity ,flexibilty & blood

compatibility. Radiopacity -2 to 3cm. Rarely 11 to

40cm. High radiopacity is a feature of more

aggressive wire, Tip load- Amount of force required

to deflect the tip into a predetermined configuration. Exp-gms of force.

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Coating

- silicone, teflon, polytetrafluoroethylene, hydrophilic polymer.

Hydrophilic wire- crosses severe stenosis & total occlusion,

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J-curve guidewire

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Spring tip wire & Plastic wire Spring wire:A) stainless steel tip B) Nitinol tip jointed to stainless steel

shaft Steerability helps Plastic wire: Little resistence,

torquability lost , useful for severe stenosis with heavy calcification.

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In 1929 Werner Forssmann demonstrated that a simple Rubber catheter could be passed to the pulmonary artery through the Anti- Cubital Vein and An angiographic film could be obtained using radiographic contrast.