Pulmonary artery catheterization

Pulmonary artery catheterization

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  Pulmonary Artery Catheterization Dr.Md.Toufiqur Rahman MBBS, FCPS, MD, FACC, FESC, FRCPE, FSCAI, FAPSC, FAPSIC, FAHA, FCCP, FRCPG Associate Professor of Cardiology National Institute of Cardiovascular Diseases(NICVD), Sher-e-Bangla Nagar, Dhaka-1207 Consultant, Medinova, Malibagh branch Honorary Consultant, Apollo Hospitals, Dhaka and STS Life Care Centre, Dhanmondi [email protected] CRT 2014 Washington DC, USA
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  History • First Cardiaccatheterization – ▫ According to Andre Cournand, it was first performed by Claude Bernard in 1844, in a horse, both rt and lt ventrilces were entered by retrograde approach from the jugular vein and carotid artery ▫ Werner Forssmann is credited with performing the first cardiac catheterization of a living person himself, at the age of 25 yrs • Forssmann for his contribution and foresight shared the Nobel Prize in Medicine with Andre Cournand and Dickinson Richards in 1956
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  History • 1929- Dr.Warner Forssman proven that right heart catheterization is possible in humans • 1964- Dr. Bradley introduced small diagnostic catheter • 1970- Balloon Flotation Catheter by Doctor H.J.C Swan and William Ganz
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  Technique for vascularaccess:  The true “Seldinger™ technique” is not used for percutaneous puncture into vessels.
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  Vascular Sheath  Percutaneousintroduction and then the use of an indwelling vascular sheath in vessels is the standard technique for catheterization of pediatric and congenital heart patients.  Ideal sheath should have: 1. Dilator  1. long, fine and smoothly tapered tip. 2. inner lumen of the dilator tip should tightly fit over the guide wire 3. tip of the dilator should have a smooth, fine transitional taper onto the surface of the wire. 2. female Lure™ lock connecting hub at the proximal end 3. back-bleed valve 4. Lateral tube / flush port
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  Vascular Sheath When introducedfrom the inguinal area, the sheath should be long enough to extend into the common iliac vein. In small infants a sheath into the femoral vein should extend proximal to the formation of the inferior vena cava.
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  Vascular Sheath  Idealshort sheath (7.5 cm long) for venous site –  5 Fr for an infant or child (<15– 20 Kg) and  7 Fr for a larger child or adult  Extra long sheaths (45 to 90 cm ) are used to – 1. guide catheters directly and repeatedly to an area within the heart itself (biopsies, blade catheters), 2. for trans septal procedures, 3. to deliver special devices within the heart or great vessels (stents, occlusion devices), and 4. for the withdrawal of foreign bodies from the vascular system.
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  Swan-Ganz Catheter(Pulmonary Artery Catheterization) •Swan-Ganz Catheter- Balloon flotation Pulmonary Artery catheter • Use for monitoring critically ill patients (mostly in the ICU) • Catheterization only possible on the right side of the heart • Catheter is hooked up to a Cardiac Output computer
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  Thank [email protected] Asia PacificCongress of Hypertension, 2014, February Cebu city, Phillipines Seminar on Management of Hypertension, Gulshan, Dhaka