Invasive Cardiology: A Manual for Cath Lab Personnel, Third Edition (Learning Cardiology)

663 Pages·2010·9.08 MB·English

by  Sandy Watson, Kenneth A. Gorski

INVASIVE
CARDIOLOGY
A MANUAL FOR CATH LAB PERSONNEL
THIRD
EDITION
Sandy Watson, RN, BN, NFESC
Swiss Cardiovascular Centre
University Hospital, Bern, Switzerland
Kenneth A. Gorski, RN, RCIS, RCSA, FSICP
Cardiovascular Laboratories
Cleveland Clinic Heart and Vascular Institute
Cleveland, Ohio
World Headquarters
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978-443-5000 United Kingdom
CONTENTS
Preface ............................................................. v 6 Cardiac Computer Tomography.................... 91
J. David Wilson
Foreword........................................................ vii
7 C ardiac Magnetic Resonance
Dedication ...................................................... ix Imaging......................................................... 99
Contributors ................................................... xi Jane M. Kasper
Sandy Watson
Reviewers ........................................................xv
8 A sepsis in the Cardiovascular
1 Introduction ................................................... 1 Catheterization Laboratory ......................... 107
Sandy Watson Rachael Ramsamujh
Kenneth A. Gorski Brenda Ridley
2 Cardiovascular Anatomy and Physiology......... 7 9 Cath Lab Staff Duties ................................. 119
Jeff Davis Sandy Watson
3 E lectrocardiology and Rhythm Jeff Hunter
Interpretation................................................ 29 10 N ursing Care of the Interventional
Rick Meece Cardiac Procedure Patient ........................... 131
Neil E. Holtz Marsha Holton
A ppendix: Quick Guide to ECG 11 Diagnostic Catheterization.......................... 143
Interpretation................................................ 49 Darren Powell
4 Radiography.................................................. 61 Carl F. Moxey
Murray Crichton 12 Hemodynamics ........................................... 163
5 Contrast Media ............................................. 81 Sandy Watson
Charles C. Barbiere Jeff Davis
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iv Contents
13 Intravascular Ultrasound ............................. 187 27 Pediatric Interventional Cardiology............. 413
Kenneth A. Gorski Monica Arpagaus-Lee
Loren D. Brown
14 F unctional Assessment of Coronary
Disease........................................................ 201 28 P ercutaneous Carotid Angiography and
Kenneth A. Gorski Intervention ................................................ 433
Sandy Watson Daniel Walsh
Stephanie Ray
15 P ercutaneous Transluminal Coronary
Sharon Holloway
Angioplasty ................................................. 211
Rick Meece 29 R enal Artery Interventions .......................... 441
Kenneth A. Gorski Brenda McCulloch
16 Intracoronary Stents.................................... 227 30 Lower Extremity Angiography and
Sandy Watson Intervention ................................................ 453
Kenneth A. Gorski Charles C. Barbiere
17 Distal Embolization Protection ................... 239 31 E ndovascular Abdominal
Brenda McCulloch Aneursym Repair ........................................ 463
Corissa Pederson Matin Ghorbati
18 A threctomy and Thrombectomy ................. 245 32 Foreign Body Retrieval................................ 471
Kenneth A. Gorski Sandy Watson
19 Cardiac Defect Closure Devices .................. 257 33 E mergencies in the Cardiac Catheterization
Sandy Watson Laboratory .................................................. 477
Charles C. Barbiere
20 Septal Alcohol Ablation............................... 267
Sandy Watson 34 Defibrillation and Resynchronization.......... 491
Ilcias G. Vargas
21 P ercutaneous Valve Commissurotomy,
Repair, and Replacement............................. 271 35 I ntra-Aortic Balloon Pump and
Sharon Holloway Other Cardiac Assist Devices ...................... 497
Rena L. Silver Brenda McCulloch
22 Endomyocardial Biopsy............................... 293 36 Balloon Pericardotomy................................ 513
Arlene Ewan Sharon Holloway
23 Electrophysiology........................................ 303 37 Temporary Cardiac Pacing .......................... 517
Elizabeth A. Ching Patrick Hoier
Stephanie Lavin
38 Cardiac Pharmacology ................................ 535
Henry L. Blair
John E. Hawk
24 Cardiac Pacing ............................................ 323 Sherri L. Derstine-Hawk
Laura Nyren Ryan Bickel
Lezlie Bridge
39 Cardiovascular Research ............................. 557
25 Implantable Cardioverter Defibrillators....... 365 Regina Deible
Laura Nyren Leslie Sweet
Joan M. Craney
Glossary ....................................................... 573
Phyllis J. Gustafson
Index .......................................................... 601
26 Hemostasis and Vascular Closure Devices ... 393
Kenneth A. Gorski
Thomas H. Maloney
PREFACE
The cardiac catheterization laboratory is one of very few have been written to address the train-
the most fascinating areas of medicine to work ing needs of nonphysician members of the team.
in. In these small procedure rooms, a team of This text was been written by cath lab nurses and
physicians, nurses, and cardiovascular invasive technicians for cath lab nurses and technicians. It
specialists perform diagnostic examinations and has been designed not only to be a helping hand
therapeutic procedures on patients’ hearts with to those just starting out in the specialty but also
plastic tubes and wires. The level of technology to serve as a reference for those who have been
used in modern cardiovascular labs provides a working in our field for some time
continual challenge to the cath lab professional. We would like to thank the Swiss Cardiovas-
Despite this, patient care is the central pillar cular Centre at the University Hospital of Bern,
upon which our work rests. The patient is the Switzerland, and the Cleveland Clinic in Cleve-
common denominator in each of the areas cov- land, Ohio, for providing an environment in
ered in this book. which such an undertaking can be nurtured.
Many excellent textbooks dedicated to the
field of cardiac catheterization are available, but SANDY WATSON AND KENNETH A. GORSKI
v
FOREWORD
The nurses and technicians working in cardiac In the beginning, angioplasty was an elective
catheterization laboratories and the postinter- procedure, performed in a generous time frame
ventional care units have played a pivotal role in during office hours. Today, it is often an emer-
coronary angioplasty from the very first case on gency procedure, performed at odd hours, on
September 16, 1977, in Zürich. The inventor patients for whom every minute counts, and
of the method, Andreas Grünzig, relied heavily in an environment where the emphasis is on
on their background work, their help with the efficiency.
equipment, and their attention to the needs of New techniques and devices constantly come
the patients. and go. Some of them need little preparation, as
Originally, it was the preparation of the bal- does the stent that is now an integral part of the
loons and the sophisticated pneumatic inflation angioplasty procedure in virtually all cases. Some,
device that took up most of the time of the assis- however, are intricate and only manageable by an
tant nurse or technician. Over the years, inflation experienced and well-trained hand; these include
devices became simpler and balloon preparation lasers, atherectomy devices, intracoronary filters
unnecessary. The catheterization laboratory tech- and clot removers, ultrasound equipment for 2D
nicians and nurses have become more and more or 3D imaging, Doppler flow or intracoronary
intimately involved in the procedure itself. In pressure assessments, or invasive tools used to as-
many places, they assist the responsible physician sess plaque vulnerability. Drugs need to be pre-
with sterile manipulations at the table, either as a pared in specified dilutions to be injected either
sole assistant or as a member of a team of nurses, manually into the coronary artery, another vessel,
technicians, and physicians. or through infusomats or pressurized fluid lines.
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viii Foreword
Customization, calibration, and initial trouble- volume operators. It has also been shown con-
shooting of the X-ray equipment and equipment clusively that this deficiency is corrected when
that monitors the patient’s vital signs also fall into low-volume operators work in the realm of an
the responsibilities of nurses and technicians at experienced catheterization laboratory (with the
many invasive-interventional cardiac laboratories. help of experienced catheterization personnel).
Finally, percutaneous left ventricular assist devices, The book that you are holding in your hands
such as the Tandem Heart or the Impella pump, is the product of a tremendous amount of
can only act as true lifesavers with a team of doc- individual and collective brain work, sweat, and
tors, nurses, and technicians who are highly quali- dedication. While being created, it had to be con-
fied, motivated, and available around the clock. stantly adapted to new knowledge, new data, and
Moreover, most laboratories extend their range new ideas. Once printed, these adaptations have
of action to peripheral vessels, such as the aorta to take place in the minds of the reader—at least
leg, renal, and carotid arteries. New techniques until the next edition.
for procedures in and around the heart emerge Each individual chapter can and should be
that again need expert knowledge and manual used independently. Each reflects primarily the
dexterity. Such interventions include diagnostic experience, the policies, the techniques, and the
and therapeutic electrophysiology; implantation thoughts of its author. There may be significant
or exchange of complex pacemaker systems or divergence from the reader’s personal view of the
percutaneous cardioverter-defibrillator-pacers; topic as formed by his or her teachers and places
percutaneous valve repairs or replacements; shunt of work. This is intentional and overediting of
closure devices for patent foramen ovala, atrial the chapters has been carefully avoided because
septum defects, ventricular septum defects, or the this would transform them into a confusing enu-
patent ductus arteriosus; embolizations of fistulae; meration of possible ways to do things. Marry-
septal alcohol injection for ablation of obstructive ing the described technique, which invariably
hypertrophic cardiomyopathy; and pericardial is a valid and seasoned one, with the technique
balloon fenestrations. The preceding list is not used by the reader, should improve the overall
exhaustive and is growing virtually by the year. performance.
Because many physicians practicing interven- Thanks go to all the contributors whose names
tional cardiology and associated procedures have are listed, but also to all those that remain anony-
a relatively large caseload, there is no way that mous. They made invaluable suggestions to the
they can keep abreast of all the minute details authors either before or after seeing the text or
of the different techniques and devices. That is they simply trained the authors, thereby impart-
where the importance of the laboratory assistants ing their expertise, style, and knowledge on their
comes into play most conspicuously. They typi- disciples.
cally participate in all the cases performed at the We are convinced that this book harbors a
institution. They assimilate the experience of all wealth of valuable information and teaching ma-
physicians practicing in the particular institution terial. We are hopeful that it will be a captivating
collectively, and they add their own continued reading experience and some fun, too. It is quite
professional education and brainpower. They are likely that many a young doctor in training in
the living reference book and equipment manual this field will grab the book, flip a few pages, and
for the physician. wind up reading it all and learning more than she
It has been shown conclusively that low- or he might wish to admit.
volume operators produce inferior results with
interventional cardiology compared with high- BERNHARD MEIER
DEDICATION
To the women who surround me: Laura, Eva, and Giuljana;
you are the color in my days. Thank you for sharing your lives with me.
It is a privilege to be here with you. I also thank my mother, Alison Watson,
for this wonderful life that she has given me.
SANDY WATSON
To my wife, Cathy, and my three wonderful boys, David, Kenny, and Jonathan,
who pray for me daily, and to Mom and Dad, Evelyn and Bob Gorski.
I cannot remember you ever putting your personal wants or needs before those
of the family; your examples taught me the values of honesty and hard work.
Thank you all for being there.
KENNETH A. GORSKI
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