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

663 Pages·2010·9.08 MB·English
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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 Jones & Bartlett Learning Jones & Bartlett Learning Canada Jones & Bartlett Learning International 40 Tall Pine Drive 6339 Ormindale Way Barb House, Barb Mews Sudbury, MA 01776 Mississauga, ON L5V 1J2 Canada London W6 7PA 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 iii 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. vii 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 ix

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