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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

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 CardiologyNational 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 2014Washington

DC, USA

History• First Cardiac catheterization –▫ 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

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

Technique for vascular access:

The true “Seldinger™ technique” is not used for percutaneous puncture into vessels.

Vascular Sheath

Percutaneous introduction 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 valve4. Lateral tube / flush port

Vascular Sheath

When introduced from 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.

Vascular Sheath

Ideal short 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.

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

Thank [email protected]

Asia Pacific Congress of Hypertension, 2014, February

Cebu city, Phillipines

Seminar on Management of Hypertension,

Gulshan, Dhaka