3. 3
DEFINITION:
A catheter is a hollow flexible tube that can be inserted into a body
cavity, duct or vessel. Catheters thereby allow drainage or injection of fluids
, distend a passageway or provide access by surgical instruments.
The process of inserting a catheter is catheterization.
In most uses a catheter is a thin,
flexible tube: a "soft" catheter;
in some uses,
it is a larger, solid tube: a "hard" catheter.
The first curve is called primary curve for
Engagement.
The second curve is called secondary curve
to give support to that Catheter against the
Vessel wall.
4. 4
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)
Fluoropolomers (PTFE) (TEFLON)
Polyurethane (PUR)
Silicone (SI)
5. 5
PARTS OF A CATHETER
HUB
BODY
TIP
HUB
BODY
TIP
6. 6
FRENCH CATHETER SCALE:
The French catheter scale (most correctly abbreviated as Fr, but also often
abbreviated as FR or F) is commonly used to measure the outer diameter of
cylindrical medical instruments including catheters ,needles etc.
In the French Gauge system as it is also known, the diameter in millimeters of the
catheter can be determined by dividing the French size by 3, thus an increasing
French size corresponds with a larger diameter catheter.The following equations
summarize the relationships:
D(mm) = Fr/3 or Fr = D(mm)*3
MEASUREMENT:
Most commonly in adult DiagnosticCatheters of 5 – 7 Fr is used.
7. 7
TYPES OF CATHETERS:
CLASSIFICATION :
Catheters can be classified depending on
SIDE HOLES :
-: Single Hole
-:End Hole with side holes.
-:Blocked end with side holes only.
SIZES :
Abdominal – 6-80 cm
Thoracic or Carotid Arteries – 100-120 cm
NOTE: Size depends on :
> age of the patient
> selective or super selective study
> size of the vessels.
NOTE: Ideal practice is to use the smallest diameter catheter feasible for
any particular study to minimize the risk of arterial damage by the
procedure.
9. 9
Some Other Types of Catheters:
Hydrophilic Catheters :
Hydrophilic-coated catheters have a layer of polymer
coating that is bound to the catheter surface.
The polymer absorbs and binds water to the catheter,
resulting in a thick, smooth and slippery surface.
Intermittent Catheters:
Intermittent catheters are hollow tubes used to drain
urine from the bladder.
Pediatric Catheters:
Usually its around 80cm.
10. Different Catheter Curves
For Different Purposes:
> Judkins Left (JL)
> Judkins Right ( JR)
> Judkins Left ShortTip
> Judkins Right ShortTip
> Amplatz Left ( AL)
> Amplatz Right ( AR)
> Left Coronary Bypass
> Right Coronary Bypass
> Cardiac Pigtail
> Multipurpose
11. 11
CATHETERS CAN BE BROADLY CLASSIFIED
UNDER THESE GROUPS:
DIAGNOSTIC CATHETERS
Used for Angiographs .
GUIDING CATHETERS
Used for Angioplasty.
• Guiding catheters are like angiography catheters only difference is that
guiding catheters are more stiffer & firm as it carries Balloon catheters,
PTCA wires and stent delivery system.
• Mild stiffness comes due to the wire braided design.
• Good Push ability .
• GoodTractability.
12. 12
PUNCTURE NEEDLES:
Used to cannulate or puncture the artery.
Usual Sizes include
18 ga, 19 ga , 20ga, 21 ga.
The selection of the Size depends on
the guide wire going to be inserted
through that needle port.
Seldinger Needle
13. 13
GUIDE WIRE:
Diagnostic guide wires are used to traverse vascular anatomy to aid in
placing catheters and other devices. Guide wires are used for both
Cardiology and Radiology angiographic procedures.
• Guide wires are relatively simple spring type wires that
provides necessary firmness and the control to the site where
Angiogram will be taken.
• A the name suggests it ‘ Guides’ the catheter.
• PTFE coated Soft tip for the smoothness during the insertion
• Less trauma to the intimal wall of the artery
15. 15
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.
16. 16
Sven- Ivar Seldinger
In 1953 ,
Sven –Ivar Seldinger invented
The technique of gaining access
Percutaneusly into an artery
without An arteriotomy.
17. 17
TECHNIQUE OF INSERTING A CATHETER
SELDINGER TECHNIQUE:
The technique of catheter insertion via
double-wall needle puncture and guide-wire is known as
The SELDINGER TECHNIQUE.
DoubleWall Puncture:
Mostly done.
Compression to prevent Hematoma of the other wall.
Rotatory movement to get the needle into the lumen.
SingleWall Puncture:
Usually done for patients co-agulation time is less.
22. OTHER CATHETERS
GUIDEWIRES USED IN
ANGIOGRAPHY
1. TEREMO WIRE
2. TIGER CATHETER
MULTIPURPOSE FOR
BOTH LEFT AND
RIGHT CORONARY
3. CATHETER FOR
ANOMALOUS ORIGIN
OF RT CORONARY
AND IN PDA
23. INTERVENTION THERAPIES FOR
HEPATIC MALIGNANCIES
BENIGN BILIARY OBSTRUCTION
MALIGNANT BILIARY OBSTRUCTION
PERCUTANEOUS MANAGEMENT OF
PORTAL HYPERTENSION
PERCUTANEOUS CHOLECYSTOSTOMY
PERCUTANEOUS MANAGEMENT OF
BILIARY CALCULI
24. Regional arterial infusion and
chemoembolisation is the most common
technique used in hepatic malignancies
Chemoembolisation agents should have
characters of rapid first pass clearence, steep
dose response curve
Temporary agents commonly used are gelfoam
cause recanalisation in 4-6 weeks
Permanent are polyvinyl alcohol cause
angiogenesis
Lipiodol is agent used for diagnostic imaging
in liver
25. The arterial supply of the liver is mapped out and portal vein
patency is established, catheterization of the hepatic arteries is
undertaken. With the new lubricious coatings, this usually can be
accomplished with 5.0-5.5 French catheters
cirrhosis and hepatocellular carcinoma coexist frequently in
patients with chronic hepatitis, the portal circulation should also be
assessed for hepatofugal flow.
Because the hepatic artery is to be embolized intentionally,
confirmation of portal vein patency is essential. This can be
accomplished with superior mesenteric or splenic artery
angiography to rule out thrombosis
repeated chemoembolizations, the blood supply of the liver must
be reassessed continuously because different flow patterns will
emerge over time this is mainly due to collateral formation from the
“culprit vessels” from peripheral arteries
31. HYPERVASCULA
R LIVER TUMOUR
AND FISTULA
FROM LEFT
HEPATIC ARTERY
TO IVC
COIL BLOCKAGE
OF FISTULA
BEFORE
CHEMOEMBOLIS
ATION TO
PREVENT LEFT
TO RIGHT SHUNT
33. RADIOFREQUENCY ABLATION
underlying principle is the local creation of heat, via a percutaneously or
surgically placed probe, that destroys tumor tissue while insulating and
sparing adjacent normal liver.
using probes as small as 15-gauge to 17-gauge needles, alternating
current causes tissue coagulation by frictional heating. Tumor tissue is
ablated as temperatures reach 50-100 C, and yet, noncancerous tissue
as close as 0.5 cm away is spared
34. Complete and accurate demonstration of the bile duct
obstruction and of the bile ducts above and below the lesion is
a key element in the management of bile duct stenoses and
obstructions. This will usually require opacification of the bile
ducts by percutaneous transhepatic cholangiography
(PTC), endoscopic retrograde cholangiopancreatography
(ERCP), or injection of contrast through any indwelling
catheters such as T tubes.
Procedures performed are:-
Dilatation
Endoprosthesis
Metallic stenting
35. Dilatation
percutaneous biliary dilatation using balloon dilation catheters include
those of Burhenne (1975) via a T-tube tract and of Molnar and Stockum
(1978) via the transhepatic route.
The balloon size should match the estimated caliber of the duct on
either side of the stricture and is usually in the 4- to 8-mm range. Duct
rupture is most unusual with correctly sized balloons even though high
pressures (up to 16 atm) are not infrequently needed to dilate the
stricture. Progress in balloon manufacture now provides balloons that
can be used at up to 20 atmospheres in pressure. Stricture dilatation
can be very painful, and adequate sedation and pain control are
important.
A drainage catheter, of 10-12 French and occasionally 14 French, is left
across the stricture for 6 weeks and then exchanged for a new self-
retaining catheter positioned in the biliary tree above the stricture.
36. POSITION OF PATIENT FOR PTBD AND THE OPACIFICATION
OF BILIARY RADICLE AS SHOWN IN THE SECOND IMAGE
WITH DILATION OF CBD
37. PATIENT WITH OPEN CHOLECYSTECTOMY AND DAMAGE TO
RIGHT HEPATIC DUCT WHICH WAS REPAIRED BY ROUX EN Y
FUTHER SUFFERED CHOLANGITIS DUE TO STRICTURE TREATED
BY BALLON DILATATION
38. METALLIC STENTING
INDICATIONS
ALL SURGICAL OPTIONS ARE EXHAUSTED AND
DILATATION HAVE FAILED
Gianturco stent appears to provide reasonable palliation
PROCEDURE
GIANTURCO STENT NO 8, 10, 12 MM IS USED
VIA PERCUTANEOUS TRANSHEPATIC ROUTE VIA
EXISTING T- TUBE
CATHETER PLACED OVER WIRE AND CONTRAST
INJECTED VIA SIDE ADAPTER
DILATOR PASSED ALONG THE STRICTURE AND
FOLLOWED BY SMALL PEEL AWAY INTRODUCER
INTRODUCER PEELED AWAY WITH THE SELF
RETAINING STENT IN PLACE
40. ROLE OF RADIOLOGIST
PERFORM CECT OR MRCP TO PROPERLY DELINEATE
THE LIVER AND BILIARY TRACT ANATOMY
FUTHER DEFINE THE ANATOMY USING PTC AND
PERFORM A PTBD
IMPROVE METABOLIC STATUS OF THE PATIENT
PERFORM A HEPATIC ARTERIOGRAPHY TO RULE
OUT AND TUMOUR OR MASS ENCASING THE LIVER
AND FOR MARKING THE LIVER ANATOMY
41.
42. the general location of the puncture site within the
biliary tree (i.e., peripherally or centrally); (2) the
angle formed by the junction of the needle and
the specific duct entered; and (3) the therapeutic
objectives of future biliary interventions. After the
diagnostic PTC is performed using a 21- to 23-
gauge “skinny needle” (Chiba needle or trocar
needle), a percutaneous biliary drainage (PBD) is
performed
Eventual placement of an 8-10F multi-side-hole
locking pigtail catheter across the obstruction
44. TRANSHEPATIC CHOLEDOCHOLITHOTOMY
1. a 21- or 22-gauge needle is used to access the duct of interest. A 0.018-inch guide
wire is advanced through the needle, maneuvered into the common bile duct, and
exchanged for a standard 0.035-inch guide wire over an intermediary exchange
dilator
2. an appropriate catheter and guide wire may be manipulated through the distal duct
and bowel. It would be traumatic to extract large calculi through the transhepatic
tract.
3. Therefore, a technique that will
allow expulsion of stones or stone
fragments through the duct into
the duodenum must be used.
45. TRANS JEJUNAL CHOLEDOCHOLITHOTOMY
IN DISEASES ASSOCIATED WITH RECURRENT CALCULI AND BILE
DUCT STRICTURES
FREE ASSESMENT OF HEPATIC DUCT AND FOR LONG TERM LINE
PLACEMENT
TO ENSURE COLON IS NOT PUNCTURED IT IS PRE OPACIFIED BY
BARIUM ONE DAY PRIOR HEPATIC FLEXURE
METALLIC ANCHOR DEVICE IS PLACED IN SMALL BOWEL FOR
JEJUNOPEXY
DRAIN CAN BE EASILY REINSERTED IF IT FALLS OFF
EASY RECATHETERISATION
PERCUTANEOUS CHOLANGIOSCOPY
A 3-5 MM ENDOSCOPE CAN BE PASSED THROUGH THE T TUBE
TRACT FOR ASSESSMENT AND REMOVAL OF THE STONES
ESWL
ANGIOPLASTY BALLON CATHETERS
FOGARTHY CATHETERS
47. IT INCLUDES THE FOLLOWING PROCEDURES
1. TRANSHEPATIC VARICEAL EMBOLIZATION
2. TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC
SHUNTS (TIPS)
3. PERCUTANEOUS REVISION OF SURGICAL
PORTOSYSTEMIC SHUNTS
4. CHECK SHUNT PATENCY
48. TRANS HEPATIC VARICEAL EMBOLISATION IN A
PATIENT WITH UNCONTROLLED BLEEDING VARIECES
1. TRANS
HEPATIC
PORTOGRAM
HEPATOFUGAL
FILLING
1. CORONARY
VEIN
VENOGRAM
2. VENOUS
OCCLUSION
BY CONTRAST
3. SPLENIC
PORTOGRAM
SHOWS NO
VARIECES
49.
50. PERCUTANEOUS
TREATMENT OF PORTAL
HYPERTENSION
1. TRANS HEPATIC
PORTOGRAM
OCCLUSION OF
PORTAL VIEN
2. SPLENIC PORTOGRAM
SHOWS LEFT GASTRIC
COLLATERALS
3. WALLENT,S STENT
DEPLOYED AFTER
OCCLUSION
4. SPLENIC PORTOGRAM
SHOWS NORMAL FLOW
WITH NO
COLLATERALS
