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-:By Group C Bibin .C, Idrees .H, Shruti .I. 1 CATHETERS

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2 What is a CATHETER ?

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3 Late Latin, from Greek: KATHETER, came from KATHIENAI, kathe- to send down : kat-, kata-, cata- + hienai- to send . HISTORY AND ORIGIN OF “CATHETER”

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4 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.

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5 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)

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6 Ideal characteristics of catheters Better Torque Control Strength Radiopacity Flexible Atraumatic Tip Low Surface frictional resistance for good trackability over guide wire.

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8 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 Diagnostic Catheters of 5 – 7 Fr is used.

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10 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.

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11 TYPES OF CATHETERS SHAPES Straight Catheter Pigtailed Catheter Cobra Shaped Catheter Side Winder Catheters (Shepherd)

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12 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.

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Different Catheter Curves For Different Purposes: > Judkins Left (JL) > Judkins Right ( JR) > Judkins Left Short Tip > Judkins Right Short Tip > Amplatz Left ( AL) > Amplatz Right ( AR) > Left Coronary Bypass > Right Coronary Bypass > Cardiac Pigtail > Multipurpose

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14 Judkins Left Judkins Right Amplatz Left Amplatz Right

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15 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 . Good Tractability.

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16 Balloon Catheters:

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17 Butterfly Catheters Foleys Catheter (1way, 2way or 3way)

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18 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

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19 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

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20 Shape of the Tip : J Tip / Straight Tip

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21 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.

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22 Sven- Ivar Seldinger In 1953 , Sven –Ivar Seldinger invented The technique of gaining access Percutaneusly into an artery without An arteriotomy.

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23 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. Double Wall Puncture: Mostly done. Compression to prevent Hematoma of the other wall. Rotatory movement to get the needle into the lumen. Single Wall Puncture: Usually done for patients co-agulation time is less.

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27 COMPLETE APPARATUS: > Needle Guide Wire Sheath Catheter

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28 USES & APPLICATION s OF CATHETERS: Placement of a catheter into a particular part of the body may allow: Draining urine from the urinary bladder as in urinary catheterization, e.g., the Foley catheter. Drainage of urine from the kidney pelvis by percutaneous nephrostomy. Drainage of fluid collections, e.g. an abdominal abscess. Administration of intravenous fluids, medication or parenteral nutrition with a peripheral venous catheter. Angioplasty , angiography , balloon septostomy, balloon angioplasty. Often Seldinger technique is used.

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29 Direct measurement of blood pressure in an artery or vein. Direct measurement of intracranial pressure. Administration of anesthetic medication into the epidural space, the subarachnoid space, or around a major nerve bundle such as the brachial plexus. Subcutaneous administration of insulin or other medications. A central venous catheter is a conduit for giving drugs or fluids into a large-bore catheter positioned either in a vein near the heart or just inside the atrium. A Swan - Ganz catheter is a special type of catheter placed into the pulmonary artery for measuring pressures in the heart. CONTD…

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33 Method s and apparatus for cleaning, decontaminating, and sterilizing catheters Before giving for sterilization, catheter should be washed in water and with air jets so that clots in the catheter lumen come out. Methods for cleaning, decontaminating, and sterilizing catheters are by using a combination of liquid and gaseous/plasma sterilization techniques to ensure the complete and efficient sterilization of a catheter . Angiographic dye and saline are removed from the interior of the balloon and its lumen . The outer surfaces of the catheter and a guide wire lumen of the catheter are cleaned, decontaminated, and sterilized with a liquid sterilant. The liquid sterilant fills a balloon and a balloon lumen of the catheter . The filling, retaining, and draining steps are repeated until an interior of the balloon and the balloon lumen are sterilized.

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34 STERLIZATION OF CATHETERS: Methods for catheter sterilization : The catheter is dried and then a plasma or gaseous sterilant is used to sterilize at least the outer surfaces and the guide wire lumen of the catheter. Techniques for effectively sterilizing catheters, particularly long-dwelling intravenous catheters includes >> the transmission and dispersion of ultraviolet or infrared radiation

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35 REFERENCES: Websites: Wikipedia Google Books: Radiological Procedures –A Guideline Cardiac Catheterization.

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