Nawaloka Cardiac Catheterization Lab

The new cardiac catherization lab at Nawaloka Heart Center uses technology from the Phillips Allura System, allowing our Cardiologists to perform cardiac catherizations and a broad range of radiology special procedures. This is the one and only cath lab of same kind in whole Island. The Allura Xper FD systems optimize cath lab efficiency with the leading solution for diagnostic, interventional and pediatric cardiology, as well as vascular interventions and electrophysiology. The new cath lab is the latest addition to the array of advanced services offered by Nawaloka Heart Center.

What is Cardiac Catheterization?

Cardiac Catheterization (Cath) is a specialized study of the heart during which a catheter, or thin hollow flexible tube, is inserted into the artery of the groin or arm. Under x-ray visualization, the tip of the catheter is guided to the heart. Pressures are measured and an x-ray Angiogram (Angio) movie of the heart and blood vessels are obtained while injecting an iodinated colorless "dye" or contrast material through the catheter. Coronary angios are obtained by injecting the contrast material into the opening or mouth of a coronary artery. The iodinated solution blocks the passage of x-rays. X-ray movie pictures taken during the injection of the contrast material allow the coronary arteries to be visualized. In other words, coronary arteries are not visible on x-ray film. However, they can be made temporarily visible by filling the coronary artery with a contrast solution that blocks x-ray.

The coronary arteries are vital because they supply oxygen and nutrients to the heart muscle. Without blood flow, the muscle would sustain permanent damage in the form of a heart attack or myocardial infarction.

Cardiac Catheterization (Cath) is also known as Heart Cath, Angiogram (Angio) or Arteriogram. The latter two terms describe the use of contrast material to take x-ray pictures of the heart.

If catheters are introduced through the femoral or groin artery, the procedure is known as "left heart" catheterization, because the catheter goes from the femoral artery to the aorta, coronary arteries, and the Left Ventricle (LV). This accounts for the majority of procedures. Left heart cath can also be performed by using the artery in the arm.
If a catheter is also placed in the right femoral vein to measure pressures within the right side of the heart, the procedure is called "right heart" catheterization. This is used in patients with congenital heart disease, diseases of the heart valve, or certain conditions involving the pericardium, or sac, of the heart. This may also be used in certain diseases of the heart muscle, heart failure, shock, or when measurements of heart output or lung pressures are needed. Right and left heart catheterization is a combination of both.

Cardiac Catheterization (Cath) is most commonly performed by inserting a thin flexible tube into the right femoral artery which is located under the skin, in the right groin. Occasionally the right or left arm (brachial artery) or wrist (radial artery)approach may be employed (as shown below). Step-by-step, we will now walk you through a cardiac cath procedure.

What Preparations are Needed?

Cath is performed during a hospitalization (inpatient) procedure, when the patient is admitted and discharged on the same day or very next day of the procedure.

  • In the majority of cases, catheters are introduced through a tiny needle hole in the right groin. In such cases both groins are shaved in preparation for the procedure, on the outside chance that the other groin may have to be used.
  • The patient is ten transferred from the stretcher to the Cath table The Cath Lab technologists (Techs) and nurses help reassure the patient and explain the various things that the patient will experience.

What Happens After Arrival in the Cath Lab?

  • The groin areas are scrubbed with an antiseptic solution.
  • The patient is covered with sterile drapes from the neck down . This is just another step in ensuring that the cath procedure remains sterile.
  • The groin area is then "numbed" with the use of local anesthesia. This is induced by injecting lidocaine into the skin and adjoining area. The process is similar to a dentist numbing the gums prior to a dental procedure. The patient may feel a little stinging sensation at this time.
  • The artery is felt by the fingertips, and a needle is directed towards the arterial pulsation. When blood escapes out of the needle, the cardiologist knows that entrance to the artery has been gained. Since the area was previously "numbed" with local anesthesia, there is usually very little discomfort associated with this.
  • A thin flexible wire is then introduced into the needle. This is known as a guide-wire because it helps guide catheters, just like a rail guides the path of a train. The purple plastic "tip deflector" helps straighten the curved and floppy tip of the guide wire. The needle and the tip deflector are then removed.
  • A tubular and flexible plastic sheath that is usually about 2 1/2 or three millimeters in diameter (thickness) is advanced over the guide-wire and placed in the artery. This serves as a passage-way or introducer for the insertion of catheters. The sheath has a white plastic "hub" that sits outside the skin. The hub contains a one-way valve that allows catheters to be introduced through the sheath but prevents blood from escaping.
  • A tubular and flexible plastic sheath that is usually about 2 or 2 1/2 millimeters in diameter (thickness) is advanced over the guide-wire and placed in the artery. This serves as a passage-way or introducer for the insertion of catheters. The sheath has a white plastic "hub" that sits outside the skin. The hub contains a one-way valve that allows catheters to be introduced through the sheath but prevents blood from escaping.
  • Through the sheath, and over a guide-wire, a long soft plastic tube or catheter is inserted and guided towards the heart. An x-ray monitor is used to observe the path of the catheter. Different catheter shapes are used during the procedure.
  • Working from the groin, the cardiologist rotates and gently manipulates the catheter to guide its tip into the opening of the coronary artery. X-ray movies are then taken during the injection of contrast material. Contrast material or "dye" is injected through the catheter and x-ray pictures are recorded on a movie film. The cardiologists steps on floor pedals to view x-ray images (fluoroscopy) or to film (cine angiograms) portions of the study.
  • A rotating handle sits on the side of the table. By rotating the handle, like that of a motorcycle, and by pressing on levers the cardiologist can rotate the x-ray camera around the patients chest. The camera can be moved from left to right, towards and away from the patient's head, and up and down over the chest. This allows different view or rotations of the coronary arteries to be viewed and filmed

What do I need to know about the equipment?

The x-ray camera sits on top of the patient's chest, while the x-ray beam is delivered from underneath the table. A movie camera is attached to the tube to record images on a 35mm film. Images are also noted "live" on the monitor and are also recorded on a computer disk drive and / or a video tape. The x-ray tube is rotated around the patient (side-to-side, and also towards and away from the head), as shown below. By taking pictures from different angles, the cardiologist can inspect blockages from several points of view. This increases the accuracy of assessing the clinical importance and severity of a blockage. It also helps determine the patient's candidacy for angioplasty, stenting, surgery, medical treatment, etc.
Cardiac ath is usually carried out in a hospital setting but may also be performed in some clinics or in a mobile laboratory. The patient lies on a table with an attached handle. This handle allows the cardiologist to move the table and also to rotate the x-ray tube. A plastic covered shield is present between the cardiologist and the patient to cut down on radiation. The top portion of the shield is transparent so that the cardiologist can see the patient through it. The cath lab is kept cool. Otherwise, heat would damage the sensitive electronic and x-ray equipment.

What is Experienced in the Cath Lab

The patient may have a feeling similar to a bee sting when the groin is "numbed" with local anesthesia. A sticking sensation is also felt when the needle is inserted. This is very tolerable. The cardiologist should be notified if there is a lot of discomfort or pain. Additional local anesthesia or more sedatives will usually alleviate the discomfort.
The patient will be lying on a relatively firm table and the room will be cool. During the procedure, the patient may be asked to hold his / her breath or cough. The former improves the quality of the x-ray movies when the diaphragm (muscle partition between the chest and abdomen) partially obscures a certain portion of the coronary artery. A deep breath improves the picture.
The contrast material may occasionally cause the heart to slow down. Coughing helps clear the contrast from the coronary artery. Coughing may also help correct certain types of abnormal heart rhythm. The patient should be able to watch most of the study on the TV monitor. The cardiologist may explain the findings as the procedure is carried out.
It is important to remember that the blue or green sheets covering the patient are sterile. Hands should be kept by the side and not placed on top of the sheet. The patient should not reach for the groin because it will contaminate the catheter. If a pillow needs to be rearranged or a cheek scratched, the staff will be happy to help.
Fleeting chest discomfort may also be felt during some coronary artery injections. A transient "hot flash" is usually felt when pictures of the Left Ventricle (LV) are taken, as shown below. This sensation generally clears up in less than 30 seconds.

How Long Does It Take?

The actual left heart cath procedure usually takes approximately 10 to 15 minutes. However, it may take longer if the patient has unusual anatomy of the arteries and there are technical difficulties. Additional time will be needed if the patient has had prior bypass surgery since additional pictures of the bypass vessels are needed. This can add another 10 to 15 minutes to the procedure time. An additional 10 to 15 minutes are needed if the patient requires right heart catheterization.
Approximately three to four hours after the procedure, the patient gets out of bed. The patient is usually discharged within six hours of the procedure unless additional treatment or procedures are required. A little soreness and a Band-Aid are usually the only traces of the procedure. Some patients may display a bruise at the site.
Following discharge, the mild soreness and slight bruising should resolve. However, some patients may experience tenderness and mild pain that can last a few days. If there was bruising at the time of discharge, the area of discoloration may increase in size. This does not necessarily indicate additional bleeding and may be due to the spread of blood pigments under the skin. However, you must notify your cardiologist if you note an increased swelling, particularly if it pulsates. Persistent fever is rare and also requires that the patient contact the cardiologist's office. You may be instructed to drink plenty of fluids on the night of the procedure to compensate for the urinary fluid loss induced by the contrast material.

How Safe is the Procedure?

Cath is a relatively safe procedure and is carried out all over the world on an outpatient basis. However, it must be recognized that the procedure is frequently carried out in patients with heart disease and that catheters have to be inserted into blood vessels. Despite this, the risk of a serious complication is estimated to be less than 4 and probably around 1 to 2 per thousand. Rare serious complications can include death, a heart attack, stroke and need for emergency surgery. Occasionally, patients may exhibit a rash as an allergic reaction to the contrast material. Serious allergic reactions are rare and can usually be controlled. Rarely, the contrast material may affect kidney function. This problem is more likely to occur if the patient has underlying kidney disease, and is more likely among diabetics than among non-diabetics. Other infrequent complications can include bleeding that requires blood transfusion or surgical repair, blood clots, and a sustained abnormal cardiac rhythm.

What is the Reliability of the Test?

Cardiac Cath is the "gold standard" against which all other coronary diagnostic tests are measured. However, it should be remembered that it can only pick up "fixed" Coronary Artery Disease (CAD) and may miss coronary spasm where the blockage may come and go. In these cases, medications can be used to provoke and confirm, or exclude, the presence of spasm.

How Quickly Will I Get the Results?

The cardiologist will give the patient and family a preliminary report immediately after the procedure. However, a final report will not be available until the patient is ready to go home. Some cardiologists will meet with the family prior to discharge, while others will set up a subsequent appointment to go into the details of the procedure and how it will change treatment. If there are serious blockages, and if indicated by the patient%u2019s clinical picture, hospitalization for medical treatment may be scheduled. Others may be set up for a balloon angioplasty or stent procedure, or even bypass surgery. In some cases, the angioplasty and stent procedure may be required and carried out immediately following cardiac cath. This will be discussed with the patient and family before it is performed. However, the far majority of patients go home on the same day of the procedure.

Allura family for Interventional Cardiology- The Latest Cath Lab Of Nawaloka Hospital

The Allura Xper Flat Detector family is optimized for cardiac procedures, offering excellent image quality at the lowest possible dose with Philips DoseWise.

The Allura Xper features the real-time imaging algorithm Xres, enabling clinicians to see and work in the smallest vessels of the heart. In addition Xper technology, allows clinicians to personalize settings and access an intuitive user interface while ensuring that it is integrated with any IT network. Allura Xper FD family include superb interventional tools: Allura 3D-CA for a 3D impression of the coronary vessels for improved stentplacement and lesion assessment and StentBoost for improved stent visualization in coronary arteries during interventions. All fully integrated in the Allura Xper FD systems. Our physiomonitoring and reporting solutions offer user-friendly scalable systems that are easily integrated within the larger cardiology enterprise.

Allura Xper FD10for Interventional Cardiology In Nawaloka Heart Center, Colombo.

  • For dedicated cardiovascular applications
  • Floor mounted or ceiling suspended G-arm geometry
  • Field of view: 25cm diagonal square

StentBoost

  • Unique interventional tool that visualizes stent deployment instantly
  • Quick and easy: results in less than 30 seconds
  • Corrective action can be taken during intervention

Physiomonitoring & reporting

  • Streamlined patient monitoring and efficient charting technology
  • Robust cath lab management capabilities, including inventory, scheduling, queries and statistics
  • User-friendly, statistical and transcription reporting

Integrated Cath Lab

  • Tight integration between Philips advanced cardiovascular X-Ray, physiomonitoring, reporting and cardiovascular information management systems
  • The simplicity of ONE comprehensive solution

The common Tests & Procedures In Nawaloka Cath Lab

  • Coronary Angiogram
  • Right Heart Study
  • Coronary angioplasty & Stenting - PTCA
  • Mitral Valvuloplasty %u2013 PTMC
  • Aortic Valvuloplasty %u2013 PTAC
  • PDA coiling
  • ASD Device closure
  • VSD Device closure
  • Permanent Pace Maker (PPM ) implantation
  • ACD ( Defibrillator )Implantation

Much more to help Vascular and Neurosurgeons too .



Advantages of the new lab:

All above mentioned investigations and interventions can be performed with the highest accuracy, perfection, best outcome & least complications since the quantity of dye and time required to exposure to X ray is less.
Always Nawaloka is in ahead to provide the latest of the latest in medical field to the public and our Nation ; since we are promised to do so!