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Clinical Fluoroscopy Units
Published in Paolo Russo, Handbook of X-ray Imaging, 2017
A cardio electrophysiology laboratory is very similar to a cardio catheterization laboratory and is used to insert pacemakers and recording electrodes into the heart to stimulate and record the electrical properties of various cardiac functions. These studies can also take an extended period, sometimes up to hours, so as described in earlier paragraphs, extra precautions need to be taken into consideration to avoid patient skin injuries. Also because of long cases, cardiologists have the option of using special personal X-ray shields, for example, a leaded, ceiling-mounted cylindrical device with a leaded glass window to allow close observation of the patient. This precaution avoids the need for them to wear the lead apron for extended periods of time. Some electrophysiology laboratories are equipped with two control rooms to ease monitoring the functional parameters of the heart. Advanced electrophysiology laboratories can use remote fluoroscopy coupled with high-field strength magnets, which can steer the catheters into a target area in the heart with very high accuracy.
Management of out-of hospital cardiac arrest patients with extracorporeal cardiopulmonary resuscitation in 2021
Published in Expert Review of Medical Devices, 2021
Christopher Gaisendrees, Matias Vollmer, Sebastian G Walter, Ilija Djordjevic, Kaveh Eghbalzadeh, Süreyya Kaya, Ahmed Elderia, Borko Ivanov, Stephen Gerfer, Elmar Kuhn, Anton Sabashnikov, Heike a Kahlert, Antje C Deppe, Axel Kröner, Navid Mader, Thorsten Wahlers
Ultrasound-guided punctuation of the femoral artery and vein should be performed whenever possible. At the catheterization laboratory, the punctuation of the vessels is guided via x-ray. In situations of ongoing CPR, the localization and verification of the femoral vessels is more challenging, compared to other VA-ECMO-cannulation scenarios. This is mainly due to ongoing chest compressions and deoxygenated blood, which increases the difficulty in verifying the right vessel. Therefore, echocardiographic verification becomes increasingly important, since local complications of blind punctuation consist of inadvertent arterial puncture, saphenofemoral junction cannulation, and transifaxtion of inguinal ligament during cannulation [17,18].Non-visualized techniques of insertion may result in steep or off-center penetration of the vessel that can make subsequent dilation more difficult and increases the risk of vessel perforation or kinking of the guidewire.
Shields and garb for decreasing radiation exposure in the cath lab
Published in Expert Review of Medical Devices, 2018
Aris Karatasakis, Emmanouil S. Brilakis
Architectural shielding is built into the catheterization laboratory structure or is comprised by rolling and stationary leaded shields that can provide protection to nursing and anesthesia staff. A recent study found that routine implementation of a 1.8 by 0.7 m accessory leaded glass barrier reduced nurse and technologist staff by almost two thirds [15]. Individuals whose presence is required for the duration of the case but do not have a role in the fluoroscopic suite should remain in the control room.
Latest STEMI treatment: a focus on current and upcoming devices
Published in Expert Review of Medical Devices, 2018
Elisabetta Moscarella, Salvatore Brugaletta, Manel Sabaté
The venous-arterial ECMO device is a cardiopulmonary support system that aspirates blood from the femoral vein or the internal jugular vein through a 21Fr cannula. Using an artificial membrane lung it removes carbon dioxide from and adds oxygen to venous blood, which is then returned into the arterial system via a 15- to 22-Fr outflow cannula in the femoral or axillary artery so that heart and lungs are both bypassed. One of the greatest advantages of ECMO is that it can be placed almost everywhere (in the emergency room, on the ward, in the catheterization laboratory, etc.), as it is completely transportable and fluoroscopy or echocardiography guidance is not required for successful implantation. The device provides a circulatory support up to 7 L/min, with large cannulas and contemporary rotors, in patients with circulatory and respiratory failure. However, unlike LV assist devices, V-A ECMO system cannot unload the LV. Increasing afterload progressive results in LV distention, worsening LV function, LV thrombus and intractable pulmonary edema or hemorrhage [83]. For these reasons, it should be used together with other devices. Concomitant use with IAPB [84] or Impella [85] has been proposed to lower pulmonary artery pressures and decrease LV dimensions as well as percutaneous atrial septostomy (to allow left-to-right shunting) or dobutamine administration (to improve contractility and decrease afterload). Moreover when femoral artery is chosen for the outflow cannulation attention needs to be focused on adequate retrograde oxygenation of heart and head. Absolute contraindications to ECMO implantation include aortic regurgitation, aortic dissections, severe peripheral artery disease and ethical considerations as no prospective for a bridge therapy or patient’s wish. Active bleeding is a relative contraindication because ECMO requires heparin for anticoagulation. However it has been used in high-risk patients without heparin, as it was the only strategy to save patient life [86]. Complications mainly include vascular complications as leg ischemia, compartment syndrome, major bleeding, stroke, air embolism, and significant infection [87].