Coronary Angiogram

CORONARY ANGIOGRAM 

(BARTS HEART CENTRE)

A coronary angiogram is a procedure that uses X-ray imaging to see your heart's blood vessels. The test is generally done to see if there's a restriction in blood flow going to the heart. Coronary angiograms are part of a general group of procedures known as heart (cardiac) catheterisations

Procedure Equipment list: 

- ANGIO-pack (KIMAL)

- Spike for saline bag

- 2 chloraprep

- 500ml NSS (sterile bag)

- Tegaderm dressing (to secure radial sheath)

- 6F Terumo radial sheath (Radial Approach) or 6F Cordis femoral sheath (Femoral approach)

- May use 5F catheters  and 5F sheath if patient have small radial artery, female, or small male)

For IV drug line

- 500 mL saline bag

- Extension line (long)

- 3-way tap

- 20mL luerlock syringe

- 2ml or 5 ml luerlock syringe (labeled, for midazolam)

- blunt needle for aspirating drugs

- giving set

Diagnostic Catheters: 

LCA (for left coronaries)

- 6F JL 3.5 catheter if radial

- 6F JL4 if femoral

- Others : JL 3,5,6 AR, MPA

RCA (for right coronaries)

- 6F JR4 catheter 

- Others: WR, AL1,2, AR 1,2,3, MP

Single catheter technique: 5F TIG (for RCA and LCA)

If tortous vessel or if there’s spasm: 

- 0.35 Terumo glide wire 150cm

- 0.35 Exchange wire 260cm

- 0.014 BMW wire

Medications: 

- Lidocaine 1% 5ml amp if radial (20ml if femoral) 

- Heparin 10,000iu/10mL

- 1 amp Isosorbide Dinitrate 10mg/10ml (Dilution: ISDN 2mg/2mL add with 8mL NSS to make 2mg/10mL or 200mcg/mL dilution)

- 1 amp Verapamil 2.5mg/2ml (Dilution: Verapamil 2.5mg/mL add with 4mL NSS to make 2.5mg/5mL)

- Optional: Midazolam 1mg/mL or Diazemuls 10mg/2ml

If taking aortogram or femoral angiogram

- 6F pigtail catheter

- High pressure tubing 

- High pressure Contrast syringe 

- High power injector 

- Forcep (for tapping tubes to remove air and secure tube connections)

Closure devices: 

- Angioseal (6F or 8F) for femoral access 

- TR band or Helix (regular or large) for radial access

PROCEDURE STEPS

RADIAL APPROACH:

Operator injects 2-3 mL of Lidociane 1% subcutaneously

Inserts the sheath using Seldinger Technique

Aspirates blood from sheath to confirm patency of the puncture

Verapamil 2.5mg/5mL through the sheath (spasm prevention)

Then introduce catheter with guidewire (JR4 first for RRA, JL4 for RFA)

For RCA:

1. LAO 30

2. LAO 20 CRAN 20 / PA CRAN 30

3. RAO 30

For LCA:

1. PA CAUDAL 40

2. LAO 40 CAUDAL 40

3. LAO 10 CRAN 40

4. RAO 40 CRAN 40

5. RAO 30 CAUD 30