Invasive procedures ASYNC

Question 1

What is pericardiocentesis?

Answer 1

Invasive procedure in which the physician removes (aspirates) a build up of fluid from the pericardium

Question 2

Why would we use pericardiocentesis?

Answer 2

1. Diagnostic purpose
2. Therapeutic purpose

Question 3

What is the diagnostic purpose behind pericardiocentesis?

Answer 3

Identify the types of fluid for things like
1. Hemopericardium
2. Infection vs cancer

Question 4

When would we use pericardiocentesis?

Answer 4

Can be scheduled or emergent based on purpose

Question 5

The pericardium normally contains how much fluid?

Answer 5

20-50cc of straw colored fluid

Question 6

Color of pericardial fluid can be what?

Answer 6

Question 7

What is the role of echo for pericardiocentesis? 4

Answer 7

1. Confirm location and size of pericardial fluid
2. Identify view with largest pocket, closest to the chest wall
3. Confirm needle placement
4. Reassess fluid post procedure

Question 8

In terms of pericardiocentesis, when identifying view with the largest pocket, what views are best?

Answer 8

1. Usually apical is best
2. May include off axis views

Question 9

What needs to be considered when confirming needle placement with pericardiocentesis?2

Answer 9

1. Needle may be seen in all patients on the echo
2. agitated saline can be injected to view needle positions

Question 10

What does this image represent?

Answer 10

Air bubbles injected to confirm needle locations

Question 11

What does this image represent?

Answer 11

Pericardiocentesis

Question 12

What can be associated with Pericardiocentesis?

Answer 12

Tumors

Question 13

What does this image represent?

Answer 13

Pericarditis with constriction

Question 14

What are risks of pericardiocentesis? 6

Answer 14

1. Cardiac arrest
2. Arrhythmias
3. Air embolism
4. Infection of the puncture site
5. Infection of the pericardium
6. Perforation

Question 15

What are some arrhythmias heard with pericardiocentesis?

Answer 15

SVT, AF, VT, ventricular fibrillation

Question 16

What is air embolism with pericardiocentesis?

Answer 16

RT heart perforation

Question 17

Where do we see perforation with pericardiocentesis? 4

Answer 17

1. Lung
2. Liver
3. Coronary artery
4. Heart (RV or LV)

Question 18

What does this image represent?

Answer 18

Large pericardial effusion

Question 19

What is a reliable diagnosis for heart transplant rejection?

Answer 19

Myocardial biopsy

Question 20

What is the level of risk for myocardial biopsy?

Answer 20

Low risk

Question 21

How invasive is Myocardial biopsy?

Answer 21

Invasive, May cause some patient discomfort

Question 22

Non-invasive diagnostic methods have reduced the need for biopsies, what are some? 3

Answer 22

1. Nuclear scans
2. RV strain
3. Cardiac MRI

Question 23

Myocardial biopsy is performed with what?

Answer 23

Local anesthesia

Question 24

In terms of myocardial biopsy, venous sheath is placed where?

Answer 24

In the RT IJV

Question 25

In terms of myocardial biopsy, how many specimens are obtained?

Answer 25

Multiple specimens are obtained from different sites within the RV, Tissues samples are then sent to the lab for analysis of tissue

Question 26

What are pacemakers?

Answer 26

Small electronic device that regulates the heart rate by sending electrical signals to the heart

Question 27

How many leads are in pacemakers?

Answer 27

1 or 2 lead systems

Question 28

What are the two parts of a pacemaker?

Answer 28

1. Battery unit 2. Wire

Question 29

What is part of the battery unit of the pacemaker?

Answer 29

Small metal case that contains the power source and regulates how often signals are sent

Question 30

What is part of the wire system of the pacemaker?

Answer 30

Carries electrical message back and forth between the heart and the pacemaker

Question 31

What is the size of the pacemaker?

Answer 31

Device is about the size of 2 toonies put together and weighs a bit more than an ounce

Question 32

When is a pacemeaker required?

Answer 32

1. Symptomatic bradycardia (Most common) 2. Patients with serious, uncontrollable arrhythmias

Question 33

Intra cardiac defibrillators (ICD) uses what?

Answer 33

Leads (wires threaded into the heart's chambers) to monitor every heart beat

Question 34

If a lethal rhythm appears with ICDs what happens?

Answer 34

The defibrillator shocks the heart back to a normal rhythm 1. V-tach 2. V-flutter 3. V-fib

Question 35

Who has a defibrillator?

Answer 35

1. Heart attack survivors with low ejection fraction 2. Patients at high risk for sudden cardiac death (SCD) 3. Patients post MI

Question 36

Lead perforation can affect what?

Answer 36

1. Pacemakers and defibrillators 2. Wire migration

Question 37

What does this image demonstrate?

Answer 37

Implantable defibrillator lead perforation of the RV apex