Zorg bij interventies
Interventionele procedures..................................................................................................................... 4
Angiografie .......................................................................................................................................... 4
1. Pathologie – Geschiedenis .......................................................................................................... 4
1.1 De ontwikkeling van de angiografie .................................................................................... 4
1.1.1 Substractie ....................................................................................................................... 5
1.1.2 Toekomst ......................................................................................................................... 5
1.2 Anatomie ............................................................................................................................. 6
1.2.1 Geheel bloedvaten .......................................................................................................... 6
1.2.2 Opbouw arteriële wand................................................................................................... 6
1.2.3 Punctieplaatsen ............................................................................................................... 7
2. Pathologie.................................................................................................................................... 7
2.1 Arteriosclerose (slagaderverkalking) ................................................................................... 7
2.2 Aneurysma........................................................................................................................... 8
2.3 Arteriële trombose .............................................................................................................. 9
2.4 Arteriële embolie ................................................................................................................. 9
2.5 Ziekte van Raynaud ............................................................................................................. 9
2.6 Vasculitis ............................................................................................................................ 10
2.7 Veneuze trombose ............................................................................................................ 10
2.8 Varices ............................................................................................................................... 10
2.9 Fistel .................................................................................................................................. 11
2.10 Arterioveneuze malformatie (AVM) .................................................................................. 11
3. Materiaal ............................................................................................................................... 12
3.1 Diagnostische angiografie ................................................................................................. 12
3.1.1 Angiografiezaal .............................................................................................................. 12
3.1.2 Steriele instrumententafel – voorbereiding .................................................................. 12
3.1.3 Patëntenvoorbereiding ................................................................................................. 13
3.1.4 Bevochtigen – Flushen................................................................................................... 13
3.1.5 Naalden – Spuiten ......................................................................................................... 13
3.1.6 Introducersysteem ........................................................................................................ 14
3.1.7 Guide wire ..................................................................................................................... 15
3.1.8 Catheter ......................................................................................................................... 15
3.1.9 Contrast ......................................................................................................................... 16
3.2 Interventionele angiografie ............................................................................................... 17
3.2.1 Guiding catheter/microcatheter ................................................................................... 17
3.2.2 Stent .............................................................................................................................. 18
3.2.3 Stent in groot formaat ................................................................................................... 19
1
, 3.2.4 Ballon (PTA-catheter) .................................................................................................... 19
3.2.5 Drug eluting Stent & Balloon ......................................................................................... 20
3.2.6 Drukmanometer ............................................................................................................ 20
3.2.7 Embolisatiemateriaal..................................................................................................... 21
4. Herhaling ................................................................................................................................... 22
5. Taken van de TMB en drukverbanden ...................................................................................... 23
5.1 Taken TMB: ........................................................................................................................ 23
5.2 Drukverband ...................................................................................................................... 23
6. Medicatie & Soorten onderzoeken ........................................................................................... 24
6.1 Medicatie ........................................................................................................................... 24
6.1.1 Buscopan ................................................................................................................... 24
6.1.2 Cedocard.................................................................................................................... 25
6.1.3 Dipidolor .................................................................................................................... 25
6.1.4 Dormicum .................................................................................................................. 25
6.1.5 Ebrantil ...................................................................................................................... 26
6.1.6 Heparine .................................................................................................................... 26
6.1.7 Sintrom ...................................................................................................................... 26
6.1.8 Phenergan ................................................................................................................. 27
6.1.9 Valium ........................................................................................................................ 27
6.2 Soorten onderzoek ............................................................................................................ 27
6.2.1 IVDSA: Intraveneuze Digitale Subtractive Angiografie .............................................. 27
6.2.2 Flebografie ................................................................................................................. 28
6.2.3 IADSA: Intra-Arteriële Digitale Subtractie Angiografie .............................................. 28
6.2.4 Punctietechniek ......................................................................................................... 28
6.2.4.1 Seldingernaald – punctietechniek ......................................................................... 29
6.2.4.2 Allentest..................................................................................................................... 30
7. Soorten behandelingen ............................................................................................................. 30
7.1 PTA: Percutane Transluminele Angioplastie of ballondilatatie ......................................... 30
7.2 Coiling ................................................................................................................................ 30
7.3 Stentplaatsing a. renalis .................................................................................................... 31
7.4 TACE = Transarterial chemoembolization ......................................................................... 31
7.5 Embolisatie AVM ............................................................................................................... 31
7.6 7Post Partum Bloeding ...................................................................................................... 31
7.7 AAA – Aorta abdominalis aneurysma ................................................................................ 32
7.8 Catheter speciallekes......................................................................................................... 32
7.9 PICC – Peripherally Inserted Central Catheter .................................................................. 33
7.10 Angiojet – Thrombectomie................................................................................................ 33
7.11 Jetstream – atherectomie ................................................................................................. 33
2
, 7.12 Laserjet – atherectomie .................................................................................................... 33
8. Cardiologie................................................................................................................................. 35
8.1 Anatomie ........................................................................................................................... 35
8.2 Hartkamers ........................................................................................................................ 35
8.3 Hartkleppen ....................................................................................................................... 35
8.4 Bloedstroom doorheen hart en longen ............................................................................. 35
8.5 Elektrisch systeem ............................................................................................................. 36
8.6 Bloedvaten en bloeddruk .................................................................................................. 36
8.6.1 Bloedvaten................................................................................................................. 37
8.7 Coronaire hartziekten........................................................................................................ 37
8.7.1 Angor ......................................................................................................................... 38
8.7.2 Hartinfarct ................................................................................................................. 38
8.7.3 Coronaire hartziekten – behandelingsmethoden ..................................................... 38
8.8 Structurele afwijkingen ..................................................................................................... 39
8.8.1 Hartfalen .................................................................................................................... 39
8.8.2 kleplijden ................................................................................................................... 40
8.8.3 Congenitale afwijkingen ............................................................................................ 40
8.8.3.1 Ventrikelseptumdefect (VSD) ................................................................................ 41
8.8.3.2 Atriumseptumdefect (ASD) ................................................................................... 41
8.8.3.3 Aortaklepstenose................................................................................................... 41
8.8.3.4 Pulmonalisklepstenose .......................................................................................... 41
8.8.3.5 Persisterende ductus arteriosus ............................................................................ 41
8.8.3.6 Coarctatio aortae ................................................................................................... 42
8.8.3.7 Tetralogie van Fallot .............................................................................................. 42
8.9 Hartablatie ......................................................................................................................... 42
9. Contrastreacties ........................................................................................................................ 42
9.1 Adverse reactions .............................................................................................................. 42
9.1.1 Acute adverse reaction.............................................................................................. 42
9.1.2 Late & very late adverse reaction.............................................................................. 44
10. Casussen ................................................................................................................................ 44
10.1 Casus 1 ............................................................................................................................... 44
10.2 Casus 2 ............................................................................................................................... 45
10.3 Casus 3 ............................................................................................................................... 45
10.4 Casus 4 ............................................................................................................................... 46
3
, Interventionele procedures
Angiografie
1. Pathologie – Geschiedenis
1.1 De ontwikkeling van de angiografie
3000 v.C Egyptenaren Blaascatheter: metalen buisjes
1711 Hales Trachea: glazen catheter (gans en paard) & hart
(paard)
1844 Bernard Halsslagader tot li atrium: kwiksonde (paard) →
druk meten → grondlegger huidige vorm
catheterisatie
1895 Röntgen Uitvinding Röntgen-Stralen
1896 Haschek & Lindenthal Injectie in geamputeerde hand: kalk → 1ste beeld
bloedvaten met Rö-stralen en contrast
1912 Bleichroder, Unger & Loeb Eerste catheters in mensen zonder Rö-stralen:
− In bloedvaten voor chemo
− In slagaders bij honden
1923 Bij levende mensen: eerste contrast =
Jodolie/Lipiodol
Strontiumbromide = sterkste contrasterende
contrastvloeistof
1926 Moniz 9de poging: succesvol angiogram hoofd (levende
patiënt)
Jodium in carotis
1929 Forssmann Opschhuiven catheter in arm naar hart
(bij zichzelf in spiegel en fluoroscopie)
1929 Dos Santos Translumbale Arteriografie → aorta en viscerale
bloedvaten
1934 Des Plantes 2 nieuw technieken: tomografie &
substractie
4
Interventionele procedures..................................................................................................................... 4
Angiografie .......................................................................................................................................... 4
1. Pathologie – Geschiedenis .......................................................................................................... 4
1.1 De ontwikkeling van de angiografie .................................................................................... 4
1.1.1 Substractie ....................................................................................................................... 5
1.1.2 Toekomst ......................................................................................................................... 5
1.2 Anatomie ............................................................................................................................. 6
1.2.1 Geheel bloedvaten .......................................................................................................... 6
1.2.2 Opbouw arteriële wand................................................................................................... 6
1.2.3 Punctieplaatsen ............................................................................................................... 7
2. Pathologie.................................................................................................................................... 7
2.1 Arteriosclerose (slagaderverkalking) ................................................................................... 7
2.2 Aneurysma........................................................................................................................... 8
2.3 Arteriële trombose .............................................................................................................. 9
2.4 Arteriële embolie ................................................................................................................. 9
2.5 Ziekte van Raynaud ............................................................................................................. 9
2.6 Vasculitis ............................................................................................................................ 10
2.7 Veneuze trombose ............................................................................................................ 10
2.8 Varices ............................................................................................................................... 10
2.9 Fistel .................................................................................................................................. 11
2.10 Arterioveneuze malformatie (AVM) .................................................................................. 11
3. Materiaal ............................................................................................................................... 12
3.1 Diagnostische angiografie ................................................................................................. 12
3.1.1 Angiografiezaal .............................................................................................................. 12
3.1.2 Steriele instrumententafel – voorbereiding .................................................................. 12
3.1.3 Patëntenvoorbereiding ................................................................................................. 13
3.1.4 Bevochtigen – Flushen................................................................................................... 13
3.1.5 Naalden – Spuiten ......................................................................................................... 13
3.1.6 Introducersysteem ........................................................................................................ 14
3.1.7 Guide wire ..................................................................................................................... 15
3.1.8 Catheter ......................................................................................................................... 15
3.1.9 Contrast ......................................................................................................................... 16
3.2 Interventionele angiografie ............................................................................................... 17
3.2.1 Guiding catheter/microcatheter ................................................................................... 17
3.2.2 Stent .............................................................................................................................. 18
3.2.3 Stent in groot formaat ................................................................................................... 19
1
, 3.2.4 Ballon (PTA-catheter) .................................................................................................... 19
3.2.5 Drug eluting Stent & Balloon ......................................................................................... 20
3.2.6 Drukmanometer ............................................................................................................ 20
3.2.7 Embolisatiemateriaal..................................................................................................... 21
4. Herhaling ................................................................................................................................... 22
5. Taken van de TMB en drukverbanden ...................................................................................... 23
5.1 Taken TMB: ........................................................................................................................ 23
5.2 Drukverband ...................................................................................................................... 23
6. Medicatie & Soorten onderzoeken ........................................................................................... 24
6.1 Medicatie ........................................................................................................................... 24
6.1.1 Buscopan ................................................................................................................... 24
6.1.2 Cedocard.................................................................................................................... 25
6.1.3 Dipidolor .................................................................................................................... 25
6.1.4 Dormicum .................................................................................................................. 25
6.1.5 Ebrantil ...................................................................................................................... 26
6.1.6 Heparine .................................................................................................................... 26
6.1.7 Sintrom ...................................................................................................................... 26
6.1.8 Phenergan ................................................................................................................. 27
6.1.9 Valium ........................................................................................................................ 27
6.2 Soorten onderzoek ............................................................................................................ 27
6.2.1 IVDSA: Intraveneuze Digitale Subtractive Angiografie .............................................. 27
6.2.2 Flebografie ................................................................................................................. 28
6.2.3 IADSA: Intra-Arteriële Digitale Subtractie Angiografie .............................................. 28
6.2.4 Punctietechniek ......................................................................................................... 28
6.2.4.1 Seldingernaald – punctietechniek ......................................................................... 29
6.2.4.2 Allentest..................................................................................................................... 30
7. Soorten behandelingen ............................................................................................................. 30
7.1 PTA: Percutane Transluminele Angioplastie of ballondilatatie ......................................... 30
7.2 Coiling ................................................................................................................................ 30
7.3 Stentplaatsing a. renalis .................................................................................................... 31
7.4 TACE = Transarterial chemoembolization ......................................................................... 31
7.5 Embolisatie AVM ............................................................................................................... 31
7.6 7Post Partum Bloeding ...................................................................................................... 31
7.7 AAA – Aorta abdominalis aneurysma ................................................................................ 32
7.8 Catheter speciallekes......................................................................................................... 32
7.9 PICC – Peripherally Inserted Central Catheter .................................................................. 33
7.10 Angiojet – Thrombectomie................................................................................................ 33
7.11 Jetstream – atherectomie ................................................................................................. 33
2
, 7.12 Laserjet – atherectomie .................................................................................................... 33
8. Cardiologie................................................................................................................................. 35
8.1 Anatomie ........................................................................................................................... 35
8.2 Hartkamers ........................................................................................................................ 35
8.3 Hartkleppen ....................................................................................................................... 35
8.4 Bloedstroom doorheen hart en longen ............................................................................. 35
8.5 Elektrisch systeem ............................................................................................................. 36
8.6 Bloedvaten en bloeddruk .................................................................................................. 36
8.6.1 Bloedvaten................................................................................................................. 37
8.7 Coronaire hartziekten........................................................................................................ 37
8.7.1 Angor ......................................................................................................................... 38
8.7.2 Hartinfarct ................................................................................................................. 38
8.7.3 Coronaire hartziekten – behandelingsmethoden ..................................................... 38
8.8 Structurele afwijkingen ..................................................................................................... 39
8.8.1 Hartfalen .................................................................................................................... 39
8.8.2 kleplijden ................................................................................................................... 40
8.8.3 Congenitale afwijkingen ............................................................................................ 40
8.8.3.1 Ventrikelseptumdefect (VSD) ................................................................................ 41
8.8.3.2 Atriumseptumdefect (ASD) ................................................................................... 41
8.8.3.3 Aortaklepstenose................................................................................................... 41
8.8.3.4 Pulmonalisklepstenose .......................................................................................... 41
8.8.3.5 Persisterende ductus arteriosus ............................................................................ 41
8.8.3.6 Coarctatio aortae ................................................................................................... 42
8.8.3.7 Tetralogie van Fallot .............................................................................................. 42
8.9 Hartablatie ......................................................................................................................... 42
9. Contrastreacties ........................................................................................................................ 42
9.1 Adverse reactions .............................................................................................................. 42
9.1.1 Acute adverse reaction.............................................................................................. 42
9.1.2 Late & very late adverse reaction.............................................................................. 44
10. Casussen ................................................................................................................................ 44
10.1 Casus 1 ............................................................................................................................... 44
10.2 Casus 2 ............................................................................................................................... 45
10.3 Casus 3 ............................................................................................................................... 45
10.4 Casus 4 ............................................................................................................................... 46
3
, Interventionele procedures
Angiografie
1. Pathologie – Geschiedenis
1.1 De ontwikkeling van de angiografie
3000 v.C Egyptenaren Blaascatheter: metalen buisjes
1711 Hales Trachea: glazen catheter (gans en paard) & hart
(paard)
1844 Bernard Halsslagader tot li atrium: kwiksonde (paard) →
druk meten → grondlegger huidige vorm
catheterisatie
1895 Röntgen Uitvinding Röntgen-Stralen
1896 Haschek & Lindenthal Injectie in geamputeerde hand: kalk → 1ste beeld
bloedvaten met Rö-stralen en contrast
1912 Bleichroder, Unger & Loeb Eerste catheters in mensen zonder Rö-stralen:
− In bloedvaten voor chemo
− In slagaders bij honden
1923 Bij levende mensen: eerste contrast =
Jodolie/Lipiodol
Strontiumbromide = sterkste contrasterende
contrastvloeistof
1926 Moniz 9de poging: succesvol angiogram hoofd (levende
patiënt)
Jodium in carotis
1929 Forssmann Opschhuiven catheter in arm naar hart
(bij zichzelf in spiegel en fluoroscopie)
1929 Dos Santos Translumbale Arteriografie → aorta en viscerale
bloedvaten
1934 Des Plantes 2 nieuw technieken: tomografie &
substractie
4
