Sheath, Guidewire and Catheters

Diagnostik Invasif & Intervensi Non Bedah

Pusat Jantung Nasional Harapan Kita Jakarta

Heroe Moestiko
 Type of sheaths (a tubular case)
 Standard sheath (10cm/12cm)
 Long sheath (16cm/23cm/25cm)
 Arrow sheath (12cm/24/cm/35cm.45cm/65cm)
 Shuttle sheath (90cm)
 Balkin sheath (40cm)
 Mullins sheath (63cm)
Type of sheaths (a tubular case)
& indications
 Type of sheaths (a tubular case)
& indications
STANDARD SHEATH

Normal
Vessel
anatomy

ARROW SHEATH

Tortuous vessel
 Type of sheaths (a tubular case)
& indications SHUTTLE SHEATH (90cm)
ARROW SHEATH
 Commonly use for tortuous artery
 To allow the catheter to go up easily
but sometimes in very tortuous Aorta
an extra stiff wire is needed

 Mainly use in PTA Carotid artery

 Also use in peripheral interventional,
usually PTA Subclavian
 Type of sheaths (a tubular case)
& indications MULLINS SHEATH
BALKINS SHEATH

 Mainly use in pediatric interventional

 Interventional Peripheral Sheath
 Also use in peripheral interventional, usually
 Cross-over sheath (contra-lateral)
PTA Subclavian
 For PTA iliac, SFA and etc
 Support for very tortuous Aorta.
FEMORAL SHEATH
Sheath
Dilator
Wire 0.038”
TYPES OF RADIAL SHEATH

RADIAL SHEATH 6F TERUMO

•Sheath + dilator
•Blade
•Angiocath 20G
•Terumo wire 0.025”

RADIAL SHEATH 6F AVANTI (CORDIS)

•Sheath + dilator
•Punture needle 21G
•Wire 0.021”
 VARIOUS SIZES OF SHEATH
 COLOUR CODING:
 4F- RED 9F- BLACK
 5F- GREY 10F- PURPLE
 6F- GREEN 11F-YELLOW
 7F- ORANGE 12F- DARK BLUE
 8F- BLUE 13F- DARK GREEN
14F- PINK
ANGIOGRAPHIC/GUIDING
CATHETERS
Catheter Structure
HOW CATHETERS ENGAGE
AND SIT IN THE AORTA
Catheter Engagement

NOT COAXIAL
ENGAGEMENT

COAXIAL
ENGAGEMENT
 ANGIOGRAPHIC CATHETERS

 Use for diagnostic purpose only

 Small ID which not allows
interventional devices such as
balloon, stent, IVUS and etc to
enter

Pigtail
DIAGNOSTIC CATHETER
( FEMORAL)

JL JR
DIAGNOSTIC CATHETER ( RADIAL )

OPTITORQUE 5F
GUIDING CATHETER
 Use for interventional
purposes
 Has larger ID to allow
coronary devices such as
balloon, stent, IVUS, export
catheter to enter
CATHETERS & NATIVE
ARTERIES
LCA:
 Judkins Left
 Amplatz Left
 Castillo
 Optitorque
 Extra Back-up (XB)
RCA
 Judkins Right
 Amplatz Right/Left
 Multipurpose 1
 Castillo
 Optitorque
 Extra Curve Right(ECR)
 Hockey Stick
CATHETERS & GRAFT
IMA to LAD:
 Internal Mammary Artery
 Judkins Right

SVG to LCA
 Judkins Right
 Amplatz Left
 Left Coronary Bypass

SVG to RCA
 Multipurpose
 Judkins Right
 Left Coronary Bypass
 VARIOUS CURVES OF
CATHETERS
JUDKINS RIGHT 3.5
JR 6 Multipurpose 1
(MPA1)

JR 4 Amplatz Right 1 (ARMOD1)

MPB1

JR 5 Amplatz Right Moderate

(ARMOD)

AR2
 VARIOUS SHAPE OF
CATHETERS
JUDKINS LEFT 4

Amplatz Left 1 Left Coronary Bypass

-LCB

JL5

AL 2
RCB

JL 6

Internal Mammary
AL 3 Artery - IMA
 VARIOUS SHAPE OF
CATHETERS

OPTITORQUE
145º Pigtail
Straight Pigtail
Peripheral Wires
 Diameter 0.035’ – 0.038’
 J-shaped tip: digunakan untuk arteri radial dan femoral
 Panjang wire 140 – 180 cm
Cont..
 Standard wire
 Straight tip wire
 Stiff of superstiff wires
 Exchange wire
 Hydrophilic wire ( Terumo )
 PERSIAPAN ALAT UNTUK TINDAKAN DIAGNOSTIK KORONER
ANGIOGRAPHY VIA ARTERI RADIALIS

Three way rotating Extention pressure

Spuit
Plastik steril
1cc
2,5cc
5cc
10cc
20cc

Sheath radial 5fr Sheath radial 5fr Wire J.035’/150cm

(counter puncture) (anterior puncture)
 PERSIAPAN ALAT UNTUK TINDAKAN DIAGNOSTIK
KORONER ANGIOGRAPHY VIA ARTERI FEMORALIS
Three way rotating Extention pressure

Spuit
10cc;20cc

Plastik steril

Sheath femoral 6fr Puncture needle Wire 0.35’/150cm

 PERSIAPAN ALAT UNTUK TINDAKAN INTERVENSI
KORONER ANGIOGRAPHY VIA ARTERI RADIALIS

Extention pressure

Spuit
1cc Plastik steril
2,5cc
5cc
10cc
20cc

Sheath radial 6fr Blood set manifold Wire 0.35’/150cm

Y Connector
 PERSIAPAN ALAT UNTUK TINDAKAN INTERVENSI
KORONER ANGIOGRAPHY VIA ARTERI FEMORALIS
Puncture needle Extention pressure

Spuit
10cc Plastik
20cc steril

Sheath femoral 7fr Blood set manifold Wire 0.35’/150cm

Y Connector
Coronary Wires
 Untuk melewati stenosis atau oklusi di arteri koroner
 Diameter 0.014’
 Terbuat dari stainless steel atau nitinol
 Panjang 190cm
 TUJUAN
• Untuk mencapai ujung dari pembuluh darah
• Sebagai rel untuk memasukan alat ke pembuluh
koroner
• Untuk mengakses lesi
• Untuk melewati lesi tanpa adanya trauma
• Untuk memberikan support saat memasukan alat
intervensi
Coronary guidewire
Coating
HYDROPHILIC
• Respon terhadap air
• Dipasang diatas polymer atau
stainless steel( termasuk tip
coils)
• Tipis,tidak licin saat kering,
butuh pelumas
• Menjadi gel saat basah
• Meminimalkan gesekan
• Meningkatkan kemampuan
untuk menyusur
• HYDROPHOBIC
• Menolak air
• Dilapisi silikon disepanjang
wire kecuali pada tip
• Harus basah
• Meminimalkan gesekan
• Meningkatan kemampuan
untuk menyusur
• Platinum di tip radio opaque (
biasanya 3-25cm)
3 Komponen Wire Coronary

 Coating

 Core

 Coil
 STRUCTURE

 CORE-Material
Diameter
Core taper
 TIP
 COILS, COVERS & COATINGS
Hydrophilic = gel-like when wet

Slide through vessels + lesions

Hydrophobic = wax-like when wet

Provides tactile feedback

 Polymer Jacket = gel-like & smooth
(Lubricious)

Tracks / slides through tortuous vessels and

heavily calcified lesions.
Tip Load
Tapered Wires

Fielder XT, XTA, FC

Pilot 50, 100, 200

TERIMA KASIH