Procedures Qualified to Perform

Central Venous Catheterization

Central Venous Catheterization is a procedure to provide a route for delivery of caustic or critical medications and allows measurement of central venous pressure. (MEDICINE) The access can be via Internal Jugular vein, Subclavian Vein or Femoral Vein. This procedure is indicated to get access to medicines for pain treatments, infections, and different long-term medications (cancer, dialysis) (cdc, s.f.)

After identifying the landmarks, the area will be sterilized. The physician will apply local anesthesia. The physician will move the patient in what its called “Trendelenburg position” this position with help of the surgical gurney involves the patient being placed with their head down and their feet elevated. The physician with an ultrasound machine will identify the vein and if viable will insert a syringe to draw venous blood.

Complications:

  • Infection
  • Thrombosis
  • Hemothorax
  • Pneumothorax
  • Arterial puncture

Right and Left Heart Catheterization

A heart catherization is a procedure to examine possible diseases that can affect the heart, the cardiac valves or the coronary arteries. During this procedure a cardiac catheter (long thin tube) is inserted in an artery for a left heart catheterization or thru a vein for a right heart catheterization guided by x-ray until it reaches the heart. It can be inserted in the groin, arm or neck to reach the heart.

This procedure can be indicated when:

  • Patients indicates chest pain, shortness of breath, or after a heart attack
  • Suspected degenerative changes or dysfunctions affecting the cardiac valves
  • Before heart surgery
  • For biopsies


Complications:

  • Bleeding and bruising in the insertion site
  • Allergic reaction to contrast
  • Temporary arrhythmia
  • Blood vessel damage
  • Acute heart attack
  • Infection
Intra – Aortic Balloon Pump Insertion

An intra-aortic balloon pump is a device placed in the aorta that helps the heart to pump enough blood to the body. This balloon inflates and deflates with the rhythm of the heart with each contraction.
An Intra-aortic balloon pump insertion involves using a catheter (long thin tube) with the balloon on the tip from the groin area into the femoral artery into the aorta, guided by x-ray.

This procedure can be indicated when:

  • Unstable angina
  • Cardiogenic shock
  • Mitral Insufficiency


Complications:

  • Bleeding and bruising in the insertion site
  • Infection
  • Blood vessel damage
  • Blood clots
  • Stoke
Swan – Ganz Catheterization
Pericardiocentesis / Cardiac Muscle Biopsy
Transesophageal Echocardiography

A transesophageal echocardiography study is a test to assess the function and structure of the heart by using an echocardiogram that uses an endoscope to guide an ultrasound down the esophagus, its used to see the heart without the ribs and the lungs.

This procedure can be indicated when:

  • Need to evaluate the efficiency of the heart valves and chambers
  • Evaluate different valves and chamber diseases
  • Post heart surgery checkup
  • Check for abnormalities


Complications:

  • Breathing problems
  • Heart rhythm problems
  • Bleeding
  • Injury to the teeth, mouth, throat or esophagus

Temporary and Permanent Pacemaker Implantation

A pacemaker is a device that helps the heartbeat in a regular pattern at a normal rate in case the heart can’t do it on its own, problems with the heart rhythm may cause difficulties as the heart is unable to pump the adequate amount of blood to the body.

A pacemaker can be temporary or permanent according to the problem. A temporary pacemaker is used when the problem is temporary such as when the heart is recovering or as an emergency procedure for patients with severe bradyarrhythmia and usually are hemodynamically unstable.

This procedure can be indicated when:

  • Bradycardia
  • Tachy-brady syndrome
  • Heart block


Complications:

  • Bleeding on the incision
  • Infection
  • Pneumothorax
  • Damage to the vessels
Permanent Defibrillator Implantation and Management

An implantable cardioverter-defibrillator is a battery powered device placed on the chest to monitor the hearth rhythm and detect irregular heartbeats and can send a electric shock to the heart to correct the abnormal rhythm

This procedure can be indicated when:

  • Ventricular tachycardia
  • Arrhythmias


Complications:

  • Bleeding on the incision
  • Infection
  • Pneumothorax
  • Damage to the vessels

Bi – Ventricular Pacemaker Implantation and Management

The biventricular pacemaker provides a cardiac resynchronization therapy that helps treat heart failure, by sending a small electrical signal so that both ventricles can pump at the same time. This pacemaker is implanted thru a minor surgery with a small incision on the chest with local anesthesia

This procedure can be indicated when:

  • Heart failure


Complications:

  • Bleeding on the incision
  • Infection
  • Lead displacement
  • Equipment failure

Electrophysiology Studies and Radio Frequency Catheter Ablation

An electrophysiology (EP) study is a test used to understand and map the electrical activity within your heart. The radiofrequency ablation is a procedure that guides a catheter into your heart to destroy small areas of tissue that may be causing your abnormal heartbeat. Both procedures usually use long, flexible tubes (catheters) inserted through a vein or artery in your groin and threaded to your heart.

This procedure can be indicated when:

  • EP studies can be used to get information related to abnormally fast or slow heart rhythms
  • Determine how well certain medicines treat the arrhythmias.
  • To find the source of a heart rhythm problem


Complications:

  • Infection, bleeding and bruising at the site of insertion.
  • Formation of blood clots at the end of the catheter(s) that break off and travel into a blood vessel.
  • Rarely, damage to the heart’s conduction system
  • Rarely, perforation of the heart
Direct Current Cardioversions

A direct current cardioversion is a procedure to convert abnormal heart rhythm  to a normal rhythm with a defibrillator.

This procedure can be indicated when:

  • Ventricular fibrillation
  • Atrial Fibrillation


Complications:

  • Muscle soreness
  • Atrial and ventricular premature beats
Arterial Catheterizations

An arterial catheter is a thin, hollow tube that is placed into an artery in the wrist, groin, or other location to measure blood pressure more accurately than is possible with a blood pressure cuff.

This procedure can be indicated when:

  • Severe lung problems that requires checking the levels of oxygen or carbon dioxide in the blood more frequently than 3 to 4 times a day, the arterial catheter can be used to draw blood without having to repeatedly stick a needle into the person.
  • Low blood pressure can be treated by giving IV and, in some instances, giving medications to help increase blood pressure
  • High blood pressure: In some situations, the blood pressure can go so high that it is life-threatening. Such high blood pressure must be lowered gradually in steps, and measurements with an arterial catheter help guide treatment.


Complications:

  • Infections
  • Pain during placement can result from the needle stick and placement of the catheter at the time it is inserted.
  • Bleeding can occur at the time the catheter is inserted
  • Blood clots can form on the tips of arterial catheters, the clots may block blood flow.