Fractional Flow Reserve

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SAMPLE EXCERPT
- Full procedure text, video and illustrations available with the full product
PRE-PROCEDURE
INDICATIONS
  • To assess functional severity of intermediate coronary artery lesions
  • To distinguish focal coronary disease from diffuse coronary disease
  • To identify culprit lesions in patients with multivessel coronary artery disease
  • To assess for optimal stent implantation
  • To assess in-stent restenosis
CONTRAINDICATIONS
  • Inability to achieve appropriate arterial access for coronary catheterization for any reason
  • Presence of contraindications to coronary catheterization
    • Coagulopathy
    • Decompensated congestive heart failure
    • Uncontrolled hypertension
    • Active stroke
    • Refractory arrhythmia
    • Active gastrointestinal bleeding
    • Inability of patient to cooperate
    • Active infection
    • Acute renal failure or severe chronic non–dialysis-dependent kidney disease
    • Contrast allergy in the absence of premedication
    • Unexplained fever or untreated infection
    • Severe uncorrected anemia
EQUIPMENT
  • Sterile mask, cap, gown, gloves, and drape
  • Crash cart with resuscitation equipment, intubation equipment, resuscitation drugs, and defibrillator
  • Routine patient monitors: ECG, blood pressure cuff, pulse oximeter, suction
  • Supplemental oxygen source and delivery system (mask, nasal cannula)
  • Equipment for peripheral IV placement
    • 20-gauge IV catheter
    • Small syringe and small-gauge (25- or 30-gauge) needle for subcutaneous infiltration
    • Alcohol swab or other sterile prep
    • Heparin lock or IV solution and tubing
    • Tape to secure IV
    • Bandage for IV site after the procedure
  • Sterile prep solution
  • Manifold setup and/or power contrast injector
  • 1% lidocaine
  • 21-gauge needle and syringe for local anesthesia
  • 18-gauge Seldinger/Cook needle
  • Vascular introducer sheath (various French sizes) with J-tipped wire
  • 180" or longer 0.035" J-tipped guidewire
  • Coronary guide catheter
  • 0.014" fractional flow reserve wire
  • IV heparin
  • IV adenosine
  • Pressure dressing for femoral or other arterial catheterization site

PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Patients should remain on bed rest for 2 to 6 hours to prevent bleeding at femoral access sites and refrain from significant physical activity for 5 to 14 days afterward.
  • Patients should be cautioned to watch for swelling or bleeding at the femoral puncture site and to report these immediately to the nursing staff.
  • Patients who take metformin should be advised not to resume taking the medication for at least 48 hours after the procedure.
COMPLICATIONS
  • Bleeding
  • Vascular injury (eg, femoral artery dissection)
  • Iatrogenic coronary artery dissection or perforation
  • Intracoronary thrombus
  • Air embolism
  • Stroke
  • Arrhythmia
  • Cardiac arrest
  • Myocardial infarction
  • Death
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