Quick-access reference for cath lab nurses & techs
STEMI Clock
EKG-to-balloon timer
Medications
Doses, routes & notes
Contrast Calc
GFR & max contrast dose
Device Setup
Impella, IABP, Pacer
Sheath / Wire
Compatibility charts
Anatomy
Coronary & leg vessels
Pressures
Right heart & formulas
Common Medications
Quick reference for cath lab medications — doses, routes & key notes
| Medication | Class | Dose / Route | Key Notes |
|---|---|---|---|
| Heparin | Anticoagulant | 70–100 units/kg IV bolus; titrate to ACT >250–300s | Check ACT q30min. Standard for PCI anticoagulation. |
| Bivalirudin (Angiomax) | Anticoagulant | 0.75 mg/kg IV bolus, then 1.75 mg/kg/hr infusion | Alternative to heparin; shorter half-life. Monitor ACT. Good for HIT patients. |
| Abciximab (ReoPro) | GP IIb/IIIa | 0.25 mg/kg IV bolus, then 0.125 mcg/kg/min x12hr | Max infusion 10 mcg/min. Watch for thrombocytopenia. |
| Eptifibatide (Integrilin) | GP IIb/IIIa | 180 mcg/kg IV bolus x2 (10 min apart), then 2 mcg/kg/min | Reduce dose in renal impairment (CrCl <50). Infuse 18–24hr post-PCI. |
| Nitroglycerin | Vasodilator | 100–200 mcg IC bolus; or 5–200 mcg/min IV gtt | Treat coronary spasm, reduce preload. Avoid if SBP <90 or RV infarct. |
| Nicardipine | CCB / Vasodilator | 100–200 mcg IC; or 5–15 mg/hr IV gtt | IC for no-reflow / radial spasm. IV for hypertensive emergency. |
| Verapamil | CCB | 100–200 mcg IC bolus | IC for radial spasm or no-reflow. Avoid with severe LV dysfunction. |
| Adenosine | Diagnostic | IC: 100–200 mcg (RCA), 200–300 mcg (LCA); IV: 140 mcg/kg/min | Used for FFR. Contraindicated in severe asthma. |
| Atropine | Anticholinergic | 0.5–1 mg IV; may repeat q3–5min (max 3 mg) | For bradycardia, vasovagal. Have at bedside for RCA interventions. |
| Dopamine | Vasopressor | 2–20 mcg/kg/min IV gtt | Low (2–5): renal; Mid (5–10): inotropy; High (10–20): vasopressor. |
| Phenylephrine (Neo) | Vasopressor | 100–200 mcg IV bolus; or 40–180 mcg/min gtt | Pure alpha agonist. For hypotension without tachycardia. |
| Norepinephrine (Levo) | Vasopressor | 0.1–0.5 mcg/kg/min IV gtt; titrate to MAP | First-line for cardiogenic shock with low SVR. Central line preferred. |
| Epinephrine | Vasopressor | 1 mg IV q3–5min (code); 1–10 mcg/min gtt | Code drug. Low-dose gtt for refractory bradycardia/shock. |
| Protamine | Reversal | 1 mg per 100 units heparin; IV slow push | Reverses heparin. Give slowly — anaphylaxis risk. |
| Midazolam (Versed) | Sedation | 0.5–2 mg IV; titrate q2–3min | Moderate sedation. Have flumazenil available. |
| Fentanyl | Sedation/Analgesia | 25–100 mcg IV; titrate q3–5min | Short-acting opioid. Have naloxone available. |
| Lidocaine | Antiarrhythmic | 1–1.5 mg/kg IV bolus; then 1–4 mg/min gtt | For VT/VF. Also local anesthetic at access site. |
| Amiodarone | Antiarrhythmic | 150 mg IV over 10 min; then 1 mg/min x6hr | For refractory VT/VF. Causes hypotension — give slowly. |
| Cangrelor (Kengreal) | Antiplatelet | 30 mcg/kg IV bolus, then 4 mcg/kg/min infusion | IV P2Y12 inhibitor. Rapid onset/offset. |
STEMI Clock
Enter the EKG time — clock counts elapsed time from that moment. Goal: D2B < 90 min
Enter EKG Time
12hr: type 2:30 and select AM/PM | 24hr: type 0230 or 14:30
Contrast & Fluid Calculator
Weight-based contrast limits and GFR-adjusted maximum contrast dose
Patient Data
Sheath & Wire Compatibility
Which guide catheters fit which sheaths, and common wire specifications
Guide Catheter → Sheath Compatibility
| Guide Catheter | OD | 5 Fr Sheath | 6 Fr Sheath | 7 Fr Sheath | 8 Fr Sheath | Common Use |
|---|---|---|---|---|---|---|
| 5 Fr | ~1.67 mm | ✓ | ✓ | ✓ | ✓ | Diagnostic, radial |
| 6 Fr | ~2.0 mm | ✗ | ✓ | ✓ | ✓ | Standard PCI |
| 7 Fr | ~2.33 mm | ✗ | ✗ | ✓ | ✓ | Complex PCI, atherectomy |
| 8 Fr | ~2.67 mm | ✗ | ✗ | ⚠ | ✓ | Rota (large burr), IVUS + PCI |
Common Guidewires
| Wire | Ø | Tip Load | Characteristics | Use |
|---|---|---|---|---|
| Runthrough NS | 0.014" | 1.0 g | Hydrophilic, floppy tip | Workhorse, standard PCI |
| BMW | 0.014" | 2.2 g | Moderate support, versatile | General PCI workhorse |
| Sion Blue | 0.014" | 0.7 g | Hydrophilic, excellent tip control | Tortuosity, side branches |
| Pilot 200 | 0.014" | 4.1 g | Polymer jacket, high tip load | CTO crossing |
| Gaia series | 0.010" | 1.5–4.5 g | Composite core, tapered tip | CTO micro-channel |
| Confianza Pro 12 | 0.014" | 12 g | Stiff, high penetration | CTO hard cap crossing |
| Wiggle Wire | 0.014" | 0.6 g | Flexible tip, hydrophilic | Extreme tortuosity |
| Iron Man | 0.014" | 1.0 g | Extra support shaft | Device delivery, backup |
| RotaWire Floppy | 0.009" | — | Required for rotablator | Rotational atherectomy only |
| Pressure Wire (FFR) | 0.014" | — | Sensor at tip | FFR / iFR assessment |
Guide Catheter Inner Lumen
| Guide | Inner Lumen | Max Device Compatibility |
|---|---|---|
| 5 Fr | 0.058" (1.47 mm) | Most balloons & stents; no atherectomy |
| 6 Fr | 0.070" (1.78 mm) | Standard stents, IVUS, rota burrs ≤1.5 mm |
| 7 Fr | 0.081" (2.06 mm) | Kissing balloons, rota ≤1.75 mm, atherectomy |
| 8 Fr | 0.091" (2.31 mm) | Large rota ≤2.15 mm, complex CTO, Impella passage |
Introducer Sheath Reference
| Sheath | ID | OD | Access | Typical Use |
|---|---|---|---|---|
| 4 Fr | 1.33 mm | ~1.8 mm | Radial | Diagnostic (small radial) |
| 5 Fr | 1.67 mm | ~2.2 mm | Radial/Femoral | Diagnostic angio |
| 6 Fr | 2.00 mm | ~2.6 mm | Radial/Femoral | Standard PCI |
| 7 Fr | 2.33 mm | ~3.0 mm | Femoral | Complex PCI, atherectomy, IABP |
| 8 Fr | 2.67 mm | ~3.4 mm | Femoral | Large device PCI, TAVR access |
| 12–14 Fr | 4.0–4.7 mm | ~5.2–5.8 mm | Femoral | Impella CP / MCS devices |
| 21–25 Fr | 7.0–8.3 mm | ~8.5–10 mm | Femoral (surgical) | ECMO, Impella 5.5, large bore MCS |
Device Setup Guides
Step-by-step setup for mechanical circulatory support
Impella CP/5.5
IABP
Temp Pacer
Impella CP / 5.5 — Quick Setup
CP: up to 3.7 L/min | 5.5: up to 5.5 L/min cardiac output support.
Equipment List
| Item | Details |
|---|---|
| Impella catheter | CP (14 Fr) or 5.5 (23 Fr) — verify correct model |
| Automated Impella Controller (AIC) | With power cable, plugged in and powered on |
| Purge cassette | Heparinized D5W (25,000 units heparin in 500 mL D5W) |
| Micropuncture kit | 21g needle, 0.018" wire, 4–5 Fr dilator |
| 14 Fr peel-away sheath | Included in Impella CP kit (or 23 Fr for 5.5) |
| Contralateral sheath | 5–6 Fr for arterial monitoring / angiography |
| 0.018" placement guidewire | Included in Impella kit |
| Pigtail catheter | For LV angiography / positioning confirmation |
| Stiff guidewire (0.035") | For serial dilation if needed |
| Suture & securing device | 2-0 silk, StatLock or equivalent |
| Sterile drapes & gown | Full sterile field |
| Pressure transducer | For contralateral arterial line |
| Heparin flush | For sheaths and monitoring lines |
Setup Steps
Obtain Arterial Access
Large bore femoral. CP: 14 Fr peel-away. 5.5: surgical cut-down or 23 Fr. Micropuncture, confirm with angio. Contralateral sheath for monitoring.
Prep the Catheter
Flush with purge solution (heparinized D5W — typically 25,000 units heparin in 500 mL D5W). Verify optical sensor & motor housing. Connect to AIC.
Insert & Advance
Over 0.018" wire under fluoro. Position inlet ~3.5 cm below aortic valve in LV. Confirm placement signal on controller.
Set Performance Level
Start P2, increase to target (P8 CP, P9 5.5). Monitor for suction. Verify position echo/fluoro.
Secure & Monitor
Purge flow 10–15 mL/hr (CP). Monitor motor current, placement signal, pressures, purge pressure.
⚠ Do NOT leave on P1 — thrombus risk. Monitor distal limb perfusion. Repo if suction recurs.
Key Alarms
| Alarm | Cause | Action |
|---|---|---|
| Suction | Inlet against wall / low volume | ↓ P-level, volume, reposition |
| Purge High | Kink / occlusion | Check tubing, flush |
| Purge Low | Leak / empty cassette | Replace cassette, check connections |
| Position (Red) | Migration | Reposition under fluoro/echo |
IABP Setup
Augments diastolic pressure (coronary perfusion), reduces afterload. ~10–20% CO increase.
Equipment List
| Item | Details |
|---|---|
| IABP console | Powered on, helium tank connected & verified |
| IABP balloon catheter | Correct size per height (25/34/40/50 cc) |
| 7–8 Fr arterial sheath | Per manufacturer recommendation |
| Micropuncture kit | 21g needle, 0.018" wire, 4–5 Fr dilator |
| 0.025" or 0.030" IABP guidewire | Included with IABP catheter kit |
| Pressure transducer | For arterial waveform monitoring & timing |
| ECG cable | Connect patient to IABP console for trigger |
| Sterile drapes & gown | Full sterile field |
| Suture material | 2-0 silk for securing catheter at hub |
| Heparin flush | For sheath sidearm |
| Tegaderm / dressing | Sterile site dressing |
Setup Steps
Femoral Arterial Access
7–8 Fr sheath. Seldinger technique, confirm with fluoro.
Select Balloon Size
<5'0": 25 cc | 5'0"–5'4": 34 cc | 5'4"–6': 40 cc | >6': 50 cc. Tip 1–2 cm distal to L subclavian.
Insert & Position
Over guidewire. Tip at 2nd–3rd ICS on CXR. Above renals, below L subclavian.
Connect & Set Timing
Purge helium. Trigger: ECG or arterial pressure. Start 1:2 to optimize. Inflate at dicrotic notch.
Optimize Timing
Augmented diastolic > unassisted systolic. Deflation = lowest point before next systole. Switch to 1:1.
⚠ Contraindicated: aortic regurgitation, dissection, severe PVD. Never leave static — thrombus risk.
Timing Errors
| Error | Waveform | Effect |
|---|---|---|
| Early Inflation | Before dicrotic notch | Premature AV closure, ↓ SV |
| Late Inflation | Well after notch | Suboptimal coronary augmentation |
| Early Deflation | Sharp drop before systole | Suboptimal afterload reduction |
| Late Deflation | Assisted AEDP ≥ unassisted | ↑ Afterload, impeded ejection |
Temporary Transvenous Pacemaker
Equipment List
| Item | Details |
|---|---|
| Pacing generator (pulse generator) | Verify fresh 9V battery; set to demand (VVI) |
| Bipolar pacing catheter | Balloon-tipped (Swan-type) or non-balloon; 5–6 Fr |
| Swan-Ganz introducer (Swandom) | 6–7 Fr introducer sheath with hemostasis valve & sidearm |
| Micropuncture kit | 21g needle, 0.018" wire, 4–5 Fr dilator (for IJ/femoral access) |
| 0.035" J-tip guidewire | For introducer sheath placement |
| Syringe (3 mL) | For balloon inflation (if balloon-tipped catheter) |
| Pacing cables / alligator clips | Connect catheter terminals to generator (+/−) |
| Sterile sleeve | For catheter if repositioning may be needed |
| Pressure transducer | Optional — for waveform-guided placement |
| Sterile drapes & gown | Full sterile field |
| Lidocaine 1% | Local anesthesia at access site |
| Suture & dressing | 2-0 silk, Tegaderm for site |
| Transcutaneous pacing pads | On patient as backup before & during procedure |
Setup Steps
Venous Access
IJ or femoral. 6–7 Fr introducer. RIJ preferred.
Prep Catheter
Check balloon. Connect to generator (VVI demand mode). Fresh battery.
Advance to RV
Under fluoro, through RA to RV apex. Inflate balloon in RA, deflate in RV.
Confirm Capture
5 mA, rate 10–20 above intrinsic. Find threshold (<1 mA ideal). Set 2–3× threshold.
Set & Secure
Rate 60–80. Sensitivity 2–3 mV. Secure, dress site, CXR for confirmation.
⚠ Transcutaneous pads as backup. Monitor for loss of capture, perforation, displacement.
Anatomy Reference
Coronary & peripheral anatomy — diagrams and angiographic views
Coronary Diagram
Angiographic Views
Leg Vessels
Coronary Dominance
| Type | PDA Supplied By | Prevalence |
|---|---|---|
| Right Dominant | RCA → PDA | ~85% |
| Left Dominant | LCx → PDA | ~8% |
| Co-Dominant | Both RCA & LCx | ~7% |
Tap any image placeholder to upload your own fluoro/angiographic images. Images are stored locally in your browser.
Left System Views
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RAO Caudal
RAO 30° / Caudal 20°
Best for: LM, proximal LAD, proximal LCx. Opens the LM bifurcation.
Tap to add image
RAO Cranial
RAO 30° / Cranial 20°
Best for: Mid & distal LAD, diagonal branches. Separates LAD from diagonals.
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LAO Cranial (Spider)
LAO 45° / Cranial 25°
Best for: LM bifurcation, LAD/LCx separation, proximal diagonals. The "money shot" for LM disease.
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LAO Caudal
LAO 45° / Caudal 20°
Best for: LCx, obtuse marginal branches (OM1, OM2). Opens circumflex territory.
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AP Cranial
Straight AP / Cranial 30°
Best for: Mid LAD, septal perforators, diagonal origins. Good for LAD length assessment.
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AP Caudal
Straight AP / Caudal 20°
Best for: LM, proximal LAD/LCx bifurcation. Alternative LM view.
Right Coronary Views
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LAO Straight
LAO 45°
Best for: Proximal & mid RCA. Standard RCA view. Shows AV groove course.
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RAO Straight
RAO 30°
Best for: Mid RCA, acute marginal branches. Opens RCA bifurcation.
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LAO Cranial (RCA)
LAO 30° / Cranial 20°
Best for: Distal RCA, PDA, posterolateral branches. Shows crux & distal bifurcation.
Quick View Reference
| View | Angles | Best Visualizes |
|---|---|---|
| RAO Caudal | RAO 30° / Caud 20° | LM, proximal LAD, proximal LCx |
| RAO Cranial | RAO 30° / Cran 20° | Mid-distal LAD, diagonals |
| Spider (LAO Cranial) | LAO 45° / Cran 25° | LM bifurcation, LAD/LCx separation |
| LAO Caudal | LAO 45° / Caud 20° | LCx, OM branches |
| AP Cranial | AP / Cran 30° | Mid LAD, septals |
| AP Caudal | AP / Caud 20° | LM, proximal bifurcation |
| LAO (RCA) | LAO 45° | Proximal & mid RCA |
| RAO (RCA) | RAO 30° | Mid RCA, acute marginals |
| LAO Cranial (RCA) | LAO 30° / Cran 20° | Distal RCA, PDA, PLB |
Right Heart Pressures
Normal hemodynamic values for right heart catheterization
Right Atrium (RA)
2–6
mmHg (mean)
RV Systolic
15–30
mmHg
RV Diastolic
0–8
mmHg
PA Systolic
15–30
mmHg
PA Diastolic
4–12
mmHg
PA Mean
9–18
mmHg
PCWP / Wedge
6–12
mmHg (mean)
Cardiac Output
4.0–8.0
L/min
Cardiac Index
2.5–4.0
L/min/m²
SVR
800–1200
dynes·sec/cm⁵
PVR
20–120
dynes·sec/cm⁵
Mixed Venous O₂ Sat
60–80
%
Key Hemodynamic Formulas
| Parameter | Formula | Normal |
|---|---|---|
| Cardiac Output (Fick) | CO = VO₂ / (CaO₂ - CvO₂) × 10 | 4–8 L/min |
| Cardiac Index | CI = CO / BSA | 2.5–4.0 L/min/m² |
| Stroke Volume | SV = CO / HR × 1000 | 60–100 mL/beat |
| SVR | SVR = (MAP - CVP) / CO × 80 | 800–1200 |
| PVR | PVR = (mPAP - PCWP) / CO × 80 | 20–120 |
| Transpulmonary Gradient | TPG = mPAP − PCWP | <12 mmHg |
Common Pathologic Patterns
| Condition | RA | RV | PA | PCWP | CO |
|---|---|---|---|---|---|
| Cardiogenic Shock | ↑ | ↑ | ↑ | ↑↑ | ↓↓ |
| RV Infarct | ↑↑ | ↑ sys/↑ diast | ↓ or N | N or ↓ | ↓ |
| Pulmonary HTN | ↑ | ↑↑ | ↑↑ | N (pre) or ↑ (post) | ↓ |
| Tamponade | ↑ (=PCWP) | ↑ diast | ↑ diast | ↑ (=RA) | ↓ |
| Constrictive | ↑ (=PCWP) | Dip-plateau | N or ↑ | ↑ (=RA) | ↓ |
| Hypovolemia | ↓ | ↓ | ↓ | ↓ | ↓ |
| Sepsis (early) | ↓ or N | N | N | ↓ or N | ↑ |
