PVDOMICS: Right Heart Catheterization
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1 PVDOMICS: Right Heart Catheterization Cardiovascular Physiology Core Cleveland Clinic, Cleveland OH March 16, 2018 NHLBI Pulmonary Vascular Disease Phenomics Program Funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health with support from the Pulmonary Hypertension Association
2 Introduction This training is intended to serve as a reference document for PVDOMICS study coordinators who will be collecting and transmitting right heart catheterization (RHC) data. It will also include information and training on the blood draw that takes place during the right heart catheterization procedure. 2
3 Coordinator Responsibilities All right heart catheterizations will be performed by a trained and licensed medical professional. Study coordinators are responsible for ensuring that all data is obtained and transmitting that data to the Cardiovascular Physiology Core (CPC) Study coordinators may need to supervise the collection of omics blood during the RHC and assist in transporting this blood to the lab in a timely fashion. 3
4 Order of Procedures Resting Right Heart Catheterization in Supine Position Oxygen Challenge in Supine Position Exclude if CO 2 retainer or if mpap < 20 Vasodilatory Challenge in Supine Position Exclude if PCWP 25 or if mpap < 20 Fluid Challenge in Supine Position OR Invasive CPET in Upright* Position *Mayo does invasive CPETs in supine position 4
5 Data To Be Obtained Pressures Saturations Outputs Right Atrial Superior Vena Cava Thermodilution Right Ventricular Right Atrial Direct Fick (optional) Pulmonary Capillary Wedge Pulmonary Arterial Pulmonary Capillary Wedge Pulmonary Artery
6 Data Obtained: Blood Samples The following blood samples will be obtained during the resting RHC per the blood protocol. Venous (via introducer, before RHC) (27.5mL) Systemic Arterial (optional, before RHC) (6.5mL) Pulmonary Capillary (Wedge) (6.5mL) Pulmonary Arterial (Mix) (6.5mL) All blood samples must reach the lab within 1 hour of the draw time. 6
7 Data Obtained: Blood Samples 1. Participant must rest for 10 min before blood collection Side port of introducer 2. VENOUS blood collection Discard 3ml OMICS blood: 27.5ml* ml Red PAX gene (RT) 2. 10ml Lavender (ice) 3. 10ml Lavender (ice) 4. 5ml Gold (ice) OPTIONAL 2a. SYSTEMIC Arterial blood collection Discard 3ml Blood gas: 1ml OMICS blood: 6.5ml* Arterial access 1. 4ml Lavender (ice) ml Red PAX gene (RT) 3. Resting RHC hemodynamic measurements 4. Measure PCW pressure Distal port 5. Pulmonary Capillary (Wedge) blood collection Discard 3ml OMICS blood: 6.5ml* 1. 4ml Lavender (ice) ml Red PAX gene (RT) 6. Measure PA pressure Distal port 7. Pulmonary Arterial (Mix) blood collection Discard 3ml OMICS blood: 6.5ml* 1. 4ml Lavender (ice) ml Red PAX gene (RT) Order of RHC Order of OMICS Blood Collection 2 * non-heparinized syringe heparinized syringe RT = room temperature Continue with the rest of the RHC procedure and challenges ice = place on wet ice 7
8 Blood Collection Supplies Vacutainers Four 2.5mL PAXgene (Red) Two 10mL EDTA (Lavender) Three 4mL EDTA (Lavender) One 5mL SST (Gold) 2.5mL PAXgene 5mL SST 4mL EDTA 10mL EDTA Blood Transfer Device Allows you to transfer blood from the syringe to the vacutainer tubes 8
9 Blood Transfer Device Needs to have a female Luer adapter! Luer adapters and holders are also sold separately 9
10 Blood Draw: Venous & Optional Arterial 1. Participant must rest for 10 min before blood collection Side port of introducer 2. VENOUS blood collection Discard 3ml OMICS blood: 27.5ml* ml Red PAX gene (RT) 2. 10ml Lavender (ice) 3. 10ml Lavender (ice) 4. 5ml Gold (ice) OPTIONAL 2a. SYSTEMIC Arterial blood collection Discard 3ml Arterial access Blood gas: 1ml OMICS blood: 6.5ml* 1.4ml Lavender (ice) 2.2.5ml Red PAX gene (RT) 3. Resting RHC hemodynamic measurements Order of RHC Order of OMICS Blood Collection 2 * non-heparinized syringe RT = room temperature heparinized syringe ice = place on wet ice 10
11 Blood Draw: Venous Venous omics Blood Draw Participant has to be resting for 10 minutes before drawing the blood. After the introducer has been placed, but before any other procedures or measurements are performed, draw the venous blood sample from the SVC through the side port of the sheath. Draw back 3mL of blood using a sterile syringe and discard the sample. Draw back 27.5mL of blood using a second sterile syringe for omics analysis. Then fill the tubes from the syringe using a sterile transfer device. 11
12 Blood Draw: Pulmonary Capillary (Wedge) 4. Measure PCW pressure 5. Pulmonary Capillary (Wedge) blood collection Discard 3ml Distal port OMICS blood: 6.5ml* 1. 4ml Lavender (ice) ml Red PAX gene (RT) Order of RHC Order of OMICS Blood Collection 2 * non-heparinized syringe RT = room temperature heparinized syringe ice = place on wet ice 12
13 Blood Draw: Pulmonary Capillary (Wedge) Blood draw must be done after all pressure measurements have been completed. Do not draw if PCW saturation <90% Draw back 3mL of blood using a sterile syringe and discard the sample. Then use a second sterile syringe to draw 6.5mL of blood for omics analysis. Transfer the blood to the appropriate blood collection tubes using a blood transfer device. 13
14 Blood Draw: Pulmonary Artery (Mix) 6. Measure PA pressure 7. Pulmonary Arterial (Mix) blood collection Discard 3ml OMICS blood: 6.5ml* 1.4ml Lavender (ice) 2.2.5ml Red PAX gene (RT) Distal port Continue with the rest of the RHC procedure and challenges Order of RHC Order of OMICS Blood Collection 2 * non-heparinized syringe RT = room temperature heparinized syringe ice = place on wet ice 14
15 Blood Draw: Pulmonary Artery (Mix) Blood draw must be done after all pressure measurements have been completed. Draw back 3mL of blood using a sterile syringe and discard the sample. Then use a second sterile syringe to draw 6.5mL of blood for omics analysis. Transfer the blood to the appropriate blood collection tubes using a blood transfer device. 15
16 Recording Data: Pressure Tracings You should receive paper printouts of pressure tracings. Need 17 printouts (at least) 2 printouts per location (RA, RV, PWCP, PA) for the resting RHC (spontaneous breathing & breath hold) 1 printout per location (RA, PWCP, PA) for the oxygen challenge, nitric oxide challenge, & fluid challenge/icpet All pressure tracings need to have an ECG tracing on them Digitized or computer generated mean line should be recorded with all tracings. 16
17 Condition should be noted ECG tracing Measurement location must be noted somewhere Mean Line Pressure scale and Speed
18 RHC Transmission to the CPC 1. Label and De-identify the RHC printout (if necessary) a) Verify that each waveform printout has the participant s 6 digit ID #, participant s alphacode and the date of RHC test indicated on it somewhere b) If one of those 3 elements is missing, add the missing element on the RHC printout (handwrite or use a sticker) _XX_ c) Verify that no identifying information exists on the RHC printout d) Cross off or obscure any identifying information that does exist on the printout (e.g. name, date of birth, SSN, MRN, initials) 18
19 RHC Transmission to the CPC 2. Scan the de-identified RHC printout into a secure computer and save it as a PDF file. 3. Name the PDF file according to the following convention: RHC_######_ac_mmddyyyy.pdf Type of Test Alphacode File Type PVDOMICS ID# Date of Test 19
20 RHC Transmission to the CPC 4. Submit RHC to DCC. Use the secure WinSCP portal to transmit the pressure tracings and any accompanying report pages 5. Document the date you transmitted the RHC on Form Enter Form 280 into the PVDOMICS Study database. 7. Keep the paper copy of Form 280 and the original waveform printouts in the participant s study file maintained at your site. 20
21 For Questions Please Contact Jennifer Kirsop, Research Coordinator CPC group: Phone: (216)
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