SEARCH · PubMed Health

Results for “Catheterization”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 217 records · Page 12Linked to original sources

PubMed2003

Development and validation of a simple model to predict severe coronary artery disease after myocardial infarction: potential impact on cardiac catheterization use in the United States and Canada.

BACKGROUND: Improved patient selection may optimize the efficiency of cardiac catheterization in both high- and low-rate regions. The purpose of this study was to develop and validate a clinical model for predicting high-risk coronary artery disease (CAD) after myocardial infarction (MI) and to examine the model's potential impact on the use rate of both US and Canadian catheterization practices. METHODS AND RESULTS: By the use of baseline clinical variables from 1122 patients in the angiographic substudy of the Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes (GUSTO-1) trial, we developed a model that was predictive of severe CAD (left main or triple-vessel disease). The final model, which included prior MI, age, sex, hyperlipidemia, and decreased left ventricular ejection fraction (C-index = 0.70), was externally validated in 781 patients in the GUSTO IIb trial. Although the probability of severe CAD predicted 5-year survival, the frequency of catheterization in both Canada and the United States bore no relationship to severe CAD risk in the GUSTO-1 trial. By use of the model, we estimated that as much as 15% of US catheterizations from both GUSTO-1 and GUSTO IIb might have been avoided, without significantly compromising the number of patients with severe CAD who were identified (sensitivity = 0.94). By applying the model to Canadian practices, an additional 30 cases of severe CAD might have been identified per every 1000 catheterizations performed, without increasing the catheterization rate. CONCLUSIONS: The likelihood of severe CAD after ST-elevation MI may be predicted from simple baseline clinical variables. The use of a severe CAD predictive model to guide patient selection might enhance the cost-effectiveness of both aggressive and conservative catheterization practices.

Analysis of Variance↗

PubMed2006

Predictive factors of acute urinary retention requiring catheterization following 125I prostate brachytherapy.

OBJECTIVE: To analyze predictive factors of acute urinary retention requiring catheterization after (125)I prostate brachytherapy. METHODS: A group of 227 consecutive patients with localized prostate cancer were treated with (125)I prostate brachytherapy between September 2003 and December 2004. The clinical, treatment-related and dosimetric factors were evaluated for the need for catheterization owing to urinary retention. RESULTS: Twelve patients (5.3%) required catheterization. The median time to onset was 2 days after implantation (range 1-7 days). Univariate analysis demonstrated that pre-implant ultrasound prostate volume, number of seeds, number of needles and neoadjuvant hormonal manipulation were predictive for catheterization. In multivariate analysis, the number of needles and neoadjuvant hormonal manipulation were significant independent predictive factors for catheterization (P = 0.002 and 0.025, respectively). The risk of catheterization in the cluster in which the number of needles was >24 was 4.07 times as high as that in the cluster in which the number of needles was < or =24 [11.3% versus 3.0%, P = 0.020; 95% confidence interval (CI) 1.24-13.36], and the risk in the hormonally manipulated patients was 7.05 times as high as that in the hormone-naïve patients (7.7% versus 1.2%, P = 0.034; 95% CI 0.89-55.64). CONCLUSION: Our data suggest that the number of needles and hormonal manipulation might be the strongest predictors for catheterization.

Aged↗

PubMedDate not supplied

A prospective safety study of femoral vein versus nonfemoral vein catheterization in patients with burns.

A prospective study was undertaken to determine the safety of femoral vein catheterization in patients with burns. Forty-two patients had a total of 275 catheterizations and were divided into two groups: group 1, femoral vein catheterization = 80 catheters and group 2, nonfemoral vein catheterization = 195 catheters (180 subclavian, 8 internal jugular, and 7 supraclavicular). All catheters were changed to new sites every 48 hours, and dressings were changed every 24 hours. Bacteriologic surveillance was accomplished by submitting the tip and subcutaneous segment of the catheter for semiquantitative cultures. Skin exit-site cultures were obtained, and blood was drawn through the catheters for fungal-isolator cultures before removal. Catheter colonization was defined as greater than or equal to 5 colony-forming units on either the subcutaneous segment or the catheter tip. Catheter-related sepsis was diagnosed when the same organism was recovered from the fungal isolator bottle and either part of the catheter and when there was no other identifiable source of sepsis. The rate of occurrence of colonized catheters was 7.5% (6 of 80) in the femoral vein catheterization group and 13.8% (27 of 195) in the nonfemoral vein catheterization group. Catheter-related sepsis occurred in 2.5% (2 of 80) of femoral and 1% (2 of 195) of nonfemoral catheters. None of these differences are statistically significant. There were no noninfectious complications from femoral vein catheterization. Two subclavian catheters had to be repositioned. This study suggests that central venous access in patients with burns can be safely employed with the use of the femoral vein.

Burns↗

PubMed2004

Bladder contraction strength parameters poorly predict the necessity of long-term catheterization after a pubovaginal rectus fascial sling procedure.

PURPOSE: We verified if the necessity of long-term catheterization after a pubovaginal rectus fascial sling procedure can be predicted by preoperatively determined bladder contraction strength. MATERIALS AND METHODS: We analyzed the files of 58 consecutive nonneurogenic women who underwent a sling procedure for severe or refractory stress urinary incontinence. Preoperative urodynamic measurements in these patients were re-analyzed using the power factor WF and the bladder contractility index as bladder contraction strength parameters. Catheterization was considered necessary if the patient self-catheterized at least once daily. RESULTS: One patient was lost to followup. Three and 6 months after surgery 24 (42%) of 57 and 18 (33%) of 54 patients were on catheterization. On average patients who were not on catheterization had a stronger bladder but the results were not consistently statistically significant. CONCLUSIONS: A trend toward higher bladder contraction strength in patients not on catheterization was found. However, preoperative urodynamic examination can only poorly predict the necessity of long-term catheterization after sling surgery.

Female↗

PubMed1997

A prospective randomized controlled trial comparing suprapubic with urethral catheterization in rectal surgery.

BACKGROUND: Bladder drainage is necessary for several days following rectal surgery. Urethral catheterization has long been known to be associated with significant morbidity. Therefore a prospective randomized trial was performed to determine if this morbidity could be decreased by suprapubic catheterization. METHODS: One hundred and thirty-seven patients undergoing rectal surgery were prospectively randomized to either suprapubic or urethral catheterization. RESULTS: After exclusions, 108 patients were analysed. Of the 49 patients with suprapubic catheters there was 14% morbidity, and of the 59 patients with urethral catheters there was 32% morbidity. Significant bacteriuria was halved with suprapubic catheterization. Patient acceptability of suprapubic catheterization was high, and there was no increased morbidity in any of the areas studied. CONCLUSIONS: This study suggests that suprapubic catheterization has advantages over urethral catheterization with decreased bacteriuria, and greater patient acceptability. However, the significance of decreased bacteriuria is not clear and therefore we can only say suprapubic catheter drainage is comparable to urethral catheter drainage.

Bacteriuria↗

PubMed1995

Cutting the cost of catheterization for acute retention--a hospital or domiciliary procedure?

OBJECTIVE: To report the views of General Practitioners (GPs) and patients on the most appropriate place and person to catheterize patients in acute urinary retention. PATIENTS AND METHODS: Two separate questionnaires were sent to 50 local GPs and 100 patients who had recently been referred with acute urinary retention. The questionnaires were designed to ascertain the most appropriate place and person to catheterize these patients. They also established the number of hospital admissions due to acute retention, the use of ambulances and the uptake of the district nurse services. RESULTS: Whilst 54% of GPs advocated domiciliary catheterization, only 20% of emergency catheterizations were carried out in the home. Nearly half the patients catheterized in the Accident and Emergency Department were admitted acutely and 41% of patients had travelled to hospital by ambulance. Patients were equally divided about where they would prefer to be catheterized, but 70% of patients stated that they were happy to be catheterized by a trained nurse; no GP opposed this concept. CONCLUSION: The cost/benefit analysis of these results strongly supports the case for establishing best-practice guidelines to promote an emergency domiciliary service led by GPs and trained district nurses and thus hasten the emergency care of acute retention and cut costs.

Acute Disease↗

PubMedDate not supplied

Effects of lumbosacral subarachnoid catheterization in horses.

OBJECTIVES: To evaluate the effects of long duration subarachnoid catheterization in horses on cerebrospinal fluid (CSF) cellularity and bacteriology, arterial blood pressure, heart rate, respiratory rate, rectal body temperature, and spontaneous locomotor activity. STUDY DESIGN: Prospective experimental study. ANIMAL: Five clinically normal healthy adults horses weighing 511 +/- 47 kg. METHODS: Subarachnoid catheters were placed using sedation and local anesthesia and maintained for 48 hours in standing horses. Cerebrospinal fluid samples were tested for cellularity and bacteria growth. Heart rate, respiratory rate, arterial blood pressure, and body temperature were recorded. Locomotor activity was graded. One-way repeated measures ANOVA and Bonferroni's test were used to statistically compare data from baseline to 12, 24, and 48 hours. RESULTS: Subarachnoid catheterization in horses produced an acute inflammatory reaction after 12 hours of catheterization, as evidenced by a statistically significant increase in CSF white blood cell count. No bacterial contamination was encountered. No significant differences were found in heart rate, respiratory rate, body temperature, and arterial blood pressure. The horses did not develop motor ataxia or proprioceptive deficits during 48 hours of catheterization. CONCLUSIONS: Results of this study suggest that 48 hours of subarachnoid catheterization in horses does not produce clinical signs of neurologic dysfunction or cardiovascular and respiratory changes, even though an inflammatory reaction occurred. CLINICAL RELEVANCE: Subarachnoid catheterization in horses is preferred for monitoring CSF pressure or for repeated collection. Understanding the effects of catheterization alone, allows the clinician to better interpret abnormalities in CSF collected.

Animals↗

PubMed1999

Analysis of charges and complications of permanent pacemaker implantation in the cardiac catheterization laboratory versus the operating room.

During the last two decades, an increasing number of permanent pacemakers have been implanted outside of the operating room (OR) by nonsurgeons. Previous investigators have demonstrated that pacemakers can be safely implanted in the cardiac catheterization laboratory with no increase in complications or infections. This is the first study of its kind to simultaneously evaluate cost, length of hospitalization, and complications between pacemakers implanted in the OR by surgeons with those implanted in the catheterization laboratory by an electrophysiologist. A total of 254 consecutive pacemaker implants were analyzed over a 2-year period. The OR group consisted of 122 patients with a mean age of 64 +/- 21 years versus 132 patients in the catheterization laboratory group with a mean age of 65 +/- 17 years. The indication and type of pacemaker implanted were similar among both groups with 78% of OR patients and 73% of catheterization laboratory patients receiving dual chamber devices. The average cost for pacemaker implantation in our study was significantly higher in the OR group $5,464 +/- $1,670 versus $2,682 +/- $8 for the catheterization laboratory group (P < 0.001). There was a reduction in preimplant days in the catheterization laboratory group 3.16 +/- 12.40 days versus 5.65 +/- 9.54 days in the OR group (P < 0.05). Complications were minimal and there were no significant differences between the two groups. This study confirms that pacemakers can be safely implanted in the catheterization laboratory by nonsurgeons with no increase in complications and a significant reduction in hospital costs.

Aged↗

PubMedDate not supplied

A non-human primate model for the in utero chronic catheterization of the umbilical vein. A preliminary report.

Short-term ultrasound-guided fetal umbilical cord catheterization in humans has been reported. However, before chronic umbilical vein catheterization is attempted in humans the technique must be tested in the non-human primate model. If the fetus was to tolerate this procedure, chronic fetal umbilical vein catheterization could be used for drug administration, parenteral fetal nutrition or to monitor the changes of hematologic parameters during and after open or endoscopic fetal surgery. In this study, 4 pregnant baboons were used to test the feasibility of ultrasound-guided umbilical vein catheterization. Although the umbilical vein was successfully catheterized in all the animals, only 1 fetus survived the postoperative period. The 3 immediate fetal deaths were due to a fetal intra-amniotic hemorrhage, while the most likely cause of death of the 4th animal was infection. In the surviving fetus and mother, blood was sampled once a day. Neither fetomaternal hemorrhage nor thrombosis could be documented. We conclude that ultrasound-guided transplacental umbilical vein chronic catheterization is technically difficult but feasible in the baboon model. Further studies in this model are needed to improve the catheterization technique and to monitor the extent of time that the catheter may be tolerated within the umbilical vein.

Animals↗

PubMed1990

Prognostic value of radionuclide angiography in medically treated patients with coronary artery disease. A comparison with clinical and catheterization variables.

To evaluate the usefulness of multiple measures from rest and exercise radionuclide angiography (RNA) in predicting cardiovascular death and cardiovascular events (death or nonfatal myocardial infarction) and to assess the prognostic usefulness of the RNA relative to clinical and catheterization data, we studied 571 stable patients with symptomatic coronary artery disease who had upright rest/exercise first-pass RNA within 3 months of catheterization and were medically treated. With a median follow-up of 5.4 years, 90 patients have died from cardiovascular causes, and 147 patients have either died or suffered a nonfatal myocardial infarction. Using the Cox regression model and a preselected group of RNA variables, the most important RNA predictor of mortality was exercise ejection fraction (chi 2 = 81, p less than 0.00001). Neither rest ejection fraction nor the change in ejection fraction from rest to exercise contributed additional predictive information. Two other RNA study variables, the change in heart rate from rest to exercise and rest end-diastolic volume index, did contribute additional prognostic information to the exercise ejection fraction (chi 2 = 23, p less than 0.0001). Compared with noninvasive clinical data (history, physical examination, electrocardiogram, and chest radiograph), RNA variables were considerably more predictive of mortality (chi 2 = 71 [clinical variables] versus chi 2 = 104 [RNA]). Remarkably, the strength of the relation of RNA variables with mortality was equivalent to that of the set of catheterization variables previously demonstrated in our large angiographic population to be prognostically important (chi 2 = 104 [RNA] versus chi 2 = 102 [catheterization variables]). The RNA contained 84% of the information provided by clinical and catheterization descriptors combined. Furthermore, the RNA contributed significant additional prognostic information to the clinical and catheterization data (chi 2 = 13.6, p = 0.0035). For cardiovascular events, the relative prognostic usefulness of the RNA was similar, although relations with this outcome were generally weaker. Descriptors from the rest/exercise RNA exhibit a powerful relation with long-term outcomes and can be useful in defining risk, even when clinical and catheterization data are available.

Cardiac Catheterization↗

PubMed1994

Role of spin echo and cine magnetic resonance imaging in presurgical planning of heterotaxy syndrome. Comparison with echocardiography and catheterization.

BACKGROUND: Patients with heterotaxy syndrome frequently have complex congenital cardiac and noncardiac malformations requiring detailed diagnostic evaluation by noninvasive as well as invasive imaging modalities for management planning. Recent advances in magnetic resonance imaging (MRI) techniques allow detailed delineation of cardiovascular anatomy and blood flow in young infants with rapid heart rates. The present study was undertaken to prospectively evaluate the role of MRI in the presurgical evaluation of patients with heterotaxy syndrome. METHODS AND RESULTS: Between January 1 and December 31, 1992, 14 consecutive patients with heterotaxy syndrome and complex congenital heart disease were enrolled in a prospective protocol. After evaluation by echocardiography and cardiac catheterization, a tentative management plan was recorded. Subsequently, a MRI study was performed and surgical planning was reevaluated. MRI was found to be comparable to echocardiography in terms of length of examination and sedation requirements. Surgical planning was altered in four patients because MRI provided additional data not evident on echocardiography and catheterization. Comparison of diagnostic yield between echocardiography, catheterization, and MRI showed that MRI is superior to echocardiography and often to catheterization in delineation of systemic and pulmonary venous anatomy and their relation to mediastinal structures. When the anatomic and hemodynamic data obtained by echocardiography and MRI were considered together, cardiac catheterization data were necessary only to determination of pulmonary vascular resistance before Fontan operation. CONCLUSIONS: MRI provides excellent anatomic and functional information that in some patients was not available by echocardiography or catheterization. Combined with echocardiography, MRI provides the high-quality diagnostic information necessary for management planning in most patients with heterotaxy syndrome. Cardiac catheterization is indicated when determination of pulmonary vascular resistance is necessary for decision making or when an interventional procedures is indicated.

Abdomen↗

PubMed2005

Bladder ultrasound increases catheterization success in pediatric patients.

OBJECTIVES: To determine whether volumetric bladder ultrasound (VBUS) determinations improve the rate of successful pediatric catheterizations and caregiver satisfaction. METHODS: This randomized controlled trial was conducted at an urban academic emergency department. Patients younger than 36 months requiring diagnostic urine samples were randomized into one of two groups: VBUS or conventional catheterization (CC). Patients were excluded if they were critically ill or had genitourinary abnormalities. VBUS catheterizations were postponed for 30 minutes if the transverse bladder diameter was <2 cm. Data included demographics, number of catheterizations required for success (>/=2.5 mL urine) (SucC), and the number of postponed catheterizations. Caregiver satisfaction scores using a ten-point Likert scale (1 = poor, 10 = excellent) were obtained for time to SucC, physical handling of child (PhysH), and overall satisfaction. Descriptive statistics, chi-square tests, t-tests, and correlation coefficients were used where appropriate. RESULTS: Of 64 patients, 33 underwent VBUS-guided catheterization. The groups did not differ regarding gender (39% male) and age (mean age: CC, 9.4 months, SD = 7.8; VBUS, 7.7 months, SD = 5.5; p = 0.33). SucC occurred in 94% (VBUS) versus 68% (CC) of patients (p = 0.007). The two groups did not differ on any of the caregiver satisfaction indices (time to SucC: VBUS = 8.9 vs. CC = 8.1; PhysH: VBUS = 9.3 vs. CC = 8.6; overall satisfaction: VBUS = 9.3 vs. CC = 8.5; all p > 0.15). CONCLUSIONS: Although there was no significant difference in caregiver satisfaction between the VBUS and CC groups, implementation of VBUS greatly improved the success rates of pediatric emergency department catheterizations. This improvement is achieved with a rapid and easily mastered VBUS technique.

Child, Preschool↗

PubMed1992

Cardiac catheterization through the internal jugular vein in pediatric patients. An alternative to the usual femoral vein access.

The percutaneous femoral vein approach is used routinely for cardiac catheterization in the pediatric age but in some children, it may be impossible as in the case of iliac vein or inferior vena cava thrombosis due to previous cardiac catheterization, or inconvenient as for right ventricular endomyocardial biopsies. In the period between 1982 and 1990, 160 cardiac catheterizations or right ventricular endomyocardial biopsies were performed in 102 children. Patients ranged in age between 2 months and 17 years (mean, 3.8 years) and in weight from 3.2 to 57.3 kg (mean, 14.4 kg). Indications for the internal jugular vein approach were as follows: (1) thrombosis of the inferior vena cava due to previous cardiac catheterization in 42 patients (41 percent); (2) right ventricular endomyocardial biopsy after cardiac transplant in 19 patients (19 percent); (3) control catheterization of the pulmonary arteries following classic or bidirectional cavopulmonary anastomosis in 16 patients (16 percent); (4) superior vena cava obstruction following Mustard's procedure in 14 patients (14 percent); (5) failed percutaneous femoral venous approach in six patients (6 percent); and (6) absence of the hepatic segment of the inferior vena cava in four patients (4 percent). The right or left internal jugular vein could be entered in all but three procedures (98 percent). Seventeen patients had more than one procedure through the same internal jugular vein and the vein was found patent in all. A complete right heart cardiac catheterization was performed using this route. Right ventricular endomyocardial biopsy and interventional procedure were performed through this route. Two major complications occurred. A patient developed a central transient ischemic attack and another patient developed a persistent Horner syndrome. Accidental carotid puncture occurred in five patients without consequences. Our data indicate that cardiac catheterization in infants and children can be performed safely through the internal jugular vein, with a high success rate and a low incidence of major complications.

Adolescent↗

PubMed2005

Does lidocaine gel alleviate the pain of bladder catheterization in young children? A randomized, controlled trial.

OBJECTIVE: Bladder catheterization (BC) is a commonly performed, painful procedure in the pediatric emergency department (ED). A survey demonstrated that analgesia is infrequently used for several brief painful procedures, including BC, in pediatric patients. In this study, we evaluated the use of 2% lidocaine gel to alleviate the pain associated with BC in young children (<2 years) in the ED. METHODS: We conducted a randomized, double-blind, placebo-controlled trial comparing pain scores during bladder catheterization with 2% lidocaine gel versus nonanesthetic lubricant. We used a previously validated scale for measuring brief procedure-related pain in preverbal children (Face Legs Arms Cry Consolability Pain Scale [FLACC]). A total of 115 patients were recruited; 56 patients were randomized to the control group, and 59 were randomized to the lidocaine group. Lubricant was applied to both the genital mucosa and the catheter. Pain measurements were recorded at 3 time intervals: before insertion of the catheter, during catheterization, and after catheterization. Interobserver reliability had been previously established in an observational pilot study. RESULTS: The difference in mean FLACC scores between the control (7.55 +/- 2.56) and study groups (7.37 +/- 2.87) during catheterization was not statistically significant. The change in FLACC from time 1 (preprocedure) to time 2 (during procedure) was statistically significant in both groups, suggesting that bladder catheterization is a painful procedure. CONCLUSIONS: Altering the standard practice of use of nonanesthetic lubricant with 2% lidocaine gel as lubricant during bladder catheterization in young children may not be helpful in alleviating the pain associated with the procedure.

Anesthetics, Local↗

PubMed2003

The effects of education on anxiety among Chinese patients with heart disease undergoing cardiac catheterization in Hong Kong.

OBJECTIVE: To examine the effects of patient education on anxiety among Chinese patients with heart disease undergoing cardiac catheterization in Hong Kong. DESIGN: Randomized experimental design, data collected on three occasions from subjects. SETTING: A regional major hospital in Hong Kong. SUBJECTS: 62 clients who met the inclusion criteria were randomly allocated into experimental and control groups with 31 subjects in each group. INTERVENTION: Group education before cardiac catheterization. MAIN OUTCOME MEASURES: State Anxiety Inventory (STAI Form Y-1) and Knowledge about Cardiac Catheterization. RESULTS: State anxiety of all subjects reached the highest at the time just before cardiac catheterization and recorded the lowest at the time following the procedure. A lower level of anxiety was experienced by the experimental subjects who received the education intervention when compared with the control subjects who did not receive the education intervention before cardiac catheterization. CONCLUSION: The study provides initial information about anxiety reduction with education intervention among Chinese heart disease patients undergoing cardiac catheterization. It is envisaged that the study may also assist health professionals in developing and designing effective educational programmes for clients prior to cardiac catheterization.

Anxiety↗

PubMed2000

Evaluation of absorbed radiation dose to working staff during cardiac catheterization procedures.

BACKGROUND: Cardiac catheterization has been used frequently for the evaluation and treatment of patients with heart diseases. The working staff, particularly cardiologists who perform these procedures, have the highest potential risk of receiving high radiation doses due to close contact with patients. The purpose of this study was to measure and evaluate the accumulated radiation dosage of the cardiologists while they were performing clinical procedures in the cardiac catheterization laboratory. The working environment of the catheterization laboratory was also monitored for radiation. METHODS: Thermoluminescent dosimeters (TLDs) with very high sensitivity were employed for dose evaluations. They were taped to various parts of the body of the cardiologists during catheterization procedures. For environmental monitoring, TLDs were also distributed at several sites of the catheterization rooms for a period of 2 to 4 weeks. RESULTS: The study showed that the left wrist of the cardiologists received the highest radiation dose (338 microsieverts [microSv]/procedure) and the left lens received the second highest dose (149 microSv/procedure) during the procedures. The dose to the knees was unexpectedly high (92 microSv/procedure), partly due to radiation leakage from the lead curtain shielding under the patient couch. On average, the effective radiation dose per year was 37 mSv/y for a cardiologist who performs 10 catheterization procedures per week. Compare this to the occupational exposure limit of 50 mSv/y. The estimated accumulated equivalent dose to the lens was 152 mSv/y, which exceeded the regulatory limit for occupational exposure. CONCLUSIONS: Using proper lead shielding and increasing the distance from the radiation source are good strategies for reducing the radiation dose in medical staff. The work area outside the catheterization room was considered safe because the radiation level was essentially equivalent to the background radiation level.

Cardiac Catheterization↗

PubMed2001

Routine perioperative pulmonary artery catheterization has no effect on rate of complications in vascular surgery: a meta-analysis.

Despite widespread use pulmonary artery catheterization has not been proven to reduce complications or mortality. One study supported the use of routine preoperative pulmonary artery catheterization in moderate-risk vascular surgery patients; several other studies have reported that pulmonary artery catheterization is not efficacious. Our goal was to scrutinize the data using meta-analysis. This is a systematic review of the literature. MEDLINE was searched for all articles on pulmonary artery catheterization, optimization, oxygen delivery, and preoperative preparation of vascular surgery patients. Data from papers judged appropriate for inclusion were analyzed using a computer program, Easy MA. Complications were defined as only those that could have reasonably have been prevented by or resulted from pulmonary artery catheterization. Of hundreds of possible papers only four were found to be adequate randomized prospective studies with similar exclusions, therapeutic endpoints, and interpretable complication and mortality rates. Controls included 174 patients versus 211 in the protocol group. Power analysis showed that the combined sample sizes were adequate. The meta-analysis demonstrates that the studies are homogeneous. The use of a pulmonary artery catheter does not prevent morbidity or mortality. Of the studies providing data on the amount of intravenous fluid administered three reported that statistically significantly more fluid was given to patients who underwent pulmonary artery catheterization. Meta-analysis indicates that in moderate-risk vascular surgery patients routine preoperative pulmonary artery catheterization is not associated with improved outcomes.

Catheterization, Swan-Ganz↗

PubMed1992

Comparison of Doppler echocardiography and cardiac catheterization in patients requiring valve surgery: search for a 'gold standard'.

OBJECTIVE: To compare the sensitivities of Doppler echocardiography and cardiac catheterization in the diagnosis of severe valvular heart disease in patients requiring valve surgery. DESIGN: Retrospective analysis of Doppler echocardiograms and cardiac catheterizations. SETTING: Tertiary referral cardiovascular centre in a university setting. PATIENTS: Sixty-nine patients undergoing valve surgery between July 1988 and July 1990. RESULTS: The sensitivities of echocardiography and cardiac catheterization were 84 and 87%, respectively (P = 1.0) in 32 patients who underwent aortic valve surgery primarily for severe aortic stenosis; 83 and 67%, respectively (P = 1.0) in six patients with severe aortic regurgitation, and 100 and 85%, respectively (P = 1.0) in seven patients with combined severe aortic stenosis and regurgitation. The sensitivities of echocardiography and cardiac catheterization in 11 patients who underwent mitral valve surgery for severe mitral stenosis were 73 and 91%, respectively (P = 0.6) and 69 and 92%, respectively (P = 0.3) in 13 patients with severe mitral regurgitation. Sensitivities of echocardiography and cardiac catheterization in the diagnosis of severe tricuspid regurgitation in five patients who had tricuspid valve repair were 100 and 80%, respectively (P = 1.0). Two patients with severe aortic stenosis by echocardiography, but not by catheterization, did not undergo aortic valve replacement during valvular surgery; both required aortic valve replacement within two years of initial surgery because of heart failure. Four patients with severe tricuspid regurgitation identified by echocardiography did not have tricuspid repair; three had pulmonary hypertension and these patients had resolution of tricuspid regurgitation on follow-up. One patient with severe tricuspid regurgitation and absence of pulmonary hypertension required reoperation for tricuspid valve repair 10 months after initial operation. CONCLUSIONS: The sensitivity of echocardiography and cardiac catheterization in the detection of severe valvular lesions requiring surgery is similar. Discordant results should be reviewed carefully with knowledge of the inherent pitfalls of both techniques in order to ensure optimal patient outcome.

Adult↗