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PubMed2004

Geographical location of residence and uniformity of access to cardiac revascularization services after catheterization.

BACKGROUND: The centralization of health care services has numerous potential benefits but April compromise access for individuals living in remote areas. OBJECTIVES: To examine the association between a patient's place of residence and the likelihood of undergoing a coronary revascularization procedure within one year after cardiac catheterization. METHODS: All Alberta residents undergoing cardiac catheterization between 1995 and 1998 were examined. Geographical distance from patient place of residence to a centralized catheterization facility was calculated. The adjusted odds of undergoing cardiac revascularization within one year of catheterization was determined as a function of distance, controlling for differences in patient age, clinical factors and economic status. RESULTS: Of 21816 residents who underwent cardiac catheterization in the province, 10997 had a revascularization procedure. Graphical examination of distance revealed a change in revascularization rates in patients living more than 450 km from revascularization centres. Further analysis was conducted using this cutpoint. Patients living in these remote areas were more likely to undergo a coronary revascularization procedure within the next year (adjusted odds ratio 1.65, 95% CI 1.05 to 2.59). However, these same residents were also less likely to undergo catheterization in the first place when compared with other Albertans (270 versus 398 procedures per 100000 population). CONCLUSION: Only a small proportion of the population living in Alberta's most remote areas were more likely to undergo a revascularization procedure, indicating a remarkable uniformity of access to revascularization after coronary cardiac catheterization has occurred. This study examines the use of an existing database to gain further insights into the relationship between geography and access to cardiac care, and the distance-access relationship for coronary revascularization in Alberta.

Alberta↗

PubMed1991

The effect of cardiac catheterization upon management of advanced aortic and mitral valve disease.

We assessed the incremental effect of cardiac catheterization upon the management of 93 adult patients with aortic and/or mitral valve disease, referred for surgical consideration. There were 52 patients with aortic valve disease, 29 with mitral valve disease and 12 with aortic and mitral valve disease. Prior to cardiac catheterization, a detailed unblinded ultrasound assessment of each valve was made utilizing 2D and Doppler ultrasound. Based upon the ultrasound result and the clinical assessment, the patient's cardiologist recorded a grading of valve severity and a management decision for each valve. Following catheterization and coronary angiography, the cardiologist repeated the gradings of valve severity and recorded a final management decision. After catheterization, management changed in nine patients and was unchanged in 84. Reasons for management change included differences between echocardiographic and catheterization assessment of valvular regurgitation (three patients), information on coronary anatomy (two patients), minor differences in assessed aortic valve area (one patient) and left ventricular function (one patient), and confirmation of ultrasound findings where clinical and ultrasound findings had been conflicting before catheterization (two patients). Both mitral and aortic valve disease were present in the three patients in whom management changed as a result of significant differences between echocardiography and catheterization assessment of valvular regurgitation. Management was unchanged in the 16 patients with isolated mitral stenosis. In this study, a combination of clinical and noninvasive assessment including Doppler echocardiography, resulted in a reliable evaluation of valvular disease in a large majority of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1987

Risk of developing complete heart block during bedside pulmonary artery catheterization in patients with left bundle-branch block.

We examined the incidence of complete heart block (CHB) as a complication of pulmonary artery catheterization with balloon-tipped, flow-directed catheters in patients with left bundle-branch block (LBBB). The study group included 47 consecutive critically ill patients with LBBB in the medical intensive care and coronary care units, who underwent a total of 82 pulmonary artery catheterizations. Twenty-six patients had an acute myocardial infarction, 34 patients had severe congestive heart failure (Killip class III or class IV), and 15 patients died during their hospitalization. Thirty patients had an old LBBB (more than one month in age), nine patients had a new LBBB, and the age of the LBBB was indeterminate in eight patients. There were five episodes of CHB in the group of patients with old LBBB. However, none of these episodes were related to the pulmonary artery catheterization, since CHB occurred either prior to catheterization (one case) or from one to 16 days after the pulmonary artery catheter had been removed (four cases). There were no episodes of CHB related to the pulmonary artery catheterization procedure in the patients with either old LBBB or indeterminate-aged LBBB. There were two episodes of CHB in patients with new LBBB. In both patients, the CHB occurred one day after the pulmonary artery catheter had been inserted. In both patients, CHB developed after episodes of ventricular tachycardia that eventually resulted in their deaths. Although it is unlikely, we could not rule out the possibility that the CHB was related to the presence of the pulmonary artery catheter. We conclude that the incidence of CHB complicating pulmonary artery catheterization with balloon-tipped, flow-directed catheters in critically ill patients with old or indeterminate-aged LBBB is extremely low. Therefore, we do not recommend the routine placement of a temporary transvenous pacemaker in all patients with LBBB prior to pulmonary artery catheterization.

Aged↗

PubMed1997

Right heart catheterization: is it effective?

OBJECTIVES: To discuss the advantages of different methods of determining the effectiveness of healthcare interventions, to evaluate the basis for the assumption that right heart catheterization is effective, and to consider how right heart catheterization may fail to improve outcomes in some circumstances. DATA SOURCE: Published English language literature on right heart catheterization and patient outcomes. DISCUSSION: We recently reported an association between the use of right heart catheterization in the initial care of critically ill patients and increased risk of death. This finding is troubling and warrants future study. In this article I address the role of randomized controlled trials and observational studies in the evaluation of the effectiveness of healthcare interventions. I discuss the basis in the published literature for assuming that right heart catheterization improves outcomes. Finally I present a variety of problems with right heart catheterization which might allow this procedure, which logically should help patients, to fail to achieve a beneficial effect for some patients. CONCLUSION: We must do appropriate prospective studies to determine who benefits from right heart catheterization and who does not. We owe our patients nothing less.

Catheterization, Swan-Ganz↗

PubMed2003

Is there a referral bias against catheterization of patients with reduced left ventricular ejection fraction? Influence of ejection fraction and inducible ischemia on post-single-photon emission computed tomography management of patients without a history of coronary artery disease.

OBJECTIVES: The objective of this work was to define the relationship between left ventricular perfusion/ function measures and referral rates to catheterization and revascularization early after stress gated myocardial perfusion single-photon emission computed tomography (MPS). BACKGROUND: Although revascularization yields the greatest survival benefit in patients with low ejection fraction (EF) and extensive coronary artery disease, referral patterns to catheterization and revascularization after noninvasive testing are not well defined. METHODS: We identified 3,369 patients without previous myocardial infarction or revascularization who underwent exercise or adenosine stress MPS and who were followed-up (97% complete) for occurrence of early (<60 days) post-single-photon emission computed tomography (SPECT) revascularization. Multivariable logistic regression modeling was used to determine the association of various patient characteristics and test results with performance of catheterization and revascularization as separate end points. RESULTS: In the first 60 days after stress MPS, 445 catheterizations (13.2%) and 254 revascularizations (7.5%) occurred, including 140 coronary artery bypass graft surgeries (4.1%) and 114 percutaneous coronary interventions (3.4%). Both post-stress gated EF and percent of the myocardium ischemic by stress MPS were independent predictors of revascularization. Logistic regression revealed that the likelihood of catheterization increased with both increasing ischemia and decreasing EF (c-index = 0.94, chi-square = 590). Predicted referral rates to catheterization increased with decreasing EF except in patients with severe ischemia (>15% of myocardium), where rates decreased with decreasing EF. Similar modeling of revascularization (c-index = 0.94, chi-square = 329) revealed that the likelihood of revascularization increased with increasing ischemia but, in general, decreased with decreasing EF. CONCLUSIONS: Although post-SPECT referral to both catheterization and revascularization is driven by ischemia, EF has the opposite effect on these two outcomes. Further studies evaluating the appropriateness of these referral patterns are warranted.

Adenosine↗

PubMed2004

Neuropathic bladder and intermittent catheterization: social and psychological impact on children and adolescents.

This paper describes part of larger study involving 40 families of children and adolescents with neuropathic bladder looking at the psychosocial impact of catheterization on them and their families. This study focuses on their experiences of clean intermittent catheterization (CIC) and self-catheterization (SC). Twenty-eight children and adolescents (11 males, 17 females; mean age 9 years, SD 2 years 7 months, range 5 to 20 years) with neuropathic bladder (mostly with spina bifida) participated in a semi-structured interview to explore their understanding of micturition and catheterization, and their views about the introduction and practical use of this technique. Participants were invited to draw self-portraits and figure diagrams to depict their understanding of CIC and SC. Age-appropriate self-esteem measures (Harter Pictorial Scale of Perceived Competence, the Self-Perception Profile, and the Culture-Free Self-Esteem Inventory) were administered to see if catheterization status affected emotional well-being. In an extension of this study, children's experiences of SC were explored by a postal questionnaire to all children successfully using SC who were attending the Paediatric Neuropathic Bladder Clinic. Children aged <5 years, those with learning difficulties, and those using indwelling catheters were excluded. From a total sample of 66 (31 females, 35 males), 52 parents and 42 children and adolescents (28 females and 14 males) responded. No significant difference was observed in self-esteem for those successfully catheterizing. Specific challenges involved learning SC and practical use of the technique. Concerns were leakage and being wet, and peers finding out about their continence management. Implications for the education, problem solving, and support of families and young people to promote cooperation and optimal benefits from catheterization are discussed.

Adaptation, Psychological↗

PubMed2004

Risk of infection with prolonged ventricular catheterization.

OBJECTIVE: The relationship between extended ventricular catheterization and infection remains controversial. Although studies have substantiated an increasing infection rate with prolonged catheterization, there has been less agreement on whether this trend continues beyond 10 days. Our study reviews the daily infection rate of 595 patients, 213 of whom underwent more than 10 days of catheterization. METHODS: All patients who underwent ventricular monitoring in the neurological intensive care unit from 1995 to 2003 at the University of Michigan Health System were reviewed retrospectively. Infection was defined as a positive cerebrospinal fluid culture. Life-table analysis was used to calculate daily hazard (infection) rates. Patient age, sex, diagnosis, catheter exchanges, location of patient during catheter insertion, and cerebrospinal fluid leak were evaluated as risk factors for infection. RESULTS: The average patient age was 51.3 years, and 51.3% were male. Duration of catheterization averaged 8.6 days. The overall infection rate was 8.6%. Daily infection rates increased from the onset of catheter insertion but reached a plateau after Day 4, with subsequent rates ranging predominantly between 1 and 2%, even with extended catheterization beyond 10 days. Only ventricular catheters that had been placed at other institutions significantly affected the infection rate. CONCLUSION: A relationship between duration of catheterization and infection seems to be present. However, this relationship is not linear. There is an extremely low daily infection rate that rises over the initial 4 days but then remains relatively constant even with prolonged catheter use. Clinical decisions to continue ventricular catheterization should reflect this low daily risk of infection, which does not seem to increase with extended catheter use.

Adolescent↗

PubMed2003

[Psychologic status and their influencing factors in patients suspected of coronary disease before and after coronary catheterization].

OBJECTIVE: To study the psychologic status and their influencing factors in patients suspected of having coronary disease before and after coronary catheterization. METHODS: A hundred fifty-eight inpatients (125 men, 33 women, mean age 66.1 +/- 9.6 years) who underwent a scheduled coronary catheterization for the first time and fulfilled entry criteria were enrolled. All the patients were examined by Symptom Check List-90 (SCL-90), a standard self-report symptom inventory on present psychologic status, within 24 hours before the coronary catheterization (after the information consent) and the third day after the procedure. RESULTS: (1) Before coronary catheterization, factorial scores of somatization, anxiety and phobic anxiety were higher than norm (P < 0.05 or P < 0.01). After the procedure, only somatization score was higher (P < 0.01). (2) Men had higher scores on obsessive-compulsive and psychotism than women (P < 0.05 and P < 0.01, respectively), however, women had higher scores on phobic anxiety (P < 0.05). (3) Compared with patients having coronary disease, those with angiographically normal coronary arteries seemed to have higher scores of somatization, obsessive-compulsive, interpersonal sensitivity, phobic anxiety, paranoid ideation, psychotism, global severity index and positive symptoms (P < 0.05 or P < 0.01). (4) After the procedure, significantly decreases in obsessive-compulsive, depression, hostility, global severity index and positive symptom severity index (P < 0.05 or P < 0.01) were seen. (5) Patients merely underwent coronary angiography had higher score in phobic anxiety construct than those having had coronary angiography and percutaneous transluminal coronary angioplasty (1.34 +/- 0.38 vs 1.15 +/- 0.23, P < 0.05). (6) When compared with the degree of explanation under informed consent, specific risk was not informed mentioned, a higher score in positive symptom severity index was seen (2.56 +/- 0.48 vs 2.46 +/- 0.37, P = 0.02). (7) Higher score was seen on positive symptom severity index when patients aged 70 years or more (2.62 +/- 0.45) than those under 60 years old (2.47 +/- 0.43, P < 0.05) or between 60 and 69 years old (2.45 +/- 0.40, P < 0.01). CONCLUSIONS: Patients' psychologic symptoms before and after the coronary catheterization seemed to be related to many factors. The most important appeared one was coronary catheterization itself. Women, patients with angiographically normal arteries, those of 70 years old or more were more likely to have elevated psychologic distress. Detail information including specific risk regarding the procedure was not associated with the increase of psychological symptoms. The findings emphasized the importance of psychologic assessment and counseling for patient who had undergone a scheduled coronary catheterization.

Adult↗

PubMed2006

Infection control guidelines for the cardiac catheterization laboratory: society guidelines revisited.

In the early years of diagnostic cardiac catheterization, strict sterile precautions were required for cutdown procedures. Thirteen years ago, when the original guidelines were written, the brachial arteriotomy was still frequently utilized, femoral closure devices were uncommon, "implantables," such as intracoronary stents and PFO/ASD closure devices, were in their infancy, and percutaneous valve replacement was not a consideration. In 2005, the cardiac catheterization laboratory is a complex interventional suite with percutaneous access routine and device implantation standard. Despite frequent device implantation, strict sterile precautions are often not observed. Reasons for this include a decline in brachial artery cutdown, limited postprocedure follow-up with few reported infections, limited use of hats and masks in televised cases, and lack of current guidelines. Proper sterile technique has the potential to decrease the patient infection rate. Hand washing remains the most important procedure for preventing infections. Caps, masks, gowns, and gloves help to protect the patient by maintaining a sterile field. Protection of personnel may be accomplished by proper gowning, gloving, and eye wear, disposal of contaminated equipment, and prevention and care of puncture wounds and lacerations. With the potential for acquired disease from blood-borne pathogens, the need for protective measures is as essential in the cardiac catheterization laboratory as is the standard Universal Precautions, which are applied throughout the hospital. All personnel should strongly consider vaccination for hepatitis B. Maintenance of the cardiac catheterization laboratory environment includes appropriate cleaning, limitation of traffic, and adequate ventilation. In an SCAI survey, members recommended an update on guidelines for infection control in the cardiac catheterization laboratory. The following revision of the original 1992 guidelines is written specifically to address the increased utilization of the catheterization laboratory as an interventional suite with device implantation. In this update, infection protection is divided into sections on the patient, the laboratory personnel, and the laboratory environment. Additionally, specific CDC recommendation sections highlight recommendations from other published guidelines.

Antibiotic Prophylaxis↗

PubMed1998

Prospective, randomized trial of Doppler-assisted subclavian vein catheterization.

OBJECTIVE: To examine the rate of success and complications of Doppler-guided subclavian vein catheter insertion compared with standard insertion in patients considered at high risk for failure. DESIGN: Prospective, randomized, crossover trial. SETTING: University-affiliated tertiary care medical center. PATIENTS: Two hundred forty patients were enrolled in the study. Patients were stratified for 3 known risk factors: (1) prior surgery in the subclavian vein region, (2) prior radiotherapy at the attempted catheterization site, and (3) an abnormal weight-height ratio. INTERVENTIONS: Subclavian vein catheterization was performed either in standard or Doppler-guided fashion using the Smart Needle (Peripheral Systems Group, Mountain View, Calif), which is a Doppler probe at the tip of a cannulating needle. If subclavian vein catheterization was unsuccessful after 2 attempts, patients were crossed over to the other technique. MAIN OUTCOME MEASURE: Successful cannulation of the subclavian vein. RESULTS: The success rate, either as an initial technique or as a salvage technique, and complication rate were not significantly different with use of the Smart Needle. A subgroup of physicians had a significantly lower success rate using the Smart Needle. CONCLUSIONS: Doppler guidance did not increase the success rate or decrease the complication rate of subclavian vein catheterization when compared with the standard technique in high-risk patients. Doppler guidance was not more useful than the standard technique as a salvage technique following a previous failure of catheterization. Furthermore, real-time Doppler guidance of subclavian vein catheterization is a technique that is highly operator dependent.

Adolescent↗

PubMed2001

Sex differences in cardiac catheterization: the role of physician gender.

CONTEXT: Many studies indicate that women are less likely than men to undergo cardiac procedures after an acute myocardial infarction (AMI), raising concerns of sexual bias in clinical care. However, no data exist regarding the relationship between patient sex, physician sex, and use of cardiac procedures. OBJECTIVE: To determine whether sex differences in cardiac catheterization after AMI were greater when patients were treated by male attending physicians compared with female attending physicians. DESIGN, SETTING, AND PATIENTS: Analysis of data from the Cooperative Cardiovascular Project, a retrospective medical record review. A total of 104 >231 Medicare fee-for-service beneficiaries who were hospitalized in US acute care hospitals for an AMI between January 1994 and February 1995. MAIN OUTCOME MEASURE: Use of cardiac catheterization within 60 days of admission, compared between the 4 groups of patient sex-physician sex combinations. RESULTS: Women underwent fewer cardiac catheterizations than men when treated by either male physicians (38.6% vs 50.8%; P =.001) or female physicians (34.8% vs 45.8%; P =.001). Sex differences in procedure use were not greater when a patient and physician were of different sexes (P for interaction =.85). After potential confounders in multivariable analysis were accounted for, women were less likely to undergo cardiac catheterization (risk ratio, 0.90 [95% confidence interval (CI), 0.88-0.92]), regardless of the treating physician's sex. Patients treated by male physicians were more likely to undergo cardiac catheterization (risk ratio, 1.06 [95%CI, 1.02-1.10]) than those treated by female physicians, regardless of patient sex. CONCLUSIONS: Women who have had an AMI undergo a cardiac catheterization less often than men, whether treated by a male or female physician. These results suggest that factors other than sexual bias by male physicians toward women account for sex differences in cardiac procedure use.

Aged↗

PubMed2006

Assessment of hemodynamics properties of a new-type artificial heart valve prosthesis using catheterization and echocardiography.

OBJECTIVE: The objectives of this study were to assess the hemodynamic properties of the newly developed artificial heart valve prosthesis experimentally in laboratory simulation, in an animal model, and clinically in a human model and to compare the results measured by catheterization and echocardiography. METHODS: (1) Laboratory simulation. The prosthesis was tested using a pulsatile flow simulator in the aortic position. Hydrodynamics parameters were automatically analyzed through a custom-designed data processing program. (2) Animal experiment. Six sheep subjected to mitral replacement with 21-mm-valve prosthesis were measured by open cardiac catheterization intraoperatively. Doppler echocardiography and open cardiac catheterization under dobutamine stress were performed in two sheep subjected to implantation 2.5 years ago. (3) Clinical patient observation. Observations were carried out on 14 patients with aortas replacement and 10 patients with bicuspid replacement using both doppler echocardiography and open cardiac catheterization. RESULTS: (1) Laboratory simulation. The results showed that the value of the transvalvular gradient (DeltaP) decreased with the increase of heart rate, and the values were not greater that 10 mm Hg at any given tissue annulus diameter. (2) Animal experiment. The mean DeltaP value of the six sheep was 5.2 +/- 1.7 mm Hg intraoperatively, while the corresponding DeltaP value of the two sheep 2.5 years after implantation was 6.1 +/- 0.3 mm Hg measured by open cardiac catheterization. (3) Clinical patient observation. The mean DeltaP values in the aortic position measured by catheterization and echocardiography were 6.26 approximately 4.10 and 9.42 approximately 7.48 mm Hg, respectively. The gradients in the mitral position were 2.10 approximately 1.9 and 5.28 approximately 4.10 mm Hg, respectively. CONCLUSIONS: The results demonstrate that the new-type bileaflet heart valve prosthesis only generates a relatively low transvalvar gradient and thus has good hemodynamic properties.

Adult↗

PubMed1976

Determination of the origin of elevated plasma CPK after cardiac catheterization.

Episodes of chest pain are not common in patients undergoing cardiac catheterization. The diagnostic implications of this symptom may be complicated by the occasional appearance of electrocardiographic changes mimicking those seen in acute myocardial infarction, and by the frequent elevation of conventionally measured serum enzymes. Exclusion of infarction is particularly important when coronary revascularization is contemplated. Since the MB CPK isoenzyme is relatively specific to myocardium, we assayed CPK isoenzymes in plasma samples from 184 patients undergoing cardiac catheterization to determine whether CPK elevations accompanying catheterization can be distinguished from those associated with myocardial infarction. Samples were obtained every 2 hr for 24 hr, and CPK isoenzymes quantified by a kinetic fluorometric method. Total plasma CPK increased in all patients (mean peak 0.238 +/- 0.042 (SD) IU/ml) but MB CPK remained normal in 181 patients (less than 0.005 IU/ml). In three remaining patients, MB CPK was elevated and myocardial infarction was confirmed by 99mTc (SN) pyrophosphate scan. Twelve patients after catheterization, in whom no intramuscular premedication was given, exhibited only minimal elevation of total plasma CPK. In contrast, 100 control patients with acute myocardial infarction exhibited peak total CPK activity averaging 0.833 +/- 0.037 (SD), and MB CPK was elevated in all cases (0.078 +/- 0.027 (SD) IU/ml). Thus, CPK elevations after catheterization reflect release of enzyme from noncardiac sources rather than from injured myocardium. Furthermore, increased plasma MB CPK activity may be considered a reliable index of myocardial infarction in patients undergoing cardiac catheterization.

Adolescent↗

PubMed1980

The diagnostic accuracy of combined clinical and noninvasive cardiac evaluation: comparison with findings at cardiac catheterization.

The accuracy of combined clinical and noninvasive cardiac diagnostic evaluation was prospectively examined in 108 consecutive patients referred to the heart station for echocardiographic examination prior to cardiac catheterization. History, physical examination, scalar electrocardiology, chest roentgenography, phonocardiography and pulse recording, and M-mode echocardiography were employed by the heart station cardiologist, who assigned one or more diagnoses to each patient. In addition, one of three management strategies was proposed for each patient: 1) surgery without cardiac catheterization; 2) medical therapy without cardiac catheterization; or 3) cardiac catheterization for clarification of the diagnosis. The results of the combined clinical and noninvasive evaluation were independently reviewed for each patient and compared with the diagnosis determined by cardiac catheterization, results of cardiac surgery, and total hospital course. Diagnostic predictions employing combined clinical and noninvasive cardiac evaluation were completely correct in 86% of patients, and management strategy was correct in 97% of individuals. In approximately one-half of all patients full cardiac catheterization or coronary arteriography was recommended. All management strategy errors and two-thirds of diagnostic errors occurred in patients with mitral regurgitation, aortic regurgitation, or coronary artery disease. Combined clinical and noninvasive evaluation results in accurate diagnostic information adequate for the formulation of appropriate management strategies in the majority of patients, but many individuals with cardiac disease still require invasive evaluation for complete diagnosis.

Adolescent↗

PubMed1982

Percutaneous central venous catheterization performed by medical house officers: a prospective study.

We prospectively determined the complications of percutaneous central venous catheterizations performed by medical house officers in 302 patients. We also analyzed the factors affecting the success and complication rates of such invasive procedures. The central vein was successfully catheterized in 363 (77%) of 470 attempts. The internal jugular and subclavian vein approaches were significantly more successful (86%) than the external jugular vein approach (61%, P less than 0.001 by chi 2). The success rate improved significantly when catheterization was attempted under elective circumstances (P less than 0.003) and also after the vein was initially located with a small-gauge needle (P less than 0.001). Our results suggest that efforts should be abandoned after the third unsuccessful pass with a large-gauge needle in the same site. Complications of catheter insertion included bleeding (ten patients), hematoma (15 patients), inadvertent arterial punctures (14 patients), iatrogenic pleural effusions (four patients), and pneumothoraces (eight patients). No complications appeared to have a major adverse effect on a patient's clinical course. The inexperienced operator (fewer than 25 prior catheterizations) has a success rate equal to that of the more experienced operator (more than 25 prior catheterizations), but he may be more likely to produce a complication. Medical house officers can perform percutaneous central venous catheterizations with a high rate of success and a low risk to the patient.

Arteries↗

PubMed1982

Pseudo complications of cardiac catheterization: update.

This prospective study was performed to determine whether complications that occur immediately before or after the time of scheduled catheterization are as much disease-related as procedure-related. During 24 months all complications associated with 1,606 diagnostic cardiac catheterizations were recorded if they occurred from 24 hours before the time the procedure was scheduled to 72 hours later, longer if complications were clearly procedure-related. Pseudo complications are spontaneous medical or surgical incidents that occur during the 24-hour period before catheterization is scheduled to be performed. Procedure-related complications are incidents that occur during or after the catheterization procedure. There were 13 (0.81%) procedure-related complications but not deaths. There were 13 (0.81%) pseudo complications including 4 (0.24%) deaths. All complications were similar in nature except for 3 instances of vascular injury, which were procedure-related. Pseudo complications occur as commonly as procedure-related complications and at times are more severe. Complications occurring before catheterization are related to the underlying disease process and not medical intervention. It is likely that similar disease-caused incidents occur after a catheterization and are not necessarily procedure-related.

Adolescent↗

PubMed1984

Percutaneous brachial catheterization using a modified sheath and new catheter system.

An alternative method for left heart catheterization via the brachial artery, without cutdown, is described. Percutaneous brachial catheterization was done with a modified 7F side-arm sheath with check valve. A modified 7F high flow catheter was developed employing characteristics of both multipurpose and Sones catheters. The technique was used in 100 patients for left heart catheterization, in patients with and without aortic valve disease, for left ventricular angiography and selective coronary angiography. There were no failures or serious complications. All puncture sites were managed with 15-20 minutes of compression using only a blood pressure cuff or finger pressure. Bleeding was controlled with restoration of the radial pulse in all but one patient, who had severe peripheral brachial atherosclerosis. Cutdown and thrombectomy performed before he left the laboratory using standard catheterization techniques promptly restored blood flow. It is our impression that this technique facilitated outpatient catheterizations, repeat catheterizations at sites of previous cutdowns, and reduced patient discomfort.

Adult↗

PubMed1993

Safety of cardiac catheterization via peripheral vascular grafts.

There are few data concerning the complications and technical difficulties encountered when cardiac catheterization is performed using peripheral bypass grafts for vascular access. All cardiac catheterizations performed at our institution from January 1, 1984 to April 1, 1991 were retrospectively reviewed to assess the in-hospital clinical outcomes in patients who had arterial access for catheterization achieved via prosthetic graft puncture. Seventeen procedures had percutaneous puncture of a vascular graft from a total of 2,929 arterial catheterizations performed. The interval from graft placement to catheterization was 7.5 +/- 1.1 years. Arterial sheaths were employed in all cases and corresponded to the catheter size, with 5F systems used in 53% and 7F or larger systems used in the remaining patients. No intraprocedural or postprocedural complications were recognized. Technical difficulties were limited to the inability to selectively cannulate a nondominant right coronary artery in 1 patient. We conclude that percutaneous introduction of an arterial sheath and left heart catheterization via remotely implanted vascular bypass grafts is not associated with an increased risk of procedural complications or technical difficulties.

Angioplasty, Balloon, Coronary↗