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At least 343 records · Page 19Linked to original sources

PubMed2002

Brachiocephalic veins: an overlooked approach for central venous catheterization.

Central venous access is important in both assessment and treatment of the patient. In modern clinical practice, a percutaneous approach is preferred. The well-established subclavian and internal jugular vein catheterization techniques, however, still carry the risk of major acute complications. In this article we describe a trial study of a percutaneous brachiocephalic vein catheterization technique conducted on a total of 74 cadavers undergoing autopsy. Relying on constant and easily recognizable anatomical landmarks, we performed a total of 128 catheterizations of the right and left brachiocephalic veins. The success of catheterization was ascertained by regional dissection. Our results show very high reproducibility with a success rate of about 97% on the first attempt of catheterization on both right and left sides. Equally important, collateral injury of neighboring structures was consistently absent. We propose the introduction of this rather overlooked approach into clinical practice.

Adolescent↗

PubMed1983

An improved method for transseptal left ventricular catheterization.

It is difficult to perform a retrograde left ventricular catheterization in patients having an aortic valve replacement. An improvement of the conventional transseptal catheterization (Brockenbrough method) led to a better success rate of catheterization. The fulcrum of the improved catheter was located 7 cm from the tip. Its curvature was approximately 270 degrees. Its tip was bent inward to form a pig-tail shape to prevent myocardial injury. This catheterization was performed 33 times in 32 patients. A 97% success rate was achieved. An exercise loading test was performed with a bicycle ergometer while this catheter was maintained in the left ventricle of a patient placed in a supine position. The catheter was well retained in the left ventricle and produced a minimal number of arrhythmias during exercise. The modification of this catheter has proved to be a better method of left ventricular catheterization in patients with an aortic valve replacement.

Adult↗

PubMed1984

Brachial artery catheterization employing a side arm sheath.

A major complication of left heart catheterization via the brachial artery is occlusion at the cutdown site. This is particularly a problem when patients with severe atherosclerosis are catheterized in laboratories where the brachial approach is not routinely used. A method of brachial artery catheterization is described which employs a continuously flushed side arm sheath in order to minimize local trauma to the artery from catheter exchange and manipulation. In 15 consecutive atherosclerotic patients catheterized by this method there were no complications, and all arteriotomies were closed easily with immediate restoration of a good radial pulse. This contrasts with the preceding 33 consecutive brachial catheterizations employing standard technique in similar patients in whom four patients required surgical repair, and an additional six patients required more than one closure attempt and/or catheter thrombectomy to restore a good pulse. In our laboratory the brachial sheath technique has facilitated arterial repair and reduced local complications.

Arteriosclerosis↗

PubMed1988

Development and application of transseptal left heart catheterization.

The recent interest in transseptal left heart catheterization affords an opportunity to review the development and application of this procedure. This review briefly follows the history of right and left heart catheterization to the development of the transseptal procedure. A detailed description of the technique of transseptal catheterization is provided, as well as the indications and contraindications to its use. A learning curve is associated with this technique and is inversely related to the complication rate of the transseptal approach. Physicians working in high volume catheterization laboratories may gain the experience to safely perform transseptal left heart catheterization on carefully selected patients.

Cardiac Catheterization↗

PubMed1992

A Doppler guided retrograde catheterization system.

A Doppler guided retrograde catheterization system was developed to accurately catheterize the aortic root and left ventricular chamber without X-ray. This system consists of a 20 MHz, 0.076 mm thick x 1.016 mm diameter pulsed Doppler crystal integrated into the tip of a 100 cm multipurpose triple lumen catheter. Two lumens (0.61 mm) are used for electrodes; a third lumen (1.245 mm) may be used for guidewire and pressure determination; and the system is attached to a flow velocimeter. In an aortic arch flow model, the principles of Doppler signal guidance were confirmed with flow toward the catheter tip demonstrating positive signals and flow away from the catheter tip demonstrating negative signals. The magnitude and polarity (direction) of the detected phasic and mean velocities were utilized to guide catheterization in six dogs. Using the reversal of Doppler signal polarity to indicate branch entry and manipulating the catheter so as to maintain maximal positive axial velocity, the Doppler catheter was successfully advanced from the femoral artery to the aortic valve. Branches detected by the Doppler system were confirmed by fluoroscopy. The aortic valve was audible when approached and the left ventricular chamber was recognized by its characteristic pressure waveform. The Doppler guided retrograde catheterization system offers new technology to perform left heart catheterization without X-ray and may prove useful in a variety of settings including the development of invasive ultrasonic diagnostic and therapeutic technology.

Animals↗

PubMed1993

Early ambulation following diagnostic 7-French cardiac catheterization: a prospective randomized trial.

There is a paucity of randomized studies concerning transfemoral cardiac catheterization and its complications, in particular that of 7F catheterization. Accordingly, we conducted a prospective, randomized trial comparing early ambulation (group A) 6 hr after diagnostic 7F cardiac catheterization versus late ambulation (group B) the following morning. A total of 273 patients were randomized in the study; 142 in group A and 131 in group B (NS). Except for a difference in the indications for catheterization, the baseline and procedure-related parameters were similar between the 2 groups. Early hematoma (formed within 6 hr) developed in 6 (4%) and 7 (5%) patients in groups A and B, respectively (NS). Similarly, there was no difference in the incidence of late hematoma formation (2% in each group). All hematomas detected were small and required no surgical intervention or extension of hospital stay. Our data showed that early ambulation following 7F left heart catheterization is feasible and safe. The access site complication rate is acceptably low and minor in nature.

Cardiac Catheterization↗

PubMed1995

Transhepatic central venous access for cardiac catheterization and radiologic intervention.

We describe a technique of direct puncture and catheterization of the hepatic veins for cardiac catheterization and radiologic intervention in children who lack conventional access routes. Four patients underwent eight direct hepatic vein punctures to allow cardiac catheterization (3 patients) and 5-12 F sheath insertions for balloon dilatation of hepatic vein stenoses (1 liver transplant patient). Gelfoam was injected in the sheath tract for hemostasis. All procedures were successful, including five hepatic vein dilatations and right heart access for three cardiac catheterizations. There were no complications. When conventional venous access is precluded, direct percutaneous catheterization of hepatic veins is easy, effective, and probably low risk.

Cardiac Catheterization↗

PubMed1991

Doppler echocardiography versus cardiac catheterization in the evaluation of valvular heart disease: do we have a gold standard?

Definitive evaluation of valvular heart disease is traditionally accomplished by cardiac catheterization. Recent advances in Doppler echocardiography allow noninvasive assessment of valvular heart disease with a high degree of accuracy compared to the cardiac catheterization gold standard. Doppler echocardiography may occasionally yield erroneous results due to technical difficulties in the performance of the study. A number of patient related and echo-machine related factors may also affect the Doppler measurements independent of the severity of the lesion. Thus, a discrepancy between Doppler and catheterization data is generally considered to be a failure of Doppler methods. However, catheterization data may also be flawed due to errors in the measurement of pressure and cardiac output, as well as the known shortcomings of qualitative angiography. The Gorlin equation itself suffers from several limitations, including the substitution of pressure gradient for velocity in the basic hydrodynamic equation, and the use of a constant which may not be appropriate in all circumstances. Therefore, when Doppler echocardiography and cardiac catheterization yield discordant results, both studies should be carefully reviewed and correlated with other clinical data in order to elucidate the sources of the discrepancy and ascertain the actual severity of the valvular lesion.

Cardiac Catheterization↗

PubMedDate not supplied

Bacteriuria in intermittent catheterization users: the effect of sterile versus clean reused catheters.

Monthly urine cultures were analyzed at the University of Alberta Department of Medical Microbiology and Infectious Diseases to determine whether single-use sterile catheters and clean technique reduced the incidence of bacterial colonization in those using long-term intermittent self-catheterization. Thirty subjects with spina bifida, ages 3 years to 16 years, entered a crossover study with random assignment to 6 months of sterile single-use catheters or clean reused catheters. Seventeen subjects were catheterized by a parent or caregiver; 13 were responsible for self-catheterization and cleaning of the catheters. Six months of descriptive data were also collected at Alberta Children's Hospital from a similar group of subjects with spina bifida who used sterile catheters only. In the crossover group, 38% of all urine cultures were positive regardless of whether sterile single-use or clean reused catheters were employed. The other group using only sterile catheters had a 36% positive culture rate. No difference in positive cultures was found between males and females or between children who catheterized themselves and children whose parents catheterized them. The authors concluded that plastic urethral catheters may be reused.

Adolescent↗

PubMed2003

MRI-guided coronary catheterization and PTCA: A feasibility study on a dog model.

The aim of this work was to demonstrate the feasibility of MRI-guided coronary artery catheterization and intervention in a dog model. Experiments were performed on 10 healthy dogs. A 9F introducer sheath was placed through a right carotid artery cutdown. A prototype 0.014-inch coronary MRI guidewire, a prototype 7 French MRI-guiding catheter, and two flexible surface coils were connected to a GE 1.5 T CV/i scanner for simultaneous visualization of the guidewire, guiding catheter, and chest anatomy. Images were displayed in real time on an in-room monitor. A nongated, single-slice fast gradient-echo sequence was used to obtain real-time images of the catheters and background anatomy during the intervention. Fifteen selective catheterizations were attempted in the coronary arteries, and all were successful. Selective injection of diluted gadolinium into the MRI-guiding catheter provided dynamic 2D projection coronary angiography in all cases, confirming successful catheterization. Percutaneous transluminal coronary angioplasty (PTCA) was attempted after two catheterizations, and all attempts were successful. Inflation of the balloon angioplasty catheter was performed successfully in the left anterior and circumflex arteries. Our results indicate that coronary artery catheterization and intracoronary balloon angioplasty are feasible with MRI guidance only. MRI guidance may be used as an alternative to X-ray guidance in coronary artery interventions in the future.

Angioplasty, Balloon, Coronary↗

PubMed2003

Effect of thoughtful preparation on the catheterization of children undergoing investigative studies.

AIMS: To evaluate an anesthetic sedation free method of transurethral catheterization in children. METHODS: The child and his or her parents are thoroughly prepared for the procedure by means of written and oral child-adapted information and practical instructions. To evaluate this routine, a simple questionnaire was given to 115 consecutive children undergoing transurethral catheterization. RESULTS: The questionnaire was returned by 99 children (86%). Most children and parents (95) found the preparation"good"or"very good"and tolerated the catheterization procedure well. Only six children reported the catheterization to be"very painful"(without requiring that the procedure was terminated). Complications, such as urgency, smarting pain during voidings, or both, after withdrawal of the catheter, occurred in 12 children and urinary tract infections in 3. Unexpectedly, girls were affected more often than boys. CONCLUSIONS: Careful preparation of children and their parents allows the great majority of diagnostic studies that require urethral catheterization to be accomplished without anesthesia.

Adolescent↗

PubMed1988

Selective catheterization of the brachiocephalic arteries via the right brachial artery.

Selective intra-arterial digital subtraction angiography of the brachiocephalic arteries using the right brachial artery approach was successfully performed for 169 of 173 patients, 33 of whom were outpatients. Catheterization was unsuccessful for four patients; two of them elderly hypertensive men with tortuous brachial arteries, and two of them middle-aged obese women for whom arterial puncture could not be performed. 4-F modified Simmons type catheters were used in this study. Selective catheterizations of both common carotid arteries were successfully performed in all but one patient, a woman whose aberrant right subclavian artery prevented bilateral common carotid arterial catheterizations. Selective catheterizations of the right vertebral and left subclavian arteries, though relatively difficult, were successfully performed in 84.2% and 93.9% of patients, respectively. The mean examination time for a four-vessel study was 24.3 min. No major complications were encountered. Thus, transbrachial selective catheterization of the brachiocephalic arteries proved to be safe, useful, and relatively easy to perform.

Adolescent↗

PubMed1988

The use of biofeedback in a behavioral program designed to teach an anxious child self-catheterization.

This paper presents a case study of a 7-year-old girl with a noncompliant bladder who was trained to self-catheterize using biofeedback and behavior therapy techniques. Initial attempts to train her to self-catheterize were unsuccessful owing to excessive amounts of fear, muscle tension, and refusal. After seven treatment sessions in which she was instructed in proper self-catheterization technique by a urology nurse clinician and coached in biofeedback-assisted relaxation by a clinical psychologist, the child successfully learned to self-catheterize. EMG readings showed a decrease in quadriceps muscle tension levels across sessions. Eight additional sessions were held in order to train the child's parents in proper technique and coaching procedures. Through the use of portable biofeedback equipment during actual training sessions, the biofeedback served as a cue--first to the child and coach, and later to the child and parents--for when the child needed to stop and relax. This case illustrates the usefulness of biofeedback in a comprehensive behavioral program designed to teach self-catheterization to fearful children.

Anxiety↗

PubMedDate not supplied

Immediate complications and late sequelae of arterial catheterization in children with congenital heart disease.

Early vascular complications and late sequelae are reported in relation to 195 left heart catheterizations, 125 performed by brachial arteriotomy (BA), and 70 by percutaneous femoral artery puncture (FAP) with the Seldinger technique. Vascular complications occurred in 25 patients, 11 requiring surgical intervention, which was successful in restoring normal circulation in all. The rate of complications was higher after FAP in children 6 years old or less, while after BA the rate was significantly higher in patients of 2 years or older. In patients under 2 years, brachial artery suture repair resulted in more complications than ligation, but the cases were not randomized. Late follow-up of 101 catheterizations (35 FAP, and 66 BA, of which 38 were ligated and 28 sutured) included clinical evaluation, Doppler pressure measurements, and a comparison of the length and bone development of the catheterized and non-catheterized limbs. All these have indicated an absence of any serious late sequelae in this group 6 months to 9 years (average 4 years) after catheterization.

Arteries↗

PubMed1992

Alfentanil sedation for cardiac catheterization of children with Fontan shunts.

After Fontan operation, prolonged invasive cardiac assessment is often needed. This study is a clinical evaluation of the effectiveness of flunitrazepam premedication, EMLA cream, and alfentanil continuous infusion for management of children undergoing such catheterization. Fourteen consecutive subjects aged 5-20 yr with Fontan shunts (right atrium to pulmonary artery) undergoing elective haemodynamic and electrophysiological catheterization were sedated with an individually titrated alfentanil infusion. After oral premedication with flunitrazepam 2 mg, the mean induction dose and mean maintenance requirement of alfentanil were 4.4 +/- 2.7 micrograms.kg-1 and 10.3 +/- 8.6 micrograms.kg-1 x hr-1, respectively. Mean oxygen consumption during haemodynamic catheterization was 4.1 +/- 0.4 ml.kg-1 x min-1 with an average individual variation of 10%. For every patient, tranquil and stable conditions during catheterization could be produced. It is concluded that alfentanil infusion is a method of sedation of children and adolescents with Fontan shunts during haemodynamic and electrophysiologic catheterization. However, continuous monitoring of ventilation and an understanding of the slow circulation time after Fontan operation are essential with such sedation in these patients.

Adolescent↗

PubMed2001

Propofol does not modify the hemodynamic status of children with intracardiac shunts undergoing cardiac catheterization.

Immobility and cardiovascular stability are required for cardiac catheterization. Pediatric patients need a type of sedation that also allows spontaneous ventilation without supplemental oxygen. Propofol has been adequate in hemodynamically stable patients with congenital heart disease undergoing cardiac catheterization. However, mild systemic hypotension caused by propofol may increase a preexisting right-to-left shunt. The aim of this study is to evaluate, in pediatric patients scheduled for cardiac catheterization, the effects of propofol on systemic and pulmonic circulations. Fifteen patients aged 18 months to 9 years were studied. After a fast of 4-6 hours for solid food, the patient arrived at the cardiac catheterization suite, where an IV catheter was placed. Usual monitoring was used. For sedation, without supplemental oxygen, patients received 1 mg/kg of fentanyl followed by propofol (1-2 mg/kg) titrated to immobility during preparation of the groin. A continuous infusion of propofol (100 mg/kg/min) was also started to obtain immobility during the procedure. Hemodynamic data, including systemic venous, pulmonary artery and vein, aortic saturations, and pressures, were recorded; Qp and Qs were calculated. The same set of data was re-corded 4 minutes after discontinuation of propofol and when the patient was responding to tactile stimuli. Despite lower pressures during propofol infusion, as compared with those pressures measured after discontinuation of propofol, the extent of the intracardiac shunt remained unchanged. Propofol seems to be an adequate sedative agent for pediatric patients undergoing cardiac catheterization, including those with intracardiac shunts.

Anesthetics, Intravenous↗

PubMedDate not supplied

Neonatal cardiac catheterization: A 10-year transition from diagnosis to therapy.

To assess the changing role of cardiac catheterization in the care of the neonate, a retrospective review of all catheterizations between January 1984 to December 1985 (group I) and January 1994 to December 1995 (group II) at C.S. Mott Children's Hospital was performed. Neonatal cardiac catheterization was performed more frequently (p = 0.02) in group I, comprising 14% (110 of 772) of all catheterizations versus 11% (93 of 880) in group II. Access was performed by cutdown in 15 patients (13 venous and 2 arterial), all in group I. In group I, 20 of 110 patients (18%) had balloon atrial septostomies; no other catheter interventions were performed. Interventions were more frequent (p = 0.003) and varied in group II, including 15 septostomies, 17 balloon valvuloplasties (13 pulmonary and 4 aortic), 2 coil embolizations of collaterals, and 1 cardiac biopsy. Despite the higher prevalence and complexity of interventions in group II, fluoroscopy times (median; range: 16 min; 2-55 vs 16 min; 1-107) were similar in both groups (p = not significant) as well as the prevalence of complications. Neonatal cardiac catheterizations are performed less frequently than they were a decade ago at our institution, and therapeutic interventions have become more common. Despite these changes, fluoroscopy time and the rate of complications have not increased.

Cardiac Catheterization↗

PubMed2006

The ALARA concept in pediatric cardiac catheterization: techniques and tactics for managing radiation dose.

The cardiac catheterization laboratory plays an important role in the management of children with congenital heart disease by not only enabling diagnosis but, in many cases, providing definitive therapy. The goal of the ALARA (As Low as Reasonably Achievable) concept as it applies to cardiac catheterization is to provide maximal diagnostic and therapeutic benefit while requiring the lowest possible radiation dose. A number of specific challenges unique to the setting of pediatric cardiac catheterization, such as higher heart rates, smaller cardiovascular structures, smaller body size, and wider variety of unusual anatomic variants with the potential need for relatively lengthy and complex studies, result in relatively high radiation doses (to the patient and, consequently, to laboratory personnel). In addition, the improved survival of patients with complex anatomy (e.g., palliated single ventricle anatomies) implies that many such children with chronic cardiac disease require frequent catheterizations within the first few years of life. These factors, coupled with the increased radiosensitivity of children and a longer lifespan ahead of them in which to possibly develop radiation-related sequelae, converge to create potentially ominous consequences. Attention to basic rules of radiation safety is, therefore, of tremendous importance in the pediatric cardiac catheterization laboratory. This review focuses on the importance of adequate planning of the study, optimizing image formation, management of fluoroscopy and cine angiography parameters, and the use of certain equipment features that might allow the cardiologist to lower the radiation dose without sacrificing image quality.

Body Burden↗