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PubMed2006

[Comparative study of the acceptability of the SpeediCath Set and Actreen set catheterization sets in patients performing self-catheterization].

OBJECTIVE: To compare SpeediCath Set to Actreen Set in terms of performance, acceptability and safety, in patients performing self-catheterization. MATERIAL AND METHODS: Four questionnaires were completed during this multicentre, randomized, crossover study: initial, after having tested each of the two products and patient preference at the end of the study. RESULTS: Analysis was based on 29 men performing self-catheterization. The SpeediCath Set was found to be superior to the Actreen Set in terms of ease of introduction (p=0.0055), ease of emptying (p=0.0157), quality of lubricant (p<0.0001), urethral tolerance and possibility of catheterization in bed (p= 0.0157). The patients 'global assessment was clearly in favour of SpeediCath Set (70 +/- 2.3 versus 5.7 +/- 2.5; p=0.0156) and 65.5% of patients preferred to use SpeediCath Set in the future. CONCLUSION: SpeediCath Set facilitates catheterization and improves the urethral tolerance compared to Actreen Set, with a marked patient preference in favour of SpeediCath Set.

Adult↗
PubMed1994

[Complications of central venous catheterization in hematologic patients--prospective study of 193 catheterizations].

A Prospective Study of 193 Catheterizations 193 central venous catheters introduced in 142 patients with haematological diseases were studied prospectively for complications in 1984-1992. 165 polyethylene, 14 Hickman and 14 polyurethane catheters were inserted into subclavian vein via infraclavicular access using Seldinger technique exclusively. Except bleeding, that was not serious, immediate complications occurred in 4%. Cumulative duration of catheterizations was 6370 days with median duration of one cannulation of 15 days, range 1 to 489 days. In polyethylene catheters duration of catheterization was influenced significantly by tunnelization. More than half of cannulations were accompanied by technical complications. Incidence of clinical thrombosis was 6.7%. Infectious complications were the most serious with the incidence of proven and suspected catheter-related sepsis of 25.8%, local inflammation of 41.4% and tunnel inflammation of 12.8%. They were caused in 82% of cases by gram-positive bacteria. Catheter-related sepsis was significantly associated with local inflammation, duration of cannulation and leukopenia and application of parenteral nutrition. Hickman catheters had the best "complication to catheterization duration" ratio, that give reasons for using these catheters in this group of patients.

Adolescent↗
PubMed2006

Physiological assessment of coronary artery disease in the cardiac catheterization laboratory: a scientific statement from the American Heart Association Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology.

With advances in technology, the physiological assessment of coronary artery disease in patients in the catheterization laboratory has become increasingly important in both clinical and research applications, but this assessment has evolved without standard nomenclature or techniques of data acquisition and measurement. Some questions regarding the interpretation, application, and outcome related to the results also remain unanswered. Accordingly, this consensus statement was designed to provide the background and evidence about physiological measurements and to describe standard methods for data acquisition and interpretation. The most common uses and support data from numerous clinical studies for the physiological assessment of coronary artery disease in the cardiac catheterization laboratory are reviewed. The goal of this statement is to provide a logical approach to the use of coronary physiological measurements in the catheterization lab to assist both clinicians and investigators in improving patient care.

American Heart Association↗
PubMed2000

Impact of patient characteristics, complications, and facility volume on the costs and time of cardiac catheterization and coronary angioplasty in 70 catheterization laboratories.

Although over 1 million procedures are performed in cardiac catheterization laboratories (CCLs) annually, little comparative data exist on costs or resource use in these settings. In this study, data from 70 CCLs were used to profile CCL times and total direct costs for 2 high-volume procedures: left heart catheterization (LHC) and percutaneous transluminal coronary angioplasty (PTCA) with or without stent placement. In total, 70,677 consecutive patient examinations for a 12-month period from January 1, 1998 to December 31, 1998 were analyzed. For LHC mean total direct costs averaged $306, whereas for PTCA catheterization laboratory costs averaged $3,172. The average total times for these procedures were 63 and 108 minutes, respectively. Seventy-two percent of the PTCA patients underwent coronary stenting with an associated incremental cost of $1,244. By multivariate linear regression, baseline patient characteristics such as age, gender, and clinical factors had little impact on total time and total costs. The major determinants of CCL time and cost were procedural factors (e.g., number and type of interventions) and in-lab complications, including profound hypotension, abrupt vessel closure, and emergency bypass surgery. Using facility procedure volume as a proxy for potential economies of scale, we found no relation between CCL volume and total direct CCL costs. There did appear to be a significant inverse relation between facility volume and total procedural time with CCLs that performed the highest volumes of LHC and PTCA procedures saving an average of 5 to 9 minutes per procedure. These findings may be useful in defining specific time and cost benchmarks for these commonly performed procedures and serve to underscore the critical role of reducing complications in both quality improvement and cost-saving efforts.

Aged↗
PubMed1978

The role of adjunctive drug therapy for intermittent catheterization and self-catheterization in children with vesical dysfunction.

Thirty-nine children with vesical dysfunction were managed with clean intermittent catheterization. Most children achieved effective urinary continence, the majority with the help of adjunctive drug therapy to relax the detrusor, contract the bladder neck or both. Intermittent catheterization had a generally favourable effect on infection, reflux and hydronephrosis. Intermittent catheterization in childhood is a perferred alternative to urinary diversion in cases of neurogenic bladder dysfunction.

Adolescent↗
PubMed1995

Is cardiac catheterization necessary in the era of echocardiography? Cost-effective approach combining echocardiography and cardiac catheterization.

Definitive evaluation of cardiovascular disease is traditionally accomplished by cardiac catheterization. Advances in transthoracic and transesophageal Doppler echocardiography provides an accurate and cost-effective approach when compared to cardiac catheterization. Recent data suggests that for most adult patients with aortic or mitral valve disease, Doppler echocardiographic data enables the clinician to make the same decision reached with catheterization data. Echo and Doppler studies are useful in guiding certain therapeutic interventional procedures, and in the diagnosis of aortic dissection, mechanical complications of myocardial infarction, and in identifying aortic atheromas as a potential source of embolism. Future research will need to demonstrate that not only is echocardiography cost-effective, but that it will change the outcome of the patient.

Aortic Dissection↗
PubMed1979

Umbilical artery catheterization in newborns. II. Infections in relation to catheterization.

Infections, as a complication of umbilical artery catheterization, were studied in 65 sick newborn infants. Every second day during the catheterization period peripheral blood cultures as well as blood samples for white cell count and platelets were taken. Cultures were taken from the catheter tips and from the umbilicus at the time of withdrawal of the catheter. Local or systemic antibiotics were not used prophylactically, but on rather broad clinical indications. No case of septicemia was found, but 8 infants had positive blood cultures and 16 had positive catheter tip cultures. Positive catheter tip culture occurred more often in infants who were born before 32 weeks of gestational age. Neither the duration of the catheterization nor the treatment with antibiotics influenced significantly the frequency of positive cultures.

Anti-Bacterial Agents↗
PubMed2000

Developing guidelines for allocating catheterization laboratory resources: lessons from an Ontario Consensus Panel. Consensus Panel on Cardiac Catheterization Laboratory Services in Ontario and the Steering Committee of the Cardiac Care Network of Ontario.

In March 1997, the Ontario Ministry of Health asked the Cardiac Care Network of Ontario (CCN) to develop guidelines for allocating cardiac catheterization laboratory resources. A consensus panel of providers and planners used findings from the literature and expert opinion to recommend guidelines for the operation of cardiac catheterization laboratories and criteria to be considered when allocating additional cardiac catheterization laboratory resources. This article summarizes the consensus panel's major findings that may be of value to other jurisdictions, including need identification, clinical practice, system issues, location criteria and cost considerations. The article reflects the advice given to the Ontario Ministry of Health by the CCN and is not an official position paper of the Canadian Cardiovascular Society.

Angioplasty, Balloon, Coronary↗
PubMed1997

Women's perception of pain and distress during intravenous catheterization and urethral mini-catheterization.

A study was done to prospectively compare the pain and distress of urethral mini-catheterization (MC) with the pain and distress of intravenous (IV) catheterization in women. Ten-centimeter visual analog scales were used on which the left end represented "no pain" or "no distress" and the right "the worst pain imaginable" or "extreme distress." Distress was defined to include embarrassment, anxiety, or fear. A convenience sample of 40 adult women who presented to a university emergency department and were undergoing both procedures as part of their management appraised pain and distress after IV placement and urethral MC. The mean IV pain score was 4.2 cm, whereas the mean MC score was only 2.6 cm (P = .02). The IV and MC distress score means were similar (2.3 v 2.6 cm, P = .55). These results suggest that patients perceive urethral MC as less painful than IV placement. The distress scores of these two procedures did not differ and were low in both instances.

Adolescent↗
PubMed1977

Hydro- and hemodynamic effects of catheterization of vessels. IV. Catheterization in the dog.

In four dogs the hemodynamic effects of renal artery catheterization has been analysed. Aortic and renal arterial blood pressure and renal blood flow were determined and injection of contrast medium made before during, and after the catheterization maneuver, using catheters with different outer diameters. No effect on the blood pressure or the mean renal blood flow was found until catheters were used with the outer diameter close to the inner diameter of the renal artery.

Animals↗
PubMed2004

Transpectoral ultrasound-guided catheterization of the axillary vein: an alternative to standard catheterization of the subclavian vein.

Subclavian vein catheterization is associated with failure and complications because of injury to the nearby lung and subclavian artery. Its position, sandwiched between the clavicle and the first rib, makes sonographic imaging difficult. The medially pointed sonography probe makes it difficult to align the needle as well as image the entire needle. The axillary vein lies outside of the thoracic cage and can be easily imaged in its longitudinal view along with the entire needle, guidewire, dilator, and catheter in real-time. All described techniques of venous access using sonography have used transverse images of veins, and the needle is not completely visualized. Five cases of axillary vein catheterization using longitudinal section images of the vein, and following the needle, guidewire, and line with real-time sonography, are described. The use of longer puncture needles and introducer sheaths is suggested. A larger study is required to assess the potential of this technique.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Cerebral ischemia: a complication in heart catheterization. An assessment in 2178 catheterizations].

Cardiac catheterization is highly recognized as the more definitive test in several cardiac diseases. However it has a small but definite risk. Cerebral ischemia is an unusual complication of this procedure; the main recognized physiopathological mechanism is thromboembolism. We present the analysis of 7 cases observed in 2178 consecutive cardiac catheterizations. In all cases the neurological dysfunction developed during the procedure or in the few minutes after it. One patient had a complete cerebral infarct. All cases of cerebral infarct were confirmed with computed tomography scan or magnetic resonance imaging. The clinical profile supported an embolic mechanism. The early recognition and management of this complication can influence the prognosis of these patients and therefore emphasize the importance of the monitoring of the neurological function in the hemodynamic department.

Adult↗
PubMed1991

Long-term, open catheterization of the spinal subarachnoid space for continuous infusion of narcotic and bupivacaine in patients with "refractory" cancer pain. A technique of catheterization and its problems and complications.

The technique of long-term, open catheterization of the spinal subarachnoid space for infusion of analgesics in patients with refractory cancer pain is sparsely reported in the literature. We report on a technique using 18G Portex nylon catheters and 16G-17G Tuohy needles, and its problems and complications. One hundred fifty-seven catheters were inserted in 142 patients, in most of them (79%) under deep sedation and local anesthesia. Attempts were made to place the catheter tip as close to the painful segments as possible. The catheters were tunneled subcutaneously (87% of them paravertebrally, over the shoulder, and further parasternally to the third chondrocostal cartilage). The Luer connections of the catheters were fixed to the patients' skin with monofilament steel sutures of dimension 0 and connected to a bacterial filter. At the end of the procedure, 10 ml isotonic saline was injected intrathecally to prevent postspinal puncture headache. Absorbent and impermeable dressings were applied over the tunnel exit, catheter Luer connection and bacterial filter. Antibiotics were given on the day of insertion and 2 days thereafter. During the insertion procedure, the following problems and complications were encountered; two or more attempts before successful spinal-dural puncture (32%), accidental puncture of an extradural vessel (10%), difficult dural puncture (18%), absence of free dripping of cerebrospinal fluid (CSF) in spite of successful dural puncture (4%), blood-stained CSF (9%), radicular pain and paresthesiae (4%), difficult advancement of the catheter (6%), difficult tunneling (11%), and bleeding in the tunnel (0.7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

Effect of a 'centralized intensive education system' for clean intermittent self-catheterization in patients with voiding dysfunction who start catheterization for the first time.

BACKGROUND: This study evaluated the effects of a 'centralized intensive education system' (CIES) in terms of acquiring a proper clean intermittent self-catheterization (CISC) technique by patients with voiding dysfunction. METHODS: Between March 2002 and March 2003, we prospectively and consecutively enrolled 132 hospitalized patients who learnt and started CISC for the first time due to voiding dysfunction. Patients were enrolled either of two groups (the CIES group vs the 'individualized ward education system'[IWES] group) at the time of the urologic consultation for voiding dysfunction. Out of 132 patients who enrolled in the study, 112 (45 males and 67 females, mean age 57.3 with a range of 18-81) were included in the primary analyses. The questionnaire was applied immediately before discharge. RESULTS: There were similar patient demographics and clinical parameters for the CIES (n = 62) and the IWES groups (n = 50). Of 10 items including the methodology of CISC, six items discriminated significantly in favor of the CIES (P < 0.05). The patient satisfaction with CISC education was significantly different for the two groups in terms of response to the questionnaire. The CIES group was found to be more satisfied with the education received than the IWES group (P < 0.05). Moreover, the number of trials to gain confidence to perform CISC in CIES group was significantly fewer than that of IWES group (P < 0.001). CONCLUSION: Our results demonstrate that CIES might be a superior training program for the patients with voiding dysfunction to acquire a proper CISC technique to the conventional IWES.

Adolescent↗
PubMed1993

Self-catheterization after urethrotomy. Prevention of urethral stricture recurrence using clean intermittent self-catheterization.

Following urethrotomy approximately 50% develop recurrence within 6 months. Twenty-nine consecutive patients were offered clean intermittent self-catheterization (CISC) as a preventive measure against urethral stricture recurrence following internal urethrotomy. Ten patients dropped out during the scheduled 6-month regimen. Of the 19 patients left, a significantly improved flow was maintained over the period of observation. No reoperations were required. Prior to the trial, 14 of the 19 patients had a history of recurrent urethral stricture; 92% of these recurrences were diagnosed within 6 months following urethrotomy. It is concluded that CISC seems to be a promising preventive measure against recurrence of urethral stricture.

Aged↗
PubMed1977

Hydro- and hemodynamic effects of catheterization of vessels. V. Experimental and clinical catheterization of stenoses.

The volumetric flow rate and the pressure course through free and catheterized stenoses have been analysed experimentally. The influence of the following parameters has been considered: (a) the penetration depth of the catheter into stenoses of various geometrical shapes and various dimensions, (b) the length of the stenosis, (c) the size of the annular lumen area between the catheter and the stenosis wall, (d) the geometrical shape of the stenosis. Some previous attempts to derive a simple relation between the volumetric flow through and the pressure fall across stenosis with and without introduced catheter are discussed. Clinical pressure measurements across renal artery stenoses are given, and the validity of catheter-measured pressure gradients across stenoses is discussed.

Blood Pressure↗
PubMed2003

Post-cardiac catheterization access site complications and low-molecular -weight heparin following cardiac catheterization.

The low molecular weight heparin enoxaparin is often administered to patients on long-term anticoagulation regimens who temporarily discontinue warfarin prior to undergoing invasive procedures. The clinical outcome of all enoxaparin-treated patients who underwent cardiac catheterization or coronary artery interventional procedures (n = 119) was evaluated. A total of 5 patients (4.2%) requiring anticoagulation (3 with chronic atrial fibrillation and 2 with ventricular thrombi) developed severe late enoxaparin-associated hemorrhagic or vascular complications at the femoral arterial puncture site between 3 and 11 days post-procedure. Complications included development of femoral arterial pseudoaneurysm (n = 3), hypotension (systolic blood pressure < 90 mmHg) (n = 2), acute decrease in hemoglobin levels to < 8.5 mg/dl (n = 4) and cardiac arrest (n = 1). In patients receiving standard dose enoxaparin after percutaneous invasive cardiac procedures, there is the potential for delayed and severe access site hemorrhagic and vascular complications.

Aged↗