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PubMed1988

Comparison of lead dislodgment and pocket infection rates after pacemaker implantation in the operating room versus the catheterization laboratory.

To assess and compare the rates of lead dislodgment and pocket infection in patients having procedures performed in the operating room versus those performed in the cardiac catheterization laboratory, we reviewed the records of 85 adult patients who underwent 88 procedures, all performed by one surgical team and having complete follow-ups at our institution from October 8, 1979, through November 7, 1986. Forty-five patients underwent 46 procedures in the operating room, and 40 patients underwent 42 procedures in the cardiac catheterization laboratory. There was one instance of ventricular lead dislodgment noted among the 48 leads implanted in the operating room and one instance of ventricular lead dislodgment among the 58 leads implanted in the cardiac catheterization laboratory. No instances of atrial lead dislodgment were noted. No instances of pocket infection were noted among the 46 procedures performed in the operating room or in the 42 procedures performed in the cardiac catheterization laboratory. We conclude that pacemaker implantation can be performed with equivalent safety and effectiveness in the cardiac catheterization laboratory and in the operating room.

Adult↗

PubMed1995

The history of interventional cardiology: cardiac catheterization, angioplasty, and related interventions.

The histories of cardiac catheterization, angioplasty, and other catheter interventions are spectacular journeys marked by undeterred genius, serendipity, and the vindication of the scientific method. Cardiac catheterization began with Hales's 1711 equine biventricular catheterization, other early experimental catheterizations in the nineteenth century, and Forssmann's dramatic 1929 right-heart self-catheterization. Cournand, Richards, and others finished unlocking the right heart in the 1940s; Zimmerman, Cope, Ross, and others unlocked the left heart in the 1950s; and the coronary arteries were inadvertently unlocked by Sones in 1958, leading to the advent of percutaneous femoral coronary angiography by Judkins and by Amplatz in 1967. Dotter's accidental catheter recanalization of a peripheral artery in 1963 ushered in the era of intervention, crowned by Gruentzig's balloon angioplasty in the mid-1970s and leading to today's panoply of devices used percutaneously to revascularize the coronary arteries in a variety of clinical settings.

Angioplasty↗

PubMed1982

Pediatric cardiac catheterization with same-day discharge.

A system was developed for cardiac catheterization in children without overnight hospital stay (called same-day discharge). Over a 4 year period, 233 children (aged 5 weeks to 20 years) had catheterization with same-day discharge staying an average of 11.8 hours in the hospital. In all but 1, no problems occurred after hospital discharge; 1 child required readmission for psoas tendinitis after retrograde aortography. Same-day discharge was safely applied regardless of the patient's age, diagnosis, and use of systemic heparinization, large-bore sheaths, retrograde arterial catheterization, or cineangiography. The hospital-related cost of pediatric cardiac catheterization was reduced 29% compared with that of the standard 42 hour hospital stay. Same-day discharge provides attractive elements to the physician and institution involved in cardiac catheterizations, for example: (1) improved medical care by a decrease in the length of hospitalization, (2) a significant reduction in medical costs, and (3) elimination of time pressure in training and teaching as well as therapeutic decision-making. Critical factors for the successful application of same-day discharge are coordination of multiple health care professionals and physician judgment of the patient's clinical status. We speculate that reassessment of other hospital-oriented procedures may foster the development of methods for improving medical care or reducing cost, or both.

Adolescent↗

PubMed1986

Comparison of Doppler-derived pressure gradient to that determined at cardiac catheterization in adults with aortic valve stenosis: implications for management.

Over a 1-year period cardiac catheterization was performed in 58 patients, mean age 66 years, who had elevated aortic blood flow velocity (more than 1.7 m/s) by continuous-wave Doppler echocardiography. Doppler echo signals were initially judged acceptable for quantitative analysis in 95% of patients, usually from the apical transducer position. Cardiac catheterization was performed within a mean of 8 days (60% within 1 day) of the Doppler echo study. The aortic valve mean pressure gradients at catheterization ranged from 0 to 93 mm Hg. The linear correlation coefficient (r value) between the mean pressure gradient determined by Doppler echocardiography and catheterization was 0.87. The correlation was maintained in 15 patients with aortic regurgitation (r = 0.91) and in 16 patients with significant coronary artery disease (r = 0.93). In the 16 patients with reduced cardiac output (mean 3.2 liters/min, range 2.2 to 3.9) the correlation was 0.81. A strategy for using the Doppler echo-calculated pressure gradient to manage patients with valvular aortic stenosis (AS) was derived by investigating the relation of the Doppler echo gradient to the aortic valve area in 35 patients with no aortic regurgitation detected at catheterization. All 12 patients with a Doppler echo mean gradient of less than 30 mm Hg had an aortic valve area of more than 0.75 cm2 and all 11 patients with a Doppler echo mean gradient of more than 50 mm Hg had an aortic valve area of less than 0.75 cm2.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1983

Prophylactic use of lidocaine to prevent advanced ventricular arrhythmias during pulmonary artery catheterization. Prospective double-blind study.

To determine whether prophylactic lidocaine could decrease the incidence of advanced ventricular arrhythmias, 62 patients undergoing 67 pulmonary artery catheterizations were given lidocaine or placebo before and during catheterization. Advanced ventricular arrhythmias occurred in 42 of the 67 catheterizations (63 percent). In 18 of 31 patients receiving lidocaine (58 percent) arrhythmias developed, whereas 24 of 36 patients who received placebo (67 percent) had evidence of arrhythmias. These differences were not significant. However, patients with catheterization times of less than 20 minutes who were treated with lidocaine had less ectopy (25 percent) than patients treated with placebo (68 percent) (p less than 0.05). Two patients has sustained ventricular tachycardia and both were receiving placebo. No complications of lidocaine prophylaxis were noted. Prophylactic lidocaine appears to decrease the incidence of mechanically induced arrhythmias in critically ill patients undergoing catheterization that is not prolonged.

Adult↗

PubMed1976

On-line computer processing of pressure data from cardiac catheterizations.

A flexible program system for on-line analysis of pressure data from cardiac catheterizations is described. The programs are implemented on an IBM 1800 computer, equipped with remote oscilloscope/keyboard terminals. The current computer system can handle any combination of up to 4 pressure signals. During catheterization, measurement specifications (i.e. calibration levels or sites of pressure recordings) are entered via the keyboard immediately before each recording. As an option the whole expected measurement sequence may be stored on disk before the catheterization starts. This method will minimize the necessary interaction with the computer when the same catheterization procedure is used on several occasions. Changes from the predetermined scheme may, however, be undertaken before each recording to meet with unexpected events that may arise during the catheterization. After computer detection of calibration levels, the recorded signals are digitized during 20 seconds and analysed beat-by-beat. Calculated values are averaged and presented on the terminal oscilloscope in tabular and/or graphic form. The waveform analysis performed by the program system is validated in a statistical comparison between manually and automatically computed values.

Cardiac Catheterization↗

PubMed1990

Routine electrocardiograms after cardiac catheterization. Are they useful?

In order to assess the value of routine electrocardiograms after cardiac catheterization (ECGs), 150 consecutive patients undergoing diagnostic cardiac catheterization were studied prospectively. The physician performing each catheterization was asked to rate his or her clinical index of suspicion that the electrocardiogram would be changed as a result of events during the procedure. Clinical index of suspicion and electrocardiograms were then compared for their ability to predict outcomes. Urgent clinical events within 24 hours of cardiac catheterization were defined as (1) new intensive care unit admission; (2) myocardial infarction; (3) coronary artery bypass graft surgery; (4) percutaneous transluminal coronary angioplasty; or (5) death. Chi square analysis demonstrated that neither ECGs (x2 = 2.12, p greater than 0.1) nor clinical index of suspicion (x2 = 2.43, p greater than 0.1) was better than chance alone in predicting urgent clinical events. The addition of ECGs to positive clinical index of suspicion did not increase the ability to predict urgent clinical events (x2 = 2.38, p greater than 0.1). Both ECGs and clinical index of suspicion were found to be relatively insensitive tests (sensitivity = 29% for ECGs, 43% for clinical index of suspicion). While both tests demonstrated high specificity, (89% for ECGs, 79% for clinical index of suspicion), their predictive value was equally poor (21% for ECGs, 17% for clinical index of suspicion). The addition of ECGs to clinical index of suspicion marginally increased the sensitivity of both tests to 50%. We conclude that routine postcatheterization electrocardiograms are no better at predicting urgent clinical events than clinical observation during catheterization alone, and should be performed only when index of suspicion dictates.

Angioplasty, Balloon, Coronary↗

PubMed1992

Follow-up of clean intermittent catheterization for children with neurogenic bladders.

Intermittent catheterization remains the primary method of treatment in the management of patients with neurogenic bladders such as those with meningomyelocele. In a follow-up of a previous study, we re-examined the urologic status of patients with neurogenic bladders continuing on a regimen of clean intermittent catheterization five years after the completion of the first study. Thirty-seven of the original 49 patients were available for follow-up, and no significant differences were found between those lost to follow-up and those included in this study. Among the patients re-evaluated, reflux remained unchanged or improved in most patients, renal function was maintained, and the urinary tract infection rate remained low. Additionally, continuation of an intermittent catheterization program does provide independence and social continence in most young adults with meningomyelocele. We conclude that a long-term intermittent catheterization program is associated with stable reflux status, renal function, and infection rate, and that compliance with a catheterization program can result in improved social continence and independence.

Adolescent↗

PubMed1996

Lumbar catheterization of the spinal subarachnoid space in the rat.

The method commonly used for catheterization of the lumbar subarachnoid space in the rat implies inserting the catheter through the atlanto-occipital (A-O) membrane and moving the catheter caudally along the spinal cord. The method is associated with a considerable morbidity. A method for direct catheterization of the lumbar subarachnoid space was therefore developed. Major surgery was avoided by using a catheter-through-needle technique. Of 32 rats, none died. There were no signs of neurological disturbances, and all animals gained weight as normal the first week after implantation. Data from rats catheterized by the A-O method were used for comparison. Of 40 animals, 2 died, 11 showed signs of neurological disturbances, and the mean weight was reduced during the first week after catheterization. The two groups of animals showed different behavioural responses to intrathecal injection of N-methyl-D-aspartate (NMDA, 0.1-1.6 mM, 15 microliters) which is thought to stimulate afferent pathways mediating nociception. Animals with a lumbar catheter showed licking, biting and scratching behaviour in a dose-related manner for concentrations up to 1.6 mM. The animals with A-O catheters showed a maximum level of this behaviour already at 0.4 mM, while 0.5 mM induced convulsions. A possible explanation of this difference in response to NMDA could be a long-lasting pain state in the A-O group, caused by catheter-induced changes in the spinal cord and by the extensive surgery. It is concluded that the direct lumbar catheterization has several advantages compared to the A-O method, decreasing the suffering of the animals, the neurological disturbances and the interference with nociceptive functions of the spinal cord.

Animals↗

PubMed1989

Influence of echocardiography in pre-operative cardiac catheterization in congenital heart disease.

The influence of echocardiography on pre-operative cardiac catheterization was assessed in a retrospective analysis comparing two 12-month periods. Of 245 operations in 1983, 200 (82%) had pre-operative cardiac catheterization when two-dimensional echocardiography only was used in the pre-operative assessment compared to 162 of 238 (68%) operations in July 1985-June 1986 when pulsed Doppler echocardiography also was used (P less than 0.001). Significant reductions in pre-operative cardiac catheterization were present in both open (87/87 vs 89/102, P less than 0.001) and closed (113/158 vs 73/136, P less than 0.005) heart procedures. The group with the most significant reduction in pre-operative cardiac catheterization before open heart surgery were children with atrial septal defects; of the closed heart surgical groups, the greatest reductions were in patent ductus arteriosus, coarctation of the aorta and tetralogy of Fallot. Echocardiogram diagnostic errors occurred in 22/245 (9%) in 1983 compared to 9/238 (4%) in 1985/86 (P less than 0.05). Echocardiography has resulted in a significant reduction in pre-operative cardiac catheterization and has become more accurate in diagnosis.

Cardiac Catheterization↗

PubMed1983

Venepuncture, catheterization and failure to position correctly during central venous cannulation.

The authors analyse the incidence of puncture, catheterization and failures of positioning in a series of 420 central venous catheterizations performed in 388 patients, using six transcutaneous approaches: supraclavicular and infraclavicular subclavian, external and internal transjugular, antecubital and brachiocephalic. Puncture failures were recorded at 7.9% per 36 failures from 456 attempts, catheterization failures at 5.8% per 26 failures from 446 attempts, and misplacements at a rate of 5.7% per 23 misplacements during 420 catheterizations. The results show that, in respect of puncture, catheterization and success of positioning, the supraclavicular subclavian approach may be recommended preferentially. The internal jugular, brachiocephalic and infraclavicular subclavian approaches are also advantageous. A high rate of failures and misplacements was recorded in the antecubital and external jugular groups. The antecubital veins, however, should be reserved for orthopnoeic sitting patients, the success rate being significantly increased if the patients are sitting.

Adolescent↗

PubMed1988

Prediction of the severity of aortic stenosis by Doppler aortic valve area determination: prospective Doppler-catheterization correlation in 100 patients.

Two-dimensional and Doppler echocardiography was performed prospectively in 100 patients with aortic stenosis who were undergoing clinically indicated cardiac catheterization. The purpose of this study procedure was to determine various Doppler variables predictive of the severity of aortic stenosis and to compare Doppler- and catheterization-derived aortic valve areas. Doppler-derived mean gradient correlated well with corresponding gradient by catheterization (r = 0.86). Peak Doppler aortic flow velocity greater than or equal to 4.5 m/s and Doppler-derived mean aortic gradient greater than or equal to 50 mm Hg were specific (93 and 94%, respectively) for severe aortic stenosis (defined as catheterization-derived aortic valve area less than or equal to 0.75 cm2) but were not sensitive (44 and 48%, respectively). Doppler-derived aortic valve area calculated by the continuity equation correlated well with catheterization-derived aortic valve area calculated by the Gorlin equation when either the time-velocity integral ratio (r = 0.83) or the peak flow velocity ratio (r = 0.80) between the left ventricular outflow tract and the aortic valve was used in the continuity equation. A velocity ratio of less than or equal to 0.25 alone was sensitive (92%) in detecting severe aortic stenosis. Therefore, use of various Doppler-derived values allows reliable noninvasive estimation of the severity of aortic stenosis.

Aged↗

PubMed1994

Retroperitoneal hematoma after cardiac catheterization: prevalence, risk factors, and optimal management.

PURPOSE: Retroperitoneal hematoma is an unusual, but potentially serious, complication after cardiac catheterization. The predisposing factors, typical presentation, and clinical course of this iatrogenic complication are identified, and the role of surgery in its treatment is defined. METHODS: A retrospective review of 9585 femoral artery catheterizations over a 5-year period allowed identification and evaluation of all patients with retroperitoneal hemorrhage. RESULTS: Retroperitoneal hematoma developed in 45 patients (overall prevalence 0.5%), with the highest frequency after coronary artery stenting (3%). In the group of patients who underwent coronary artery stenting, statistically significant predictors of this complication included protocol for sheath removal, female sex, nadir platelet count, and excessive anticoagulation. Signs and symptoms included suprainguinal tenderness and fullness in 100%, severe back and lower quadrant pain in 64%, and femoral neuropathy in 36%. Most patients were treated successfully with transfusion alone. Seven patients (16%) required operation; in four, hypotension unresponsive to volume resuscitation developed early after catheterization; and, in three, a progressive fall in hematocrit level led to surgery 24 to 72 hours after catheterization. CONCLUSIONS: Retroperitoneal hematoma after cardiac catheterization can usually be treated by transfusion alone. A small subset of patients who have development of hypotension unresponsive to volume resuscitation require urgent operation.

Aged↗

PubMedDate not supplied

Effects of alkalinization of lidocaine on the pain of skin infiltration and intravenous catheterization.

STUDY OBJECTIVE: To test the hypothesis that alkalinization of lidocaine decreases the pain of skin infiltration in surgical patients. DESIGN: Double-blind, randomized, prospective study. SETTING: Preoperative holding units, Brigham and Women's Hospital. PATIENTS: 184 adult surgical patients. INTERVENTIONS: We compared the efficacy of 1% lidocaine with and without 0.1 mEq/ml of sodium bicarbonate (NaHCO3) for relief of pain of (1) skin infiltration and (2) intravenous (i.v.) catheterization prior to surgery. MEASUREMENTS AND MAIN RESULTS: Patients evaluated the intensity of pain using a 100 mm visual analog scale (VAS). There were no differences between study groups (lidocaine with NaHCO3, n = 89; lidocaine alone, n = 95) with respect to site of catheterization or catheter gauge used. Lidocaine plus NaHCO3 caused significantly less pain on skin infiltration (median VAS = 4; range = 0 to 51) than did lidocaine alone (VAS = 8; range = 0 to 48; p < 0.008). Pain of i.v. catheterization also did not differ between groups. There was a weak correlation between catheter gauge and pain of i.v. catheterization (r = -0.19; p = 0.01). CONCLUSIONS: Pain resulting from skin infiltration of lidocaine solutions can be diminished by adding NaHCO3. However, catheter size is more important than the presence or absence of NaHCO3 in determining the pain of i.v. catheterization.

Adult↗

PubMed2005

The prognostic use of right heart catheterization data in patients with advanced heart failure: how relevant are invasive procedures in the risk stratification of advanced heart failure in the era of neurohormones?

BACKGROUND: Right heart catheterization long has been a routine investigation in advanced heart failure, and its measurements have been linked variably to prognosis. However, in the modern era, newer potential markers of prognosis are coming to light. This study reconsiders the use of right heart catheterization data and compares their use to that of N-terminal pro-brain natriuretic peptide (NT-proBNP), a neurohormone linked with prognosis in chronic heart failure. METHODS: We assessed prospectively the prognostic potential of baseline right heart catheterization data in 97 consecutive patients with advanced heart failure referred to the Scottish Cardiopulmonary Transplant Unit for consideration of cardiac transplantation. Patients underwent baseline routine investigation, including right heart catheterization and blood draws for NT-proBNP analysis. Patients were observed for a median of 370 days. RESULTS: The primary end-point of all-cause mortality was reached in 17 patients (17.5%), and the secondary end-point of all-cause mortality or urgent cardiac transplantation was reached in 21 (21.6%) patients. Univariate predictors of all-cause mortality included pulmonary artery systolic pressure (PASP), pulmonary artery wedge pressure (PAWP), and NT-proBNP concentration greater than their median values. Univariate predictors of the secondary end-point included right atrial pressure, PASP, PAWP, and NT-proBNP concentration greater than their median values, and left ventricular ejection fraction, cardiac output, and cardiac index less than their median values. In multivariate analyses, however, only NT-proBNP concentration remained an independent predictor of all-cause mortality. Both NT-proBNP concentration and PAWP were independent predictors of all-cause mortality and of the need for urgent cardiac transplantation. CONCLUSION: Baseline data from routine right heart catheterization are of limited prognostic use in advanced heart failure. A baseline NT-proBNP concentration is a superior, non-invasive method of risk stratification in this era of measuring neurohormones.

Cardiac Catheterization↗

PubMedDate not supplied

Reproductive performance after selective tubal catheterization.

STUDY OBJECTIVE: To evaluate the reproductive performance of women after selective tubal catheterization. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: University teaching hospital. PATIENTS: Ninety-eight infertile women with hysterosalpingographic findings of proximal tubal occlusion. INTERVENTION: Hysterosalpingography and selective tubal catheterization. MEASUREMENTS AND MAIN RESULTS: Repeat hysterosalpingography examination before selective tubal catheterization in 98 patients revealed bilateral tubal patency in 14 patients and patency of one of the tubes in 12 others (12.2%). True proximal tubal occlusion was encountered in 72 patients (139 tubes). Successful recanalization of both tubes was achieved in 25 patients (34.7%), and successful recanalization of at least one tube was achieved in 44 patients (61.1%). Of the 72 patients who underwent selective tubal catheterization, 23 patients conceived. The cumulative probability of conception was 28%, 59%, and 73% at 12, 18, and 24 months of follow-up, respectively. The median procedure-conception interval was 16.2 months. CONCLUSION: One-quarter of patients diagnosed with bilateral proximal tubal occlusion on hysterosalpingography do not have tubal obstruction. Among those with true occlusion, selective tubal catheterization leads to an overall pregnancy rate of 31.9%.

Adult↗

PubMed2005

Intermittent versus indwelling urinary catheterization in older female patients.

OBJECTIVES: To compare the use of intermittent and indwelling catheterization in older female patients with urinary retention. METHODS: A randomized, 2-week prospective study in a geriatric rehabilitation ward. Female patients of age 65 years and older with post-voiding residual urine volume (PVRU) persistently > or = 300 ml were randomly assigned to one of the two groups: intermittent catheterization (IMC group, n=36) and indwelling catheterization (IDC group, n=45). The primary outcome was the proportion of subjects being catheter-free and had a PVRU < 150 ml on day 14. The secondary outcomes were the time to become catheter-free and the rate of bacteriuria on day 14. RESULTS: Sixteen out of 27 (59.3%) in the IMC group versus 27 out of 39 (69.2%) in the IDC group achieved the primary outcome on day 14 (P=.403) without significant difference in the PVRU. The IMC and IDC groups took a mean of 8.6+/-3.3 and 9.2+/-4.0 days to become catheter-free, respectively (P=.609). Fourteen out of 22 (63.6%) in the IMC group versus 21 out of 34 (61.8%) in the IDC group had bacteriuria on day 14 (P=.888). CONCLUSION: Given the similar success rate of regaining bladder voiding function, the similar rate of bacteriuria and considering that the IMC group only underwent a median of 3 times of intermittent catheterization, we believe that the approach of intermittent urinary catheterization when required would be justified in managing elderly female urinary retention in rehabilitation ward as the presence of indwelling catheters would hinder rehabilitation and adversely affect patient quality of life.

Aged↗

PubMed1996

Training in cardiac catheterization at high-volume and low-volume centers: is there a difference in case mix?

Current guidelines recommend that cardiology trainees participate+ in a minimum of 100 cardiac catheterization procedures during their clinical training (volume minimum level 1 training). To examine the differences in case mix seen by cardiology trainees during their training in cardiac catheterization, we examined the first 100 cases done by two trainees at different hospitals. One hospital was a high-volume center performing > 5500 procedures/year, and the other was a low-volume center performing < 1500 procedures/year. Demographic and clinical characteristics of the patients undergoing cardiac catheterization were similar at the two hospitals. Indications were also similar, with the only exception being a higher rate of urgent/emergent cases among patients seen at the low-volume center (8% vs 1%). Minor differences in procedural techniques were present at the two hospitals, with the trainee at the high-volume center having more experience with arm cases (4% vs 0%) and left ventriculograms (77% vs 48%) and the trainee at the low-volume center having more experience with right-heart catheterizations (36% vs 11%) and temporary pacing wires (5% vs 2%). Neither trainee had significant experience with valvular or adult congenital heart disease (2%, low-volume center; 1%, high-volume center). These results suggest that current volume minimums may ensure relatively uniform case mix among physicians who are training in cardiac catheterization at different centers. However, training may be deficient in several areas such as valvular heart disease, congenital heart disease, and arm cases.

Adult↗