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Results for “Catheterization”

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At least 451 records · Page 25Linked to original sources

PubMed1994

Femoral vein pulmonary artery catheterization in the intensive care unit.

OBJECTIVES: To evaluate the success and complications of pulmonary artery catheterization via the femoral vein without the use of fluoroscopy, in the medical ICU. DESIGN: We retrospectively reviewed the charts of all patients receiving pulmonary artery catheters through the femoral vein in the medical ICU between July 1, 1988 and June 30, 1992. SETTING: Medical ICU at Bronx Municipal Hospital Center. PATIENTS: Thirty-three patients were studied (20 male and 13 female). The patients ranged in age from 24 to 83 years, with the mean age of 56 years. The condition at the time of catheterization was classified as septic shock (n = 22), gastrointestinal bleed (n = 7), cardiogenic shock (n = 1), cardiac tamponade (n = 1), preoperative (n = 1), or drug overdose (n = 1). MEASUREMENTS: In each case, pulmonary artery pressure tracings, electrocardiographic recordings, procedure, and nursing notes were reviewed from the time of catheter insertion. Charts were also analyzed for evidence of catheter-related septicemia, deep vein thrombosis, pulmonary embolism, or problems developing at the insertion site. RESULTS: Femoral vein pulmonary artery catheterization was performed successfully in 37 of 39 attempts (95 percent success rate) without the use of fluoroscopy. Five of the 33 patients studied had more than one femoral vein pulmonary artery catheter during their hospital course. Four of them had two femoral vein pulmonary artery catheters and the fifth patient had three femoral vein pulmonary artery catheters. Overall, 39 attempts at femoral vein pulmonary artery catheterization were made in the 33 patients studied. Three patients had 10- to 19-beat ventricular tachycardia (7.7 percent incidence) precluding catheter insertion via this approach in two instances. There was no clinical evidence of major hematomas or hemorrhages, catheter-related septicemia, deep vein thrombosis, or pulmonary emboli in any of our patients. CONCLUSION: Femoral vein pulmonary artery catheterization without the use of fluoroscopy is safe and effective.

Catheterization, Swan-Ganz↗

PubMed1998

PREPARED: Preparation for Angiography in Renal Dysfunction: a randomized trial of inpatient vs outpatient hydration protocols for cardiac catheterization in mild-to-moderate renal dysfunction.

BACKGROUND: IV hydration before and after cardiac catheterization is effective in preventing contrast-associated renal dysfunction for patients with mild-to-moderate renal insufficiency, but necessitates overnight hospital admission. We tested an outpatient oral precatheterization hydration strategy in comparison with overnight IV hydration. METHODS: We randomized 36 patients with renal dysfunction (serum creatinine > or = 1.4 mg/dL) undergoing elective cardiac catheterization to receive either overnight IV hydration (0.45 normal saline solution at 75 mL/h for both 12 h precatheterization and postcatheterization; n = 18) or an outpatient hydration protocol including precatheterization oral hydration (1,000 mL clear liquid over 10 h) followed by 6 h of IV hydration (0.45 normal saline solution at 300 mL/h) beginning just before contrast exposure. The predefined primary end point was the maximal change in creatinine up to 48 h after cardiac catheterization. RESULTS: The inpatient and outpatient groups were well matched for baseline characteristics and contrast volume. By protocol design, the outpatient group received a greater volume of hydration, although the net volume changes were comparable in the two groups. The maximal changes in serum creatinine in the inpatient (0.21+/-0.38 mg/dL; 95% confidence interval [CI], 0.02 to 0.39 mg/dL) and outpatient groups (0.12+/-0.23 mg/dL; 95% CI, 0.01 to 0.24 mg/dL) were comparable (p = not significant). There were no instances of protocol intolerance. CONCLUSIONS: A hydration strategy compatible with outpatient cardiac catheterization is comparable to precatheterization and postcatheterization IV hydration in preventing contrast-associated changes in serum creatinine. Hospital admission for IV hydration is unnecessary before elective cardiac catheterization in the setting of mild-to-moderate renal dysfunction.

Aged↗

PubMed1983

The preoperative evaluation in patients with endocarditis. Is cardiac catheterization necessary?

We retrospectively compared clinical assessment and cardiac catheterization to subsequent surgical findings with regard to specific valvular involvement, hemodynamic status, and presence of myocardial abscess in patients recommended for cardiac surgery for endocarditis. Of 105 consecutive patients with endocarditis, 19 met one or more of the following criteria suggesting the need for early surgery: congestive heart failure; systemic emboli; persistent infections or new conduction abnormalities. Of these 19 patients, seven had prosthetic cardiac valves. Clinical assessment was highly sensitive (95 percent) and specific (89 percent) for specific valvular involvement and was also highly sensitive and specific in evaluating myocardial abscess and congestive heart failure; however, clinical assessment could not identify the source of infection in one patient with multiple prosthetic valves, did not define the specific valve in one patient with right-sided endocarditis, and overestimated the severity of mitral regurgitation in one patient who had normal pressures and flows at catheterization. Catheterization incorrectly predicted multivalvular involvement in four patients. At catheterization, only one patient experienced evidence of clinical deterioration, and this was probably not related to the procedure. We conclude that although clinical assessment is correct in most patients, it may on occasion lead to an erroneous conclusion. Catheterization and angiograms are of value in the preoperative evaluation of patients with endocarditis, particularly in cases where the clinical assessment is ambiguous or uncertain. The procedures can be performed at low risk, and the information obtained may substantially influence management in some cases.

Adolescent↗

PubMed1986

The axillary vein: an alternative approach for percutaneous pulmonary artery catheterization.

The axillary vein route was investigated prospectively for percutaneous pulmonary artery catheterization in 79 patients who underwent 83 attempts. Forty nine of these patients were tracheostomized and under mechanical ventilation and eight had hemostasis disorders. Successful catheterization was achieved 74 times in the 79 patients. Pulmonary artery was reached within 6 +/- 2.1 min after the catheter was set in place in the axillary vein. Less than 1 min was needed in 53 cases. Puncture of the axillary artery was noted in 11 patients without complication. No other significant complication was noted following the punctures. Mean duration of catheterizations was 3.6 +/- 2 days. No septicemia was related to the catheterization procedure. One thrombosis of the axillary vein was noted. Catheterization of the pulmonary artery via the axillary vein is safe, simple and reliable and can represent an alternative method should the use of other routes be unsuccessful.

Adolescent↗

PubMed1988

Complete hemodynamic evaluation of patients with aortic regurgitation by outpatient right heart catheterization and digital subtraction angiography.

The aim of this study was to demonstrate that total hemodynamic evaluation of patients with aortic regurgitation can be performed on an outpatient basis by combining right heart catheterization with digital subtraction angiography (DSA). Thirteen patients with severe aortic regurgitation were catheterized as outpatients, without premedication. The pulmonary artery was entered percutaneously through the femoral vein. Cardiac output and stroke volume were measured by the indicator dilution method by injection into the inferior vena cava and sampling from the pulmonary artery. The regurgitant fraction was obtained by subtracting the indicator stroke volume from the angiographic left ventricular stroke volume. The following results are expressed as mean +/- SD. Ejection fraction (%) = 54 +/- 6; end diastolic volume index (ml) = 228 +/- 40; end systolic volume index (ml) = 198 +/- 51 and regurgitant fraction (%) = 59 +/- 7 while the pulmonary wedge pressure (mmHg) = 10 +/- 3. In 4 cases, comparison with recent catheterization data showed good agreement for all parameters (r = 0.90), except ejection fraction (r = 0.75). In conclusion, this simplified catheterization method using digital subtraction enables the procedure to be done on an outpatient basis. All essential hemodynamic data can be obtained by right heart catheterization.

Adolescent↗

PubMed1979

Chronic impairment of leg muscle blood flow following cardiac catheterization in childhood.

In 99 patients with congenital heart defects of chronic respiratory disease without clinical symptoms of disturbances in peripheral circulation, resting and maximal blood flow in the anterior tibial muscle of both extremities were investigated 2.7 years (average) after cardiac catheterization. The method used involved 133Xe clearance. Resting blood flow was normal and no difference could be demonstrated between the extremity originally used for catheterization and the contralateral control extremity. No disturbance in maximal blood flow could be proved in the extremity used for catheterization by the venous route only. Maximal blood flow was significantly lower in that extremity where the femoral artery had been catheterized or cannulated for pressure measurement and blood sampling. The disturbance in maximal flow was shown regardless of whether the arterial catheterization involved the Seldinger percutaneous technique, arteriotomy, or mere cannulation of the femoral artery. The values in the involved extremity did not differ significantly from the values in a healthy population.

Adolescent↗

PubMed2001

Percutaneous catheterization of the internal jugular vein for hemodialysis.

OBJECTIVES: The present study was aimed at evaluating the clinical experiences in the internal jugular venous catheterization for hemodialysis. METHODS: We retrospectively analyzed the data on internal jugular venous catheterization at Chonnam National University Hospital from May 2000 to February 2001. RESULTS: There were 132 uremic patients with a total of 150 attempts of internal jugular cannulation. Overall success rate was 90.9% with average puncture trials of 2.3 +/- 2.1. 124 (82.7%) of the catheterization attempts were made on the right side and 26 (17.3%) were made on the left. The catheters were left in place from 2 to 87 days with an average of 19.5 +/- 15.3 days per catheter. The dialysis sessions per catheter were from 2 to 58 with an average of 11.3 +/- 6.8. The mean blood flow during hemodialysis immediately after catheterization was 213.4 +/- 42.2 ml/min. Thirty two (21.3%) patients had early complications. These included carotid artery puncture (11.3%), local bleeding (4.7%), local pain (3.3%), neck hematoma (0.7%) and malposition of the catheter (1.3%). Seventeen (11.3%) patients had late complications. These included fever or infection (11.3%), inadequate blood flow rate (3.3%) and inadvertent withdrawal (2.0%). There was no catheter-related mortality. CONCLUSIONS: Our experiences revealed that the internal jugular vein catheterization is relatively safe and efficient for temporary vascular access for hemodialysis.

Adolescent↗

PubMed1994

Pulmonary artery catheterization in exacerbations of COPD requiring mechanical ventilation: a cost-effectiveness analysis.

UNLABELLED: The cost-effectiveness of pulmonary artery catheterization (PAC) has been questioned in many clinical situations. We sought to assess the cost-effectiveness of PAC in patients with an acute exacerbation of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation. METHODS: We constructed a decision analysis model and calculated the incremental cost/quality-adjusted life-year (QALY) saved for hypothetical patients, comparing a PAC strategy to one of no PAC. Sensitivity analyses were performed to test the stability of conclusions over wide ranges of values. RESULTS: The incremental cost/QALY saved in the cost-effectiveness analysis using baseline data is $77,407 when catheterization-driven therapeutic changes result in a 5% improvement in survival. Cost-effectiveness is sensitive to variations in post-hospital life expectancy, quality of life, and the probability of favorable therapeutic changes resulting from the use of catheterization data. CONCLUSIONS: Pulmonary artery catheterization in COPD exacerbation requiring mechanical ventilation is expensive compared to accepted medical interventions for other conditions, unless changes in therapy prompted by catheterization increase hospital survival to a level 8.7% above baseline. Randomized, controlled trials are needed to investigate the economic impact of PAC and its effect on morbidity and mortality of critically ill patients.

Catheterization, Swan-Ganz↗

PubMed2001

Screening for abdominal aortic aneurysms during cardiac catheterization.

BACKGROUND: Many authorities advocate routine screening for abdominal aortic aneurysms (AAA). Patients undergoing cardiac catheterization often have risk factors for AAA. The purpose of this study was to evaluate the clinical utility of screening for AAA during cardiac catheterization. METHODS: We prospectively examined the abdominal aorta in 127 patients undergoing diagnostic cardiac catheterization. Panning down during left ventriculography was the primary method for imaging the abdominal aorta. However, if there was difficulty advancing the catheter into the abdominal aorta, a formal postero-anterior abdominal aortogram was obtained. Off-line analysis of aortic morphology and diameters was performed. RESULTS: We achieved adequate visualization of the abdominal aorta in 99 of 127 patients. Mean age was 67 years; 75% were male. Risk factors for AAA were common, and included: history of smoking (88%); angina (84%); hypertension (57%); hyperlipidemia (52%); previous myocardial infarction (39%); diabetes mellitus (30%); obesity (21%); congestive heart failure (17%); presence of peripheral vascular disease (14%); and previous peripheral vascular procedures (12%). Panning down during left ventriculography was performed in 89% of cases in the 30 degrees right anterior oblique position. Previously undiagnosed, asymptomatic abdominal aortic aneurysms were found in 8 of 99 patients (8%). The mean intraluminal aneurysmal diameter was 2.8 +/- 1.1 cm and the mean length was 5.4 +/- 1.8 cm. Abdominal ultrasonography was performed in 7 of these cases (1 patient refused), and the mean diameter measured was 3.8 +/- 1.4 cm. Peripheral vascular disease, previous peripheral vascular surgery and difficulty advancing the catheter during the procedure were associated by univariate analysis with the presence of AAA. Multivariate analysis demonstrated that difficulty threading the catheter was the only independent predictor of the presence of AAA (odds ratio = 11.1; 95% confidence interval = 4.6-26.6; p = 0.007). CONCLUSION: Undiagnosed abdominal aortic aneurysms can be identified during routine examination of the abdominal aorta during cardiac catheterization. Because screening for AAA during cardiac catheterization is inexpensive and easily performed, it should be a routine part of the examination.

Adult↗

PubMedDate not supplied

On the need for massive additional shielding of a catheterization laboratory for the implementation of high dose rate 192Ir intravascular brachytherapy.

PURPOSE: There is a widespread belief in the cardiology and radiation oncology community that high dose rate 192Ir intravascular brachytherapy cannot be implemented without massive additional shielding of the conventional catheterization labs. The purpose of this work is to show that this is a myth, which is not based on sound radiation protection principles. METHODS: Exposure rates in air were calculated for a variety of point and line sources of 192Ir. Exposures per treatment at different distances from the source were calculated for a typical intravascular brachytherapy treatment of a 15-Gy dose at a radial distance of 2 mm from the source and for source lengths in the range of 0 to 10 cm. Additionally, exposure rates outside the catheterization lab were calculated for various lead shielding thicknesses typical of conventional X-ray facilities. These rates were used along with the NCRP recommendations on radiation facility design to assess shielding requirements. RESULTS: For a treatment dose of 15 Gy at 2 mm, the occupational exposure per treatment at 2 m in air without any tissue attenuation or shielding was 7.8 mR for a lesion length of 3.0 cm. This exposure/treatment is independent of the dose rate or the activity of the source. However, it increases as lesion length is increased, increasing from 5.4 to 24.9 mR as lesion length increased from 2 to 10 cm. Exposures in unrestricted areas outside the catheterization lab using the NCRP shielding rationale can be kept below 2 mR per treatment and using appropriate workload, use, and occupancy factors below 2 mR per week. CONCLUSIONS: The feasibility of implementing a high dose rate 192Ir intravascular brachytherapy program in a catheterization laboratory is totally independent of the dose rate or the activity of the source. If it is feasible to implement 192Ir brachytherapy in a conventional catheterization lab using low activity 192Ir seeds, then it is also feasible to do so with a high activity 192Ir afterloader.

Brachytherapy↗

PubMed2001

[Evolution of the catheterization laboratory: new instruments and imaging techniques].

The Editorial Board of the Italian Heart Journal Supplement has planned to publish a series of four consecutive papers focusing on new highlights from the cardiac catheterization laboratory, developments of new devices, coronary imaging and physiological measurement. The first paper on cineless digital angiography and new fluoroscopy systems presented in this issue of the Journal has been prepared by Danzi et al. (Brescia). The paper follows the publication of the Vergara's work (Rovereto-TN) on a similar topic presented last year in a Symposium of the Gruppo Italiano di Studi Emodinamici (GISE) at the XXXI ANMCO meeting. The recent development of cineless digital angiography and the increasing interest in new digital fluoroscopic low energy systems represent a significant change in the management of cardiac images and have significant implications in the organization of a new catheterization laboratory. The second paper will focus on the clinical applications of intravascular ultrasound imaging and will be prepared by Di Mario (Milan). Intravascular ultrasound imaging has significantly contributed to the understanding of vascular adaptation to coronary artery disease and mechanisms of percutaneous coronary interventions. This new diagnostic approach is particularly useful in assessing the early stages of disease, evaluating occult atherosclerosis and guiding the strategy of coronary interventions. Unfortunately, the application of intravascular ultrasound imaging in clinical practice remains limited. The third paper prepared by Verna (Varese) will discuss the new techniques for physiological evaluation of coronary artery disease now available in the catheterization laboratory. The use of pressure and Doppler flow-wire in the assessment of functional significance of individual coronary artery stenoses and in the evaluation of the vasodilatory capacity of coronary microcirculation may provide new insights for the clinical decision at the catheterization table. In addition, the application of myocardial contrast echocardiography with new sonicated agents for intracoronary use may represent a novel approach to the direct evaluation of regional myocardial perfusion and microvascular integrity. Intracoronary stenting has become a widely used and accepted technique in percutaneous coronary interventions. The fourth article of this series, prepared by Silva (Milan), will discuss the advantages and limitations of stenting in different clinical settings based on the results of large clinical trials. In spite of the growing number of procedures safely performed in many countries, long-term results of intracoronary stenting may be sometimes disappointing in selected patients. In-stent restenosis still represents a clinical problem limiting long-term outcome. In addition, the increasing use of new antiplatelet agents in combination with most stenting procedures rise some concern about overall cost of interventions. The objective of this editorial program is to give a view of the changing scenario of the catheterization laboratory with the new methods and devices presently available. There may be significant implications and controversial issues of interest also for all clinical cardiologists.

Cardiac Catheterization↗

PubMedDate not supplied

Massage therapy for patients undergoing cardiac catheterization.

CONTEXT: Anxiety and its pharmacological treatment can interfere with cardiac catheterization. Massage therapy has been used primarily in nonmedical settings for relaxation and stress reduction, and some research demonstrates its efficacy in medical environments. OBJECTIVE: First, to determine whether massage could be administered under "normal" conditions in an interventional cardiology center. Second, to evaluate the efficacy of massage in reducing anxiety before, during, and after a cardiac catheterization procedure. DESIGN: A prospective, randomized, controlled, single-masked, pilot study. SETTING: An interventional cardiology center at an urban hospital in New York, NY PATIENTS: Seventy-eight patients (59 men, 19 women), with a mean age of 60.1 years who were scheduled for an elective, diagnostic catheterization based on routine clinical practices. INTERVENTION: Treatment subjects received a standardized, 10-minute massage. Control subjects spent 10 minutes of quiet time with a massage therapist. MAIN OUTCOME MEASURES: We evaluated the feasibility of incorporating massage into the time period between the patient's arrival at the hospital and catheterization, patient interest in receiving massage, and staff support of this complementary therapy. We further evaluated self-ratings of anxiety and pain or discomfort on visual analog scales, vital signs, cortisol levels, and analgesic or anxiolytic intake. RESULTS: A 10-minute massage was feasibly incorporated before catheterization. Seventy percent of the patients consented to participate, and staff supported the intervention. Mean anxiety scores on a 166 mm visual analog scale dropped by 16.2 mm (SD, 24.6) in the massaged group and by 6.8 mm (SD, 17.3) in the control group (P = .081). No statistically significant results were found in pain or discomfort visual analog scale scores (P =.491), blood pressure (P = .827), heart rate (P = .935), respiration rate (P=.916), or analgesic and anxiolytic usage (P > or = .252). Cortisol levels are discussed as exploratory, data. CONCLUSIONS: The results of the study suggest that a 10-minute massage before an invasive cardiac procedure is insufficient to decrease stress measurably.

Adaptation, Psychological↗

PubMed2002

Comparative image analysis of cells in voided and catheterized urine.

OBJECTIVE: To objectively evaluate the difference in cytologic findings between specimens of voided and catheterized urine by using a comparative image analysis device, CAS200. STUDY DESIGN: Cells in voided and catheterized urine from 13 patients with transitional cell carcinoma (TCC), including 3 with grade 1, 6 with grade 2 and 4 with grade 3, were compared cytologically. The cellular area, nuclear area, nuclear/cytoplasmic ratio and nuclear density of both types of cytologic specimen were measured using CAS200. RESULTS: Cell area and nuclear area of grade 1 TCCs were significantly greater in voided urine than in catheterized urine. In contrast, cell area and nuclear area of grade 3 TCCs were significantly smaller in voided urine than in catheterized urine (P < .01), and nuclear density of grade 3 TCCs was higher in the latter than in the former. CONCLUSION: The cellular findings in voided urine were different from those in catheterized urine from the same patient. Thus, the method selected for obtaining urine specimens will affect the findings in urinary cytology.

Carcinoma, Transitional Cell↗

PubMed2002

Evaluation of aortic stenosis severity: role of contrast echocardiography in comparison with conventional echocardiography and cardiac catheterization.

OBJECTIVES: To evaluate the role of contrast Doppler echocardiography in the assessment of aortic stenosis severity, in comparison with the conventional method and using the catheterization study as the gold standard. STUDY DESIGN: Prospective comparative study. SETTING: Echocardiography Laboratory of Cardiology Department. POPULATION: We included 36 consecutive patients, 20 male, aged 67 +/- 11 years, referred for catheterization study to evaluate aortic stenosis severity. METHODS: All patients underwent conventional and contrast Doppler echocardiography and catheterization study. For contrast Doppler, we used Levovist (300 mg/ml infusion). We analyzed the following echocardiographic parameters: a) left ventricle dimensions, wall thickness and function; b) aortic valve morphology; c) post-stenotic aortic valve flow--peak velocity, velocity-time integral, peak gradient, mean gradient; d) left ventricle outflow tract flow--peak velocity, velocity-time integral; e) aortic valve functional area; f) acquisition time and Doppler signal intensity for post-stenotic aortic valve flow. Catheterization parameters analyzed: a) peak aortic valve gradient; b) mean aortic valve gradient. RESULTS: Contrast Doppler yielded higher peak gradients than conventional Doppler (85.6 +/- 30.2 vs 72.6 +/- 26.1 mmHg, p < 0.001), as well as higher mean gradients (51.4 +/- 19.0 vs 44.2 +/- 15.9 mmHg, p < 0.001). Peak gradients obtained with contrast Doppler correlated with those obtained invasively (r = 0.88, p < 0.001), although the values were higher (85.6 +/- 30.2 vs 73.6 +/- 32.0 mmHg, p < 0.001). There was no difference between mean contrast Doppler gradients and mean catheterization gradients, which showed a high correlation (r = 0.89, p < 0.001). There was no difference between peak and mean gradients obtained by conventional Doppler and invasively, which yielded correlations of 0.73 and 0.75, respectively (p < 0.001). The sensitivity of contrast Doppler for detection of severe aortic stenosis was 100% for peak gradient and 84% for mean gradient, while for conventional Doppler it was 68% and 58%. The specificity of contrast Doppler was 65% for peak gradient and 88% for mean gradient, while for conventional Doppler it was, respectively, 58% and 88%. Acquisition time for aortic flow visualization was lower (p < 0.001) and flow intensity higher for contrast Doppler, in comparison with conventional Doppler. CONCLUSIONS: In this study, contrast Doppler yielded high correlations with invasive data and higher sensitivity and specificity for detection of severe aortic stenosis than conventional Doppler. It is a useful method for evaluation of aortic stenosis severity.

Adult↗

PubMed2002

[CT dacryography without selective lacrimal duct catheterization: review of 39 patients].

OBJECTIVES: Dacryographies and CT dacryographies are usually performed after catheterization of a lacrimal canaliculus. We evaluated the quality of opacification on CT scan after simple instillation of contrast medium, without any catheterization. PATIENTS AND METHODS: 39 patients (78 nasolacrimal ducts) were examined for lacrimal pathways obstruction by CT scan after instillation of diluted contrast medium. Additional CT scan imaging was performed after catheterization when the first study did not provide adequate opacification. RESULTS: CT dacryography after instillation is a well tolerated technique. In our study, it allowed detection of all pathologic lacrimal ducts; 7 normal lacrimal pathways (after catheterization) were not opacified after instillation (false positives). The sensitivity of the method was 100%, its specificity 84%. CONCLUSION: CT dacryography after instillation is a physiologic, simple and sensitive method to evaluate lacrimal obstruction. We propose it as a first step, catheterization being used only in the absence of opacification after instillation.

Adolescent↗

PubMedDate not supplied

The effects of back massage before diagnostic cardiac catheterization.

CONTEXT: Admission to the hospital for a diagnostic cardiac catheterization can be perceived as a threat to one's health status. Autonomic nervous system arousal, particularly the sympathetic division, can elicit negative physiological and psychological human responses as a reaction to this threat. OBJECTIVE: The purpose of this study was to measure the effects of a 20-minute back massage on the physiological and psychological human responses of patients admitted for a diagnostic cardiac catheterization. DESIGN: A randomized clinical trial design was used. Data were compared in a repeated measures design before massage (T1), immediately following the back massage or standard care (T2), and 10 minutes later (T3). SETTING: A large urban academic medical center. PARTICIPANTS: Forty-six subjects admitted from home for a diagnostic cardiac catheterization. MAIN OUTCOME MEASURES: Heart rate, heart rate variability, blood pressure, respiration, peripheral skin temperature, pain perception, and psychological state. INTERVENTION: A 20-minute back massage. RESULTS: There was a significant difference between subject effect for group, with a reduction in systolic blood pressure in the treatment group (F = 8.6, P < .05). In addition, main effects were noted for time for diastolic blood pressure (F = 5.44; P < .006), respiration (F = 10.6; P < .005), total Profile of Mood States score (F = 5.9; P < .001) and pain perception (F = 4.09; P < .04) in both groups. CONCLUSIONS: A 20-minute back massage appeared to reduce systolic blood pressure in patients awaiting a diagnostic cardiac catheterization, while preparatory time in the cardiac catheterization laboratory appeared to reduce diastolic blood pressure, respiration, perceived psychological distress, and pain.

Adaptation, Psychological↗

PubMed2003

Significance of selective carotid angiography during complete cardiac catheterization in patients candidates to combined aortic valve and carotid surgery.

AIM: Association of aortic valve stenosis (AVS) with carotid artery disease (CD) constitutes a high risk clinical setting for combined surgery. Carotid angiography is still considered the gold standard for carotid artery imaging, but its use is confined in cases of dubious or inconclusive sonographic examination. Despite the widespread use of ultrasonography, selective angiography may be practical in patients undergoing complete routine cardiac catheterization for AVS due to characteristic abnormalities in flow velocity pattern due to aortic valve stenosis. The present retrospective study aims to estimate the feasibility and role of carotid angiography during complete routine cardiac catheterization in the assessment of CD associated with AVS in patients candidates for combined surgery, in whom Doppler ultrasonography was inconclusive. METHODS: In agreement with cardiac and vascular surgeons, patients aged >60 years, presence of risk factors, and inconclusive Doppler ultrasonographic examination underwent selective carotid artery angiography during complete cardiac catheterization. The angiographic and clinical records of these patients were reviewed. RESULTS: Sixty patients (male/female 28/32, mean age 64.5+/-10.6 years) underwent carotid angiography during left and right catheterization. Optimal visualization of carotid trunk anatomy and morphology was achieved in all patients. Forty-one patients (68.3%) had no carotid artery atherosclerotic involvement, whereas 4 (6.6%) had low grade CD. Fifteen patients (8.3%, male/female: 7/8, mean age 70+/-10.4 years) were diagnosed with critical stenosis of one (14 patients) or both (1 patients) internal carotid arteries. The mean lesion degree was 77.1+/-2.1%. Culprit plaques, bifurcation lesion and occlusion have been discovered in 6.6%, 20%, and 26.6% of patients, respectively. Two arterial spasms (3.3%), and no intrahospital complications were observed. CONCLUSION: In highly selected patients with combined CD and AVS and inconclusive Doppler ultrasonographic examination, selective carotid angiography during heart catheterization is safe, acceptably time-consuming and it may give an optimal anatomical picture of CD.

Aged↗

PubMed1992

Does indication sheet reduce unnecessary urethral catheterization?

The study on the effect of indication sheet on the decision of doctors in ordering urethral catheterization was done in thirteen hospitals randomly selected from all regions of Thailand. 16,959 patients in medical and surgical wards were included between April and May 1989. The rates of urethral catheterization did not change by the influence of indication sheet. However, urethral catheterization without proper indications was reduced from 27.0 per cent in the control group to 14.3 per cent in the experiment group. The indication sheet was accepted in 96.5 per cent of the occasions when doctors prescribed urethral catheterization. The indication sheet changed the doctors' decision and hence reversed the order in 3 events (0.8%). It is concluded that indication sheet was well accepted by doctors and could reduce urethral catheterization without proper indications.

Hospitals↗