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PubMed1992

Intermittent self catheterization for patients with urinary incontinence or difficulty emptying the bladder.

Urinary incontinence, difficulty voiding and recurrent urinary tract infections are common in general practice. In patients with multiple sclerosis, spina bifida, intervertebral disc lesions, spinal injuries or tumours, the symptoms may be associated with a high residual volume of urine owing to a neuropathic bladder. Similar complaints may occur in elderly people or in women with gynaecological problems owing to atonic urinary retention. Provided that a significant residual volume of urine is found on abdominal examination, ultrasound, x-ray or catheterization, both groups of patients may be helped by intermittent self catheterization. Intermittent self catheterization is a safe and simple technique. By catheterizing themselves between four and six times daily patients can gain control over their bladders. Abandoning indwelling catheters or bulky external appliances does much for a patient's morale and self esteem. In addition, since the bladder is being drained effectively, urinary tract infections cease to be a problem and the kidneys are safeguarded. Severe disability is not a contraindication since patients in wheelchairs have mastered the technique despite paraplegia, an anaesthetic perineum, spinal deformity, intention tremor, mental handicap, old age or blindness. Patients should be referred to urologists for a trial of intermittent self catheterization. If unsuccessful or unacceptable it can be abandoned with no long term consequences. If it is effective the benefits may be considerable.

Adult↗

PubMed2004

[Surgical treatment of iatrogenic cardiac traumas induced by heart catheterization].

BACKGROUND: A retrospective evaluation was made on iatrogenic cardiac traumas requiring surgical treatment, that were induced by cardiac catheterizations and interventions performed within a 17-year period. METHODS: A total of 64,911 patients underwent cardiac catheterizations and interventions from 1985 to 2002. Complications of iatrogenic cardiac traumas induced by these interventions were examined together with the surgical treatment performed within 24 hours after catheterization. RESULTS: Iatrogenic cardiac trauma requiring prompt surgical intervention was documented in 20 patients (6 females, 14 males; mean age 51 years; range 31 to 69 years). These were due to coronary angiography/balloon angioplasty-stenting in 14 (70%), percutaneous mitral balloon valvuloplasty in four (20%), and to heart catheterization in two patients (10%). Acute cardiac tamponade was detected in 10 patients (50%) resulting from perforations to the cardiac chambers in six, coronary arteries in two, and major vessels in two patients. Surgical interventions included coronary artery by-pass in 14, mitral valve surgery in four, and repair of major vessels in two patients. Perioperative mortality occurred in two patients. Six patients developed complications contributing to morbidity, including perioperative myocardial infarction (3 patients), infection (2 patients), and prolonged intubation (1 patient). CONCLUSION: In case of major cardiac complications induced during cardiac catheterizations, early diagnosis and prompt surgical intervention are of vital importance regardless of considerably high risks.

Adult↗

PubMed1992

Clean and sterile intermittent catheterization methods in hospitalized patients with spinal cord injury.

The purpose of this study was to compare the incidence of urinary infection using clean intermittent catheterization with the incidence of infection using sterile intermittent catheterization in patients hospitalized with spinal cord injury who were not receiving prophylactic antibiotics. Forty-six patients were assigned randomly to a clean (n = 23) or sterile (n = 23) study group. Catheterizations were done at least every six hours. Infection was defined as bacteriuria greater than or equal to 100,000 organisms/mL or greater than or equal to 10,000 organisms per mL with fever of 100 degrees F or greater. Results of urinary dipslides were recorded daily. Twenty-eight subjects (60.9%) converted to greater than or equal to 100,000 organisms per mL. Method of catheterization was neither associated significantly with development of greater than or equal to 100,000 organisms per mL. (X2[1,46] = .36, p = .55) nor with symptomatic infections (X2[1,46] = .15, p = .70). Data support the use of clean intermittent catheterization under the conditions used in this study, including the use of a sterile catheter each day and careful monitoring of infection and technique. Before using this method with other diagnostic groups or in different clinical settings, further investigation is needed.

Adolescent↗

PubMed2005

Racial and ethnic disparities in cardiac catheterization for acute myocardial infarction in the United States, 1995--2001.

OBJECTIVE: To examine recent trends in racial and ethnic disparities in cardiac catheterization for acute myocardial infarction (AMI) to determine whether disparities documented from the 1980s through mid-1990s persist, and evaluate whether patient and hospital characteristics are associated with any observed disparities METHODS: Cross-sectional analyses of 585,710 white, 51,369 black and 31,923 Hispanic discharges from hospitals in the Nationwide Inpatient Sample (which includes data on all discharges from 951 representative hospitals in 23 states) that had performed cardiac catheterization from 1995--2001 with a primary diagnosis of AMI. Adjusted procedure rates and prevalence ratios (PR) were computed to compare catheterization rates by race and ethnicity. MEASUREMENTS AND MAIN RESULTS: Catheterization rates were higher for whites than blacks for all years examined; rates among Hispanics increased during this period and approached the rate among whites. After adjustment for age, demographics, comorbidity, year and hospital characteristics, rates (per 100 discharges) were 58.4 for whites, 50.1 for blacks (PR 0.87; 95% CI 0.84-0.91) and 55.2 for Hispanics (PR 0.95; 95% CI 0.90-0.99). CONCLUSIONS: These nationwide data suggest blacks remain less likely than whites and Hispanics to undergo catheterization during a hospitalization for AMI. Whether this disparity stems from patient or provider factors remains to be determined.

Adolescent↗

PubMed2005

Risk of local adverse events following cardiac catheterization by hemostasis device use - phase II.

OBJECTIVES: To assess the relative risks of serious local adverse events following cardiac catheterization by type of hemostasis device (versus manual compression controls) and gender. BACKGROUND: Reports to the FDA (U.S. Food and Drug Administration) of local vascular complications associated with the use of hemostasis devices following cardiac catheterization and resulting in serious injuries, raised concerns about the safety of these devices. Review of the medical literature also posed cause for concern. METHODS: Data were obtained from the American College of Cardiology-National Cardiovascular Data Registry, modified to suit the needs of this research. It included information from 59 institutions and 13,878 cardiac catheterizations performed during the last quarter of 2003. Multiple logistic regression, using 10 different outcomes, was used to assess the risk associated with type of device and gender, while controlling for demographic and physiologic variables, type of procedure, and several indices of comorbidity. RESULTS: Serious adverse events were reported in 3.37% of patients, the most common being bleeding with hematoma (2.00%). The adjusted odds ratio for women (compared to men) was 1.73 for any vascular complication. Only one hemostasis device, VasoSeal, demonstrated a high risk of any vascular complication compared to manual compression controls (OR = 2.38 [1.47-3.85; p = 0.0004]). This risk was mainly associated with diagnostic cardiac catheterization (OR = 3.36). CONCLUSIONS: VasoSeal appears to pose a greater risk for serious local vascular complications following cardiac catheterization than either manual compression controls or other hemostasis devices. Women have almost twice the risk of men for most local complications.

Cardiac Catheterization↗

PubMed2006

[Cardiac catheterization in neonates: experience in 26 neonates].

Cardiac catheterization is rarely performed in neonates in China. The medical records of 26 neonates who underwent cardiac catheterization in Shanghai Children's Medical Center from June 1994 to June 2004 were reviewed. These infants weighed 2300 to 4500 g (mean 3 400 +/- 500 g). Postnatal age ranged from 5 to 28 days (mean 15.2 +/- 8.7 days). Right heart ventricle angiography was performed in 24 cases, left heart ventricle angiography in 20 cases and pulmonary angiography in 6 cases. Balloon aortic septostomy (BAS) was performed in 10 cases. Twenty cases were diagnosed with complex cyanotic cardiovascular malformations and 4 with acyanotic heart disease. The implantation of a temporary cardiac pacemaker was performed in 2 cases. All diagnostic and interventional procedures were successfully performed. The catheterization-related complications occurred in 15.3% of the 26 cases, but without mortality. In conclusion, cardiac catheterization is an accurate and safe method for diagnosing complex congenital heart diseases in neonates. Interventional catheterization is useful in the treatment of complex congenital heart malformations.

Cardiac Catheterization↗

PubMed2006

Safety of percutaneous left heart catheterization directly performed by cardiology fellows: a cohort analysis.

BACKGROUND: No previous study has analyzed the possible responsibility of fellows-in-training in terms of the risk of complications during cardiac catheterization. Thus, we sought to identify possible risk factors for access site complications following cardiac catheterization procedures, with particular attention to the role of cardiology fellows. METHODS: A total of 1,288 left heart catheterization procedures (both diagnostic and interventional), performed over a 1-year period at a university hospital, were retrospectively evaluated to determine the incidence of local complications (pseudoaneurysm, arterio-venous fistula, major hematoma or bleeding, vascular dissection). Several clinical (age, gender, previous coronary artery bypass surgery, indication to the exam) and procedural (procedure performed by the fellow, access site, type of procedure, urgent setting, use of glycoprotein IIb/IIIa inhibitors, simultaneous right heart catheterization, use of closure devices) covariables were considered. Major adverse cardiovascular and cerebrovascular events (MACCE: death, myocardial infarction, cerebrovascular event) were also assessed. RESULTS: The overall access site complication rate was 2.6%. On multivariate regression analysis, the only two predictors of local complications were female gender (odds ratio [OR] 3.2, 95% confidence interval [CI] 1.6-6.5) and femoral approach (OR 3.9, 95% CI 1.2-12.1). The rate of MACCE was 1.2%, mainly after percutaneous coronary interventions, with only 1 death overall (0.07%). Procedures performed by cardiology fellows were not associated with an increased incidence of either complication. CONCLUSIONS: Cardiology fellows can safely perform cardiac catheterization procedures without an increase in the rate of local and major cardiovascular complications. Of course, the presence and watchful supervision of an attending physician is still essential to ensure both patient safety and optimal training.

Aged↗

PubMed1990

Effect of cardiac catheterization on renal function.

Sensitive acute renal clearance methodology was used to investigate the incidence of radiocontrast-induced nephrotoxicity in patients undergoing cardiac catheterization. Patients at the University of Oklahoma Teaching Hospitals scheduled for elective cardiac catheterization had their creatinine clearance measured on the day preceding and the day following their procedure. All patients had a serum creatinine concentration lower than 175 mumol/l. The creatinine clearance was calculated from the mean of four consecutive 30-minute renal clearance periods obtained in the fasted state during water loading. The change in renal function following the catheterization was evaluated. There was no significant change in the creatinine clearance after the cardiac catheterization (Ccr 101.5 +/- 6.4 ml/min before and 111.6 +/- 7.4 ml/min after the procedure). A decrease in Ccr exceeding 25% occurred in 1 of 23 subjects (4.3%. Patient age, presence of diabetes, and volume of contrast agent were not adverse risk factors. The results suggest a low risk of nephrotoxicity in low-risk patients undergoing elective cardiac catheterization, even when very sensitive measures of glomerular filtration rate are utilized.

Acute Kidney Injury↗

PubMed1990

Practical value of echo Doppler evaluation of aortic and mitral stenosis: a comparative study with cardiac catheterization.

This retrospective analysis compares data derived by echocardiography and cardiac catheterization in the evaluation of aortic and mitral valve stenosis. Sixty-seven patients, aged 69 +/- 12 years, underwent 76 catheterization procedures. In all studies the Doppler recording was technically adequate. In 64 studies of patients with aortic stenosis, correlation was good between the gradient obtained at catheterization (peak 51 +/- 28 mm Hg, mean 48 +/- 24 mm Hg) and the Doppler gradient (peak 73 +/- 29 mm Hg, mean 41 +/- 17 mm Hg) (R = 0.78 peak, 0.77 mean). In 15 studies the aortic valve area, 0.8 +/- 0.2 cm2, calculated by the simplified continuity equation, correlated well with the catheterization valve area, 0.7 +/- 0.3 cm2, calculated by the Gorlin equation (R = 0.80). In 14 studies in mitral stenosis patients, the mean gradient at catheterization was 11 +/- 5 mm Hg compared to the Doppler gradient of 8 +/- 4 mm Hg (R = 0.58). The mitral valve area was 1.1 +/- 0.3 cm2 by the Gorlin equation and 1.2 +/- 0.3 cm2 by echo Doppler, using pressure half-time. When cardiac rhythm, the presence and severity of regurgitation, and the cardiac index were analyzed, none was shown to have demonstrable influence on the accuracy of the Doppler study. Doppler echocardiography can be used reliably to assess valvular stenosis in a clinical, noninvasive laboratory where routine tests are performed and interpreted by more than one individual.

Aged↗

PubMed1990

Managing scarce services. A waiting list approach to cardiac catheterization.

Relatively little attention has been directed to the provision of health care services when demand exceeds availability. Since "waiting lists" are characteristic of the delivery of cardiovascular services in Manitoba, we hypothesized that the highest priority would be given to cases with the greatest urgency. This study examined the waiting lists for cardiac catheterization in one of two tertiary health care facilities offering comprehensive cardiovascular care to a population of slightly more than one million persons. Hospital records of all patients undergoing cardiac catheterization from May 1981 through December 1982 were abstracted retrospectively. For 871 patients entering a catheterization laboratory by two different routes (Elective Care, N = 557; Immediate Care, N = 314), patient need for immediate catheterization was assessed. Clinical differences between patients in the two groups were striking. Immediate Care patients more frequently had acute congestive heart failure, prior aortic valve surgery, and chronic obstructive pulmonary disease. Immediate Care patients were most frequently in Class 4 of the NYHA functional classification and were more often treated with triple medical therapy. These clinically ill individuals were more likely to enter the hospital via the Emergency Room; they were more likely to have long hospital stays and to die in hospital. As implemented in one Manitoba hospital, the waiting list process appears to have worked fairly well; cardiac arrest, acute myocardial infarction, and death among patients waiting for catheterization were all rare events. Both those patients needing immediate care and those who could wait with a low probability of a poor outcome were successfully identified.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

PubMedDate not supplied

[Evaluation of 1200 venous catheterizations in reanimation].

The authors present a series of 1247 venous catheterizations during resuscitation, the latter being carried out under particularly strict aseptic conditions. This series contains especially: - 364 internal jugular catheterizations; - 223 subclavian catheterizations; - 130 femoral catheterizations. The total number of days of infusion is 6300, of which 3,619 were of prolonged parenteral feeding. 79.5 p. 100 of the catheters cultured proved to be sterile; in the case of those cultures which were positive, 6.5 p. 100 were due to pathogenic organisms, 13.9 p. 100 were due to saprophytes. On the whole, 7 septicemies of venous origin (0.56 p. 100 of all of the catheterizations) were observed. The détailed study of each route shows that the frequency of cultures of pathogen positive catheters is practically the same in all cases. On the other hand, the frequency of cultures of catheters positive with saprophytes is evidently higher for the internal jugular vein; this being particularly true in the male where the role of the beard as a contaminating factor is evoked. The importance of asepsis in the procedure of putting venous catheters in place and in their maintenance seems to be welle demonstrated by the results presented.

Catheterization↗

PubMed1989

[Surgery of congenital cardiopathies without previous catheterization. Preoperative evaluation and surgical indication using bidimensional echocardiography and Doppler].

With the non-invasive devices available nowadays, many congenital heart diseases may be diagnosed with a definition comparable and even perhaps superior to catheterization and angiography. According to this issue, from January 1983 to December 1987, 239 children underwent operations for palliation or correction of different cardiopathies based on an echo-Doppler assessment without prior catheterization. Preoperative echo-Doppler diagnoses had an adequate correlation with the surgical findings in 234 cases (97.9 percent), so there was no correlation in 5 cases. In general, we consider that echo-Doppler provides a complete and definitive diagnosis in most cases, thus eliminating the need for further invasive procedures, although we still have to rely on catheterization to obtain the necessary information or reassurance in some cases. Progressive increase of reliance in echo-Doppler techniques by the surgeon and self confidence of the cardiologist in his accurate state of the art will considerably increase the performance of cardiac operations without prior catheterization in the future. At present, this is our current policy, as day after day, we are increasing the diagnoses in which we consider unnecessary the catheterization to indicate surgery.

Adolescent↗

PubMed1989

Psychologic preparation for cardiac catheterization.

Cardiac catheterization is an invasive medical procedure that is anxiety arousing for most patients. Four psychologic preparatory strategies designed to reduce anxiety and enhance adaptation were compared with an attention placebo control intervention. Sixty adult patients scheduled for cardiac catheterization were randomly assigned to one of five groups: sensory-procedural information, modeling, cognitive-behavioral coping skills, modeling plus coping skills, or attention placebo control. Subjects' reactions to cardiac catheterization were assessed by using self-report, behavioral, and physiologic measures. Results indicated that subjects in the modeling and modeling plus coping skills groups were rated as less anxious and better adjusted during the catheterization than control subjects. Compared with controls, subjects in the two modeling groups also reported less subjective anxiety and greater perceived coping ability during the catheterization. All subjects who received a preparatory treatment demonstrated lower levels of autonomic arousal both during and after the test than did control subjects. The results support the efficacy of preparatory strategies that include a patient model.

Adaptation, Psychological↗

PubMed1989

Cardiac catheterization in a freestanding setting.

Cardiac catheterization, originally performed only in hospital settings, is currently undertaken in hospital ambulatory and freestanding settings. Although use of the hospital ambulatory setting is accepted, questions have been raised about the safety and effectiveness of cardiac catheterization when performed in a freestanding setting. Critics have claimed that use of freestanding centers subjects patients to additional risk of complications without affording significant benefits. Proponents maintain that selected cardiac catheterization procedures can be performed in freestanding settings without exposing patients to increased risk. Available data on complication rates indicate that freestanding centers perform catheterizations with morbidity and mortality rates substantially lower than those reported in the literature for inpatient procedures. Although questions have been raised about the validity of these data, they suggest that cardiac catheterization can be performed in a freestanding setting with acceptable safety and effectiveness.

Ambulatory Care Facilities↗

PubMed1987

Beta-blockade in acute myocardial infarction: is Swan-Ganz catheterization required before treatment?

Beta-blockade is used increasingly in early acute myocardial infarction (AMI) but may cause congestive heart failure (CHF). It is not known whether Swan-Ganz catheterization is necessary before beta-blockade in AMI. We made a retrospective analysis of 213 patients who underwent Swan-Ganz catheterization within 24 hours of AMI and compared precatheter CHF signs (dyspnoea, lung crepitations and x-ray appearance) with initial pulmonary artery wedge pressure (PAWP). One hundred nine of these patients received beta-blockade after catheterization, 31 did not tolerate beta-blockade. Absence of clinical CHF signs predicted a normal PAWP (less than or equal to 18 mmHg) in 86% of patients (42 of 49) and considerable safety in giving beta-blockade. Beta-blockade had to be stopped because of PAWP increase (greater than 5 mmHg) in 25 of 74 patients with CHF signs vs. 3 of 35 patients without CHF signs (p less than 0.005), and in 9 of 15 patients with high PAWP vs. 19 of 91 patients with normal PAWP (p less than 0.01). Only 2/28 patients (7%) intolerant to beta-blockade had a high PAWP but no clinical CHF. In conclusion hemodynamic intolerance to beta-blockade could have been predicted clinically without prior Swan-Ganz catheterization in 25/28 patients. Patients with CHF signs require catheterization if beta-blockade therapy is to be considered.

Adrenergic beta-Antagonists↗

PubMed1988

The effect of early bladder catheterization on the incidence of urinary complications after total joint replacement.

A prospective, randomized study was performed in 54 female total arthroplasty patients to determine whether straight catheterization in the recovery room might reduce the incidence of postoperative urinary infection, urinary retention, and urinary catheterization. Thirty-one patients were straight catheterized in the recovery room; 23 were not. Overall, 13% of the patients developed a urinary tract infection postoperatively, 60% of the patients required at least one catheterization, and 13% of the patients required a Foley catheter. No beneficial effect of straight catheterization in the recovery room after arthroplasty was demonstrated.

Aged↗

PubMed1986

Utility and application of pulmonary artery catheterization in aortic and aortoiliac disease.

To determine how useful pulmonary artery catheterization is in abdominal aortic surgery and which patients are most likely to benefit from the procedure, the author studied 28 patients with aneurysms and 22 with obstructive disease. Patients with multiple risk factors, except those with leaking aneurysms, were assessed before operation by pulmonary artery catheterization and volume loading (15 ml of 5% albumin/kg over 12 hours). All patients who underwent operation were assessed and monitored by pulmonary artery catheterization, beginning immediately postoperatively. In 26 patients the procedure made a substantial contribution to assessment or care of their condition, not suggested by the usual clinical and technical modalities. In four patients the proposed surgery was affected; it was cancelled in one, delayed in two and replaced by a lesser procedure in one. Two other patients, thought to have unacceptable cardiac function, were considered suitable for operation after catheterization was done. Eleven patients with suboptimal cardiac index and 2 with volume overload were recognized early after surgery. Two patients with oliguria following repair of a ruptured aneurysm had optimal cardiac indices and renal perfusion assured by pulmonary artery catheterization, which helped to identify unsuspected pulmonary hypertension in three patients, bleeding in one and intestinal infarction in one. Twenty-seven patients were challenged before surgery with 5% albumin and their response was analyzed. In 7 there was no response to the colloid challenge and they suffered much more morbidity than the 20 patients who had a positive hemodynamic response to challenge.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1986

Brachial artery injury after cardiac catheterization.

During a 3-year period, 12,158 cardiac catheterizations were performed via the brachial artery. During this same period, 106 patients were operated on for complications of brachial artery injury and/or thrombosis, an incidence of 0.9%. The indication for the cardiac catheterization was coronary artery disease in almost 92% of the patients. Early (less than 4 days) brachial artery repair was done in 90% of the patients. The operative findings were thrombosis (91%), intimal injury (54%), stenosis (13%), laceration and/or perforation (11%), and atherosclerotic plaque (6%). Because of vessel injury, localized resection was done in two thirds of the patients. Vascular continuity was obtained with axial reanastomosis in 45 patients and interposition vein graft in 26 patients. Primary lateral repair was performed in 23 patients (22%). Ninety-five percent (101 patients) had initial excellent results. Of the five patients who required reoperation, flow was restored in four patients. Thus, 99% of patients had restoration of a patent brachial artery. Contributing factors for brachial artery complications are "redo" catheterization, prolonged catheterization time, catheter change, brachial artery atherosclerosis, improper arteriotomy closure, experience of cardiologist, female patient, and failure to use heparin. Because of the unpredictability of ischemic symptoms occurring after brachial artery thrombosis, the need for bypass graft surgery when delayed, and the good results with early surgical intervention, early exploration of brachial artery complications after cardiac catheterization and appropriate repair are recommended.

Adult↗