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The effect of head position and angle of tracheal bifurcation on bronchus catheterization in the intubated neonate.

The effect of head position and angle of tracheal bifurcation on bronchus catheterization was studied in newborn infants. Frequency of bronchus catheterization following appropriate head positioning was evaluated radiographically after passage of a No. 5 French feeding tube in eight intubated neonates within 30 minutes post mortem. Positioning the infants head to the right in preparation for a suctioning procedure may facilitate but not assure catheterization of the left main stem bronchus (LMSB). Positioning the infant's head straight or rotating to the left appears to be equally effective in catheterization of the right main stem bronchus (RMSB). The predominance of RMSB catheterization in infants with their head in the straight position may be explained by the different angles of mainstem bronchi divergence which we determined using radiographs. The angles of divergence of the LMSB and the RMSB from the trachea averaged 44.4 degrees and 24.1 degrees, respectively.

Asphyxia Neonatorum↗

[Transthoracic catheterization under monitoring by ultrasono-cardiotomography and its clinical usefulness].

When serious postoperative complications such as mechanical malfunction of the implanted valve occur in patients with multiple valvular replacements, it is very urgent to evaluate the function of the valve and heart and to establish an accurate diagnosis as to the damaged prosthetic valve, while giving intensive life-saving bed-side care. Under such circumstances, transvascular heart catheterization necessary for obtaining hemodynamic data or for angiocardiography can not be applied because it is almost impossible for a catheter to pass through a prosthetic valve without potential danger. Then, the present authors have introduced a method of cardiac catheterization by a direct transthoracic route during which cardiac structures are monitored by ultrasono-cardiotomography. This method is called "transthoracic catheterization monitored by ultrasono-cardiotomography," and was applied to cases of double (aortic and mitral) valve replacements. The immobile adhesive area in the vicinity the right ventricular wall is detected from the longitudinal or horizontal cross-section pictures, through which a polyethylene catheter with stylet was introduced from the subxiphoid region and was advanced toward the left ventricle. After introduction of the catheter into the right ventricle, the catheter tip was advanced to the midportion of the ventricular septum, which was selected to avoid the penetration of the tricuspid valve and coronary arteries. Then, the catheter was passed into the left ventricle on the ultrasonic scanning plane along the direction of the short axis of the heart. After placing the catheter into the left ventricle, a small amount of contrast material was injected to confirm the precise positioning of the catheter tip in the left ventricle. Thus, the hemodynamic measurement and angiocardiograpy were performed easily. By utilizing contrast cardiotomography, valvular function was evaluated easily without any side effects as in case of angiocardiography. Furthermore, ultrasono-cardiotomography was sensitive in detecting cardiac tamponade if appeared during direct heart catheterization, making immediate treatment possible. Thus, transthoracic catheterization monitored by ultrasono-cardiotomography was useful for the evaluation of the function of the prosthetic valve, especially in cases with double valve prostheses.

Adult↗

Reusable catheter for long-term sterile intermittent catheterization.

A new resterilizable, low cost, and convenient catheter for long-term sterile intermittent catheterization of the neurogenic bladder is described. Average self-catheterization time is 2 minutes. It can be performed successfully in a wheelchair. Estimated average cost per catheterization is 10 to 20 cents. The reduced cost and greater convenience of the Wu Reusable Catheter make sterile long-term intermittent catheterization feasible for spinal cord injured patients. This should lead to reduction of urologic morbidity encountered with indwelling and external catheterization.

Humans↗

Correlation of rates of coronary artery bypass surgery, angioplasty, and cardiac catheterization in 305 large communities for persons age 65 and older.

OBJECTIVE: The rate of coronary artery bypass surgery (CABG) has been shown to vary greatly across geographic regions. This study examined whether these rates were associated with the rate of coronary artery angioplasty (PTCA) and with other community characteristics. DATA SOURCES/STUDY SETTING: The health care financing administration provided the number of Medicare hospitalizations in 1988 for conditions and procedures related to coronary artery disease. Information on physicians and hospitals was obtained from the Area Resource File, and the number of persons in each age, sex, and race category was obtained from US. census data. STATISTICAL METHODS: Age-and sex-adjusted hospitalization rates based on the patient's zip code of residence were calculated at the level of the Metropolitan Statistical Area (MSA) for white patients age 65 or older. Rates were obtained for 305 MSAs for CABG, PTCA, cardiac catheterization, angina, and myocardial infarction. PRINCIPAL FINDINGS: The rate of cardiac catheterization had a correlation of .72 with the CABG rate and .64 with the PTCA rate. The correlation of the PTCA and CABG rates with each other was .49. This correlation was not charged by adjusting for the rates of hospitalization for angina or myocardial infection, but it was reduced to only .05 (ns) after adjusting for the rate of cardiac catheterization. The rates of all three procedures had rank correlations of about .15 with the density of thoracic surgeons and about .30 with the density of hospitals with cardiac catheterization and open heart surgery units. CONCLUSIONS: Community CABG and PTCA rates tend to move in the same direction due to community factors that also affect the rates of cardiac catheterization. These community factors do not appear to include the rate of coronary artery disease, but may include resources or attitudes toward aggressive treatment of coronary artery disease.

Aged↗

[Emergency catheterization in a coronary intensive care unit. The diagnostic and therapeutic implications].

OBJECTIVE: to evaluate the diagnostic and therapeutic role of emergency hemodynamic studies, in the coronary intensive care (UCI). STUDY DESIGN: Retrospective study of--patients (P) submitted to emergency catheterization. PATIENTS: 183 P (152 M and 31 F), mean age 56 +/- 11.5 years, admitted to UCI of Hospital Santa Marta and who had cardiac catheterization performed, between October 88 and November 92. METHODS: Patient clinical files were reviewed. We considered the reasons for emergency cardiac catheterization; final diagnosis; complications in the first 24 hours; catheterization role in the therapeutic orientation. RESULTS: Reasons for hemodynamic study were: coronary artery disease (CAD) in 127 P (69%); aortic dissection in 33 P (18%); valvular disease in 19 P (10%) and other in 4 P (3%). Clinical diagnosis was confirmed in 92% and changed in 8% by hemodynamic study results. Left main coronary artery disease was diagnosed in 6.5% of CAD patients. Coronary artery disease was excluded in 5 P with previous CAD diagnosis, in 19 P with aortic dissection and in 11 valvular patients. 32% of P were sent to emergent surgery: 93% ascending aortic dissection and 20% of CAD, 76% of valvular disease. The hemodynamic study was decisive in the therapeutic option of myocardial revascularization in 77% of P with CAD: 39 emergent PTCA (31%), 13 primary (33%) and 14 P oriented to elective PTCA (11%); 26 emergent surgery and 19 P oriented to elective surgery (15%). The emergency cardiac catheterization mortality rate was 0.5%, and the morbidity 2.7%. CONCLUSIONS: The contribution of Hemodynamic Department to UCI was decisive in the diagnostic and therapeutic orientation of critical patients.

Adult↗

Rates of cardiac catheterization, coronary angioplasty and coronary artery bypass surgery in Canada (1991).

OBJECTIVE: To determine the rates of and waiting lists for cardiac catheterization, percutaneous transluminal coronary angioplasty (PTCA) and open heart surgery among adults in Canada between January 1, 1991 and December 31, 1991. Furthermore, a comparison was made with a previous survey performed in 1988. DESIGN: Mail survey. Participants were the directors of all 46 adult cardiac catheterization laboratories and representatives from all 33 adult cardiovascular surgery programs in Canada. MAIN RESULTS: A total of 69,914 cardiac catheterizations was performed during this period, a rate of 256/100,000 population. The mean waiting times for elective procedures were weighted to allow for the differences between centres in the number of patients awaiting the procedures. The mean wait for elective cardiac catheterization was 8.5 weeks, precisely the same as it had been in 1988. There were 14,617 PTCA procedures performed, a rate of 54/100,000 population. This rate had increased from 39,100,000 in the previous survey. The mean wait for elective PTCA was 9.2 weeks. A total of 13,618 coronary artery bypass procedures were performed, a rate of 50/100,000 population. The mean wait for elective coronary artery bypass surgery was 213 weeks, with the longest wait occurring in Quebec at 34 weeks. CONCLUSION: Rates for cardiac catheterization increased by 8.5% between 1988 and 1991. The mean waiting time for this procedure did not change significantly across the country in this interval. The rate of PTCA increased by 38.5% during this same time interval. The rate of open heart procedures across the country increased by 20.6%. The waiting period for these specialized cardiac procedures remains excessive, particularly for open heart surgery.

Adult↗

Femoral arteriovenous fistula following cardiac catheterization: an anatomic explanation.

The exact etiology of femoral iatrogenic arteriovenous fistula (AVF) following cardiac catheterization is not known. The most common explanation is simultaneous placement of arterial and venous catheters for left and right heart catheterization. Using a strict protocol for groin examination before and after cardiac catheterization, seven patients were found to have a groin thrill and/or bruit as a result of AVF after catheterization in the period from July 1986 to December 1990; one patient had two fistulas, making a total of eight. During the same period, a total of 2609 cardiac catheterizations were performed using the Seldinger technique; the incidence of AVF after the procedure was thus 0.22%. Arteriography was used to confirm the presence of the fistulas and identify their exact location. All eight lesions originated below the bifurcation of the common femoral artery (CFA). Three originated at the superficial femoral artery (SFA) and five at the profunda femoris artery (PFA). In the patient with two fistulas, one originated at the SFA and one at the PFA. The veins involved were the superficial femoral (SFV) in two AVFs and the profunda femoris (PFV) or its lateral circumflex branch in six. The fact that all eight fistulas originated below the bifurcation of the CFA points to a possible anatomic explanation for the formation of iatrogenic AVF. The CFA and common femoral vein (CFV) are located side by side, which makes it difficult to puncture both with one stick. Below the bifurcation, the PFV crosses laterally behind the proximal SFA and then lies in a posterior location to the PFA.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

Delayed femoral nerve palsy following femoral vessel catheterization.

We report two cases with a delayed complication of femoral vessel catheterization: femoral nerve entrapment by iliacus hematoma. Both patients had femoral artery catheterization and postoprocedural anticoagulation, followed by iliacus hematoma eruption on the side of catheterization. Diagnosis was confirmed by computed tomography and electrodiagnostic studies. The pathogenesis of iliacus hematoma-induced femoral neuropathy has been studied in detail; however, the authors could find no previous reports of catheterization causing this phenomenon. The association is probably under reported because of the delayed manifestation. Awareness of this complication could (1) minimize the neuropathy, by insuring early diagnosis and treatment and (2) reduce its incidence, by avoiding trauma to the iliacus muscle during catheterization.

Abdominal Muscles↗

Fascial sling correction of kinked efferent limb in patients with continent diversion and catheterization difficulty.

PURPOSE: We determined the efficacy of using a rectus fascial sling to revise an angulated efferent limb in patients with continent urinary diversion and difficulty with intermittent catheterization. MATERIALS AND METHODS: Two spinal cord injured women who underwent modified Indiana pouch urinary diversion required revision of each efferent limb because of difficulty with catheterization. A strip section of anterior rectus sheath was harvested and used to fix the efferent limb in position, assuring freedom from angulation and facilitating catheterization. RESULTS: Both patients remained continent for more than 2 years postoperatively and neither had further difficulties with catheterization or required additional surgery. CONCLUSIONS: Use of the rectus fascial sling in continent urinary diversion enables fixation of the efferent limb to facilitate catheterization and enhance continence.

Adult↗

Pulmonary artery catheterization: a narrative and systematic critique of randomized controlled trials and recommendations for the future.

OBJECTIVE: The purpose of this review is to evaluate the current literature regarding the efficacy of pulmonary artery catheterization, to assess the quality of existing randomized controlled trials and to make recommendations for future studies. DATA SOURCE: A Medline search was conducted of English language studies published between 1970 and 1996 using as search terms "Swan-Ganz catheterization," "pulmonary artery catheterization," and "right heart catheterization." STUDY SELECTION: Randomized controlled trials of pulmonary artery catheterization were selected for review. Sixteen randomized controlled trials were identified. DATA EXTRACTION: The quality of the randomized controlled trials was assessed and a formal meta-analysis was performed. DATA SYNTHESIS: The overall quality score was 40.15 +/- 6.32 out of a possible score of 100. Serious deficiencies were identified including a lack of a priori sample size calculations, unclear definitions of concomitant therapy, inability to blind physicians and patients, and lack of blinded outcome assessments. A random effects model found the relative risk ratio of .808 (95% confidence interval [CI] = .598, 1.091; p = .148). An analysis of potential covariates revealed patients from surgical series treated with pulmonary artery catheter (PAC)-guided therapy had a relative risk ratio of .578 (95% CI = .357, .937; p = .03) compared with control groups. Patients from medical or mixed unit series had a relative risk of 1.043 (95% CI = .784, 1.387; p = NS). CONCLUSION: Existing randomized controlled trials on PAC-guided strategies reveal a modest risk reduction that does reach statistical significance. Risk reduction appears to be greatest in surgical series. Deficiencies of these trials have important implications for the proper design of future trials.

Catheterization, Swan-Ganz↗

Noninvasive assessment of valvular heart disease: surgery without catheterization.

Forty-one patients underwent valve surgery at our institution based solely on clinical, M-mode echocardiographic, phonocardiographic, and external pulse recording findings without preoperative cardiac catheterization. Patients with clinical evidence of coronary artery disease were excluded from the study. Preoperatively, 83% of the patients were New York Heart Association functional class III or IV. In all patients, the noninvasive evaluation was considered sufficiently diagnostic of the nature and severity of valvular heart disease to allow surgery without preoperative catheterization. In 23 of 41 cases (group 1), cardiac catheterization was not performed due to the patients' unstable hemodynamic condition at the time surgery was being considered. In the remaining 18 patients (group 2), the probability of obtaining data at catheterization that would significantly affect management decisions was thought to be low, thus not justifying the cost and potential morbidity of this procedure. In all cases, the noninvasive diagnosis was corroborated at operation; there were no unexpected findings nor deaths related to incomplete or incorrect diagnoses. Over a followup period of 4.5 +/- 1.4 years, no patient experienced signs or symptoms of ischemic heart disease. In selected patients without anginal chest pain syndromes, appropriate and successful valve surgery may be performed on the basis of combined clinical and noninvasive evaluation without the need for cardiac catheterization.

Adolescent↗

Is cardiology consultation required before cardiac catheterization?

Background: In many hospitals, internists have begun to directly refer patients for cardiac catheterization without a prior cardiology consultation. The purpose of this study is to compare the results of a policy of mandatory consultation prior to catheterization with one of optional consultation. Methods: One hundred seventy-five consecutive patients who underwent catheterization with a prior cardiology consultation (closed group) were compared to 175 patients who underwent the procedure without a prior mandatory consultation (open group). The primary outcomes were defined as whether significant coronary disease was found and what therapy the patient received. Results: There was no difference in the percentage of patients who were found to have coronary disease in each group (72% in the closed group and 77% in the open group, P=NS), and there was also no difference in the percentage of patients who received revascularization therapy (43% in the closed group and 44% in the open group, P=NS). Conclusions: Allowing internists to refer patients directly for catheterization resulted in equivalent results as compared to requiring cardiology consultation. This study supports the policy of allowing direct referral for catheterization, but further studies are needed to compare the outcomes of cardiac patients cared for by hospitalists without cardiology consultation.

Journal Article↗

Reproducibility of the drug effects over time on chronic lumbar epidural catheterization in rats.

UNLABELLED: Chronically implanted epidural catheters lead to a reaction that impedes drug action. The purpose of this study in a rat model with chronically implanted epidural catheters was to investigate the change in opiate activity and histology over time with this model. A skin incision of 1-2 cm was made at the T 13 level on the back of male Sprague-Dawley rats under halothane anesthesia. Muscles were dissected bluntly from the vertebrae, and the intervertebral ligament was cut to insert an epidural catheter (polyethylene tube, outer diameter of 0.14 mm) 2-cm caudally. The longer portion of the catheter was passed through a trocar subcutaneously to exit the dorsal neck area. One, two, and six days after catheterization, the effects of morphine on thermal stimulation using the hot-box test and histology were investigated. Analgesic effects of morphine 6 days after catheterization were significantly less than those on the first and second days. Histologically, evidence of inflammation around the catheter was noted as early as 4 h after catheterization. Pericatheter fibrosis was severe after 2 days. We conclude that this model of chronic epidural catheterization in the rat evoked a histologically defined, pharmacodynamically significant, local reaction 2 to 6 days after catheter implantation. IMPLICATIONS: A rat model with chronically implanted epidural catheters should be used for testing the analgesic effects of drugs within two days after catheterization.

Analgesia, Epidural↗

Incidence of neurologic complications related to thoracic epidural catheterization.

BACKGROUND: Due to potential neurologic sequelae, the risk:benefit ratio of thoracic epidural analgesia is controversial. Surprisingly, however, few available data address neurologic complications. The incidence of neurologic complications occurring after thoracic epidural catheterization was studied in patients scheduled for abdominal or abdominothoracic surgery. METHODS: A total of 4,185 patients were studied, including 2,059 during the prospective phase of the study and 2,126 during the retrospective phase. After thoracic epidural catheterization, all patients received general anesthesia. Patients' neurologic status was assessed by an anesthesiologist using clinical criteria after operation and after epidural catheter removal. If neurologic complications were suspected, a neurologist was consulted. The incidence of specific complications was compared for different thoracic puncture sites: upper (T3/4-6/7), mid (T7/8-8/9), and lower (T9/10-11/12) catheter insertion levels. RESULTS: The overall incidence of complications after thoracic epidural catheterization was 3.1% (n = 128). This included dural perforation (0.7%; n = 30); unsuccessful catheter placement (1.1%; n = 45); postoperative radicular type pain (0.2%; n = 9), responsive to catheter withdrawal in all cases; and peripheral nerve lesions (0.6%; n = 24), 0.3% (n = 14) of which were peroneal nerve palsies probably related to surgical positioning or other transient peripheral nerve lesions (0.2%; n = 10). No signs suggesting epidural hematoma were recognized, and there were no permanent sensory or motor defects attributable to epidural catheterization. Unintentional dural perforation was observed significantly more often in the lower (3.4%) than in the mid (0.9%), or upper (0.4%) thoracic region. A single patient experienced severe respiratory depression after receiving epidural buprenorphine but recovered without sequelae. CONCLUSIONS: Thoracic epidural catheterization for abdominal and thoracoabdominal surgery is not associated with a high incidence of serious neurologic complications. In fact, the incidence of puncture- and catheter-related complications is less in the mid and upper than in lower thoracic region, and the predicted maximum risk for permanent neurologic complications (upper bound of the 95% confidence interval) is 0.07%.

Analgesia, Epidural↗

Reducing radiocontrast use in the cardiac catheterization laboratory--a behavioral modification approach.

OBJECTIVES: This study assessed the impact of behavioral modification techniques on reducing the volume of contrast dye used during cardiac catheterization and percutaneous coronary intervention (PCI). BACKGROUND: Excessive administration of radiocontrast agents in the catheterization laboratory is associated with numerous adverse effects including radiocontrast nephropathy. This may be precipitated by using large volumes of contrast dye, particularly in diabetic patients and those with pre-existing renal dysfunction. METHODS: Data were prospectively collected on 20,322 consecutive patients undergoing cardiac catheterization and PCI between January 1997 and December 2001. A focused behavioral modification program was initiated in late 1998. The physician was informed verbally during the course of the procedure and by letter after the procedure regarding the volume of contrast dye used for cases in which the radiocontrast volume exceeded 300 mL. Data were analyzed using the Fischer's exact test. RESULTS: In the prefeedback years (1997 and 1998), high contrast use occurred in 7.7% (n = 602) of the total cases (n = 7799). In the postfeedback years (1999, 2000, and 2001), this declined to 3.6% (n = 445) of the total cases (n = 12,523), representing a 53% reduction (P < .001). The effect was most pronounced in PCI, with the percentage of high contrast cases decreasing from 24% (n = 563) of the total PCI cases (n = 2348) to 10.6% (n = 359) of the total PCI cases (n = 3386), representing a 56% reduction (P < .001). CONCLUSIONS: Our study demonstrates the effectiveness of behavioral modification and the contribution it can make in reducing the volume of contrast dye used in the cardiac catheterization laboratory, particularly in PCI. Adoption of such strategies may enhance patient safety and reduce contribution it can make in reducing the volume of contrast dye used in the cardiac catheterization laboratory, particularly in PCI. Adoption of such strategies may enhance patient safety and reduce costs.

Angioplasty, Balloon, Coronary↗

Complications of central venous catheterization in critically ill children.

OBJECTIVE: Analysis of central venous catheterization complications in different access sites with the Seldinger technique. Patients and Methods: A prospective study (May 1992 through December 1996) of 308 central venous catheterizations in children of different ages in a pediatric intensive care unit. RESULTS: Access sites were the subclavian vein (76.3%), femoral vein (20.4%), and jugular vein (3.2%). The frequency of catheter placement-related complications was 22%, and the frequency of serious catheter placement-related complications was 2.9% (pneumothorax 1.9%, hemothorax 1%). Catheter placement-related complications were more common in the subclavian than in the femoral vein (chi-square, p =.02) for the larger bore catheters (chi-square, p =.01) and for the higher number of attempts (Student's t -test, p <.001). Catheter placement-related complications were not related to the age, weight, or whether the procedure was performed by the staff physician or resident. The overall complication rate for maintenance-related complications was 36%. Maintenance-related complications were more common in younger children (Student's t -test, p =.03). The most frequent maintenance-related complications were mechanical complications (catheter obstruction and central venous thrombosis), and these were higher for femoral access (chi-square, p <.01) and for catheters indwelling for a longer period of time. Infection was found in 5.8% of patients, mainly due to Staphylococcus epidermidis. Infection was not related to the site of venous access or to the length of time the catheter was left indwelling. CONCLUSIONS: Central venous catheterization can be performed readily in children of all ages with an acceptable degree of risk. The immediate complications were more frequent and severe for subclavian vein catheterization, and the highest risk factor was the number of attempts at catheter insertion. Although the most frequent late complications were mechanical, which were higher for the femoral access and long-indwelling catheters, femoral catheters can be left indwelling for longer periods if routine ultrasound follow-up is performed. Infectious complications were independent of the venous access site or the duration of catheterization.

Journal Article↗

Material thrombogenicity in central venous catheterization. I. A comparison between uncoated and heparin-coated, long antebrachial, polyethylene catheters.

In order to evaluate a new method of heparinization, uncoated (22) and heparin-coated (27) central venous polyethylene catheters were inserted in 49 patients via basilic and cephalic veins punctured at the fossa cubiti. The means duration of catheterization was 5.7 (1-11) days. One-third of the patients with heparin-coated catheters, and one sixth with uncoated catheters developed clinical thrombophlebitis, with a maximum incidence between 4 and 8 days after catheterization. A higher risk of developing thrombophlebitis in the first 4 days after catheterization was found in the patients with heparin-coated polyethylene catheters. After 8 days of catheterization, it seems that there is a lower risk of new cases of thrombophlebitis appearing both in patients with uncoated and those with heparin-coated polyethylene catheters. Radiological thrombosis, regardless of duration of catheterization and heparin-coating, was demonstrated in all 22 patients investigated by "pull-out" phlebography. The heparin-coating did not decrease the rate of thrombotic complications. Location of the catheter tip in subclavian veins was associated with a significantly higher incidence of large, parietal thrombi and catheter occlusion than when the tip was situated in anonymous veins, the superior vena cava, or the right atrium. Cannulation by heparin-coated, polyethylene tubing did not reduce the rate of catheter occlusion.

Adolescent↗

Safety of percutaneous internal jugular catheterization in cancer patients: prospective observational study.

PURPOSE: To determine predictors for failure and early complications of percutaneous internal jugular catheterization (IJC) in cancer patients. METHODS: Six hundred and thirty consecutive cancer patients who required central venous catheterization were included in a prospective observational study. The rates of failure (defined as the intervention of a second physician and/or failure at initial insertion site) and of early complications were prospectively ascertained. Logistic regression analysis estimated odds ratio (OR) and 95% confidence intervals (95% CI) for independent predictors for failure and early complications of percutaneous IJC. RESULTS: The failure rate was 6.7%, and the early complication rate was 6.7%. In multivariate analysis, left-side initial catheterization (p<0.01), prior catheterization at the same site (p=0.001) and physician inexperience (p<0.0001) were independently associated with failure. Placement requiring more than one needle pass (p<0.01 for two and p<0.0001 for three and more) and absence of fluoroscopy (p<0.0001) were independently associated with early complications. CONCLUSIONS: Percutaneous IJC is a valid option in the central venous catheterization of cancer patients due to its reliability and safety. Skilled physicians must manage difficult placements. If placement requires more than one needle pass or is made without fluoroscopy, patients must be carefully followed for potential complications.

Journal Article↗