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At least 595 records · Page 33Linked to original sources

PubMed1983

Fate of patients started on clean intermittent self-catheterization therapy 10 years ago.

We evaluated 60 patients placed on a clean intermittent catheterization program more than 10 years ago to determine their outcome. To date 27 patients still are performing self-catheterization, 18 have discontinued the procedure and 15 have been lost to followup. No patient has had deterioration in renal function. Prior incontinence was alleviated completely in 10 of the 27 patients still on the program and 10 of the 18 patients no longer on catheterization have returned to normal voiding. Clean intermittent catheterization is an effective treatment modality in properly selected patients, with few complications and excellent long-term results.

Adolescent↗

PubMed1981

Conversion to intermittent self-catheterization simplified.

Patients with indwelling catheters often resist conversion to intermittent self-catheterization because they fear urine leakage between catheterizations. We have taught our male patients to catheterize themselves through the lumen of an external condom catheter, which they wear until they achieve continence and feel safe with the new method. We herein report on the effectiveness of this approach to conversion to self-catheterization.

Humans↗

PubMed1981

Compatibility of genitourinary prostheses and intermittent self-catheterization.

The compatibility of genitourinary prostheses and intermittent self-catheterization was established in 13 prosthetic recipients who were concomitantly on intermittent self-catheterization for bladder emptying dysfunction. All patients were able to catheterize themselves successfully after implantation of the prosthesis. No prosthetic infection was encountered in our series. Two penile prosthetic recipients suffered unilateral epididymitis that was treated successfully. Although mechanical complications were encountered they were repaired readily and were not considered related to self-catheterization.

Adult↗

PubMed1980

Non-sterile intermittent catheterization with antibiotic prophylaxis in the acute spinal cord injured male patient.

The efficacy of antibiotic prophylaxis by the oral and intravesical routes was studied in acute spinal cord injury patients maintained on a non-sterile intermittent catheterization program. There were 25 male patients investigated and monitored with daily urine cultures. Significant bacteriuria occurred at a rate of 0.83 per cent. This infection rate was greater than that determined previously using a sterile catheterization technique (0.28 per cent), p less than 0.05). Control patients catheterized with a sterile technique and no antibiotic prophylaxis had an infection rate of 0.96 per cent. Establishment of significant bacteriuria was more prominent when patients were catheterized every 8 hours as opposed to every 4 hours. Despite antibiotic prophylaxis the non-sterile procedure results in unacceptable rates of significant bacteriuria. The sterile technique may be preferred in the acute spinal cord center.

Anti-Bacterial Agents↗

PubMed1976

Experience with non-sterile intermittent self-catheterization.

Although a patient subjected to intermittent self-catheterization must carry a catheter and catheterize himself under a non-sterile technique at regular intervals this method is considered the best one available for patients who lead an active social life. When family cooperation is available intermittent catheterization is a cleaner procedure, causes less complications and is easier to manage for a patient confined to bed than the indwelling catheter, cystostomy or other urinary diversion procedures. The technique is also useful for patients with spinal cord injuries, promoting the early return of bladder activity and a life free of the catheter. It is an ideal method for children with meningomyelocele, after the upper tract has been maintained carefully by an indwelling catheter or cystostomy until the child is able to catheterize himself. In these cases a small capacity bladder may be enlarged using the colon and urinary incontinence may be corrected by other operative procedures. We have treated 26 patients with this technique, including 1 with a 17-year followup. The upper urinary tract has not deteriorated in any case and the urine has remained sterile in 39 per cent of the cases.

Adolescent↗

PubMed1998

Echocardiography in the invasive laboratory: utility of two-dimensional echocardiography in performing transseptal catheterization.

OBJECTIVE: To evaluate the potential utility of transthoracic two-dimensional echocardiography as an aid in the technique of transseptal catheterization. DESIGN: We performed a prospective study of 58 patients (29 men and 29 women; mean age, 64.2 years) referred for cardiac catheterization, in whom a systematic approach was used with selective application of two-dimensional echocardiography. MATERIAL AND METHODS: The study group of 58 patients had the following diagnoses: mitral stenosis in 17, hypertrophic cardiomyopathy in 13, dilated cardiomyopathy in 13, aortic stenosis in 13, and prosthetic valve dysfunction and pulmonary hypertension in 1 each. With use of only fluoroscopic guidance, initial gentle pressure on the dilator alone was attempted for left atrial access. If the catheter resisted entry into the left atrium, two-dimensional echocardiography was performed to assess the catheter's position relative to the atrial septum, and adjustments were made accordingly. Transseptal puncture with a Brockenbrough needle was performed only after confirmation of the catheter position at the region of the fossa ovalis with two-dimensional echocardiography. RESULTS: The catheterization procedure was performed without complication in all 58 patients; the mean time to catheter placement was 5.6 +/- 3.5 minutes (range, 3 to 20). Two-dimensional echocardiography was used in 33 patients (57%) when left atrial access was not obtained. On the basis of echocardiographic images, the transseptal catheter had to be repositioned in 16 of these 33 patients (48%). CONCLUSION: Two-dimensional echocardiography offers value in demonstrating catheter position during transseptal catheterization and may be used in some patients to ensure transseptal puncture at the region of the fossa ovalis.

Adult↗

PubMed2001

Increased blood flow after catheterization and drainage in the chronically obstructed rabbit urinary bladder.

OBJECTIVES: To determine the effect of drainage on rabbit bladder blood flow after 4 weeks of partial outlet obstruction. Previous studies have shown that catheterization and drainage of the urinary bladder in control rabbits resulted in a significant nitric oxide-induced increase of blood flow to the bladder. It was also shown that 4 weeks' partial outlet obstruction caused a significant decrease in blood flow to the bladder. METHODS: Male New Zealand White rabbits underwent partial outlet obstruction by standard methods. After 4 weeks, the blood flow to the bladder muscle and mucosa was determined by a microsphere technique. Within 1 to 2 minutes after transurethral catheterization and complete drainage of the bladder, the blood flow was again determined. Unobstructed animals served as controls. Four other control animals underwent a repetitive blood flow study during 10 minutes to determine the time frame of blood flow changes after drainage. Blood flow was also measured in 2 control rabbits after transurethral catheterization without drainage and in 2 control rabbits after drainage by suprapubic puncture. To exclude the possibility that increased intravesical pressure alters the blood flow measurements, the relationship between the intravesical volume and the bladder pressure was examined in the obstructed rabbits. RESULTS: After drainage of the bladder, the blood flow to the bladder muscle increased 4.5-fold in the decompensated obstructed group (bladder weights greater than 15 g) and 2.5-fold in the compensated animals (bladder weights less than 5 g) and control animals. Blood flow to the mucosa followed the same pattern but without reaching significance. Blood flow returned to near baseline values within 5 minutes. Catheterization without drainage did not alter the blood flow. In contrast, drainage by puncture increased the blood flow significantly. Higher intravesical volumes increased the intravesical pressure slightly, but after opening the abdominal fascia, the intravesical pressure did not change with increasing volumes. CONCLUSIONS: Although the previously shown decreased blood flow to the bladder smooth muscle may be an etiologic factor in bladder contractile dysfunction secondary to partial outlet obstruction, the bladder does have the ability to increase the blood flow after drainage. This ability could be a compensatory and possibly protective mechanism after outlet obstruction.

Animals↗

PubMed2004

Contemporary outcome of cardiac catheterizations in 1085 consecutive octogenarians.

BACKGROUND: A growing number of patients > or = 80 years require cardiac catheterization. Since little is known about the overall safety of these procedures in this population, we assessed the procedure-related risks and determined predictors for complications. METHODS: We studied 1085 consecutive patients > or = 80 years (82.6+/-2.6 years; 526 males, 544 females), who underwent 1384 cardiac catheterizations in a tertiary specialist university hospital (3% of 43,517 procedures). RESULTS: A total of 373 patients (35%) required percutaneous coronary interventions (PCI), and 331 (31%) received coronary artery bypass surgery. Thirty-one patients died during hospital stay. Procedure-related complications including vascular injuries occurred in 2.1% after CATH and 11.6% after PCI. CONCLUSIONS: Despite the widespread notion that cardiac catheterization exposes patients > or = 80 years to an unwarranted risk, these data demonstrate an acceptable complication rate. Patients #10878;80 years of age should thus not be refused to undergo cardiac catheterization merely based on their age.

Aged↗

PubMed2003

Prevalence of urinary catheterization in UK nursing homes.

A postal questionnaire survey was undertaken in registered nursing homes in three different health districts in England: Gloucestershire, North Staffordshire and Leeds. Nursing homes may be registered as general nursing or mental health homes. If homes also have provision for residential beds these are defined as dual registered homes. Overall, 9% (438/4900) of residents, with an equal male:female split, had urinary catheters. There was no significant difference in the overall urinary catheterization rate in the three districts (P=0.9). There was a wide range of urinary catheterization prevalence between homes, with some homes of all three categories having no catheterized residents and several with a prevalence of over 40%. The wide range of prevalence may be due to differences in residents' underlying medical conditions or to differences in attitudes towards urinary catheterization by nursing home staff. Almost all homes (114/124, 92%) stated they had an infection control policy, but 31% (38/124) did not have a written policy on urinary catheter care. In view of the potential for morbidity, infection control policies should include a section on the care of urinary catheters and this should form part of the continuing training of nursing home staff.

Aged↗

PubMed2001

[Early deambulation following cardiac catheterization by the use of 6 Fr Angio-Seal, a new hemostatic percutaneous puncture closure device].

INTRODUCTION AND OBJECTIVES: Efficacy of the hemostatic puncture closure 8 Fr Angio-Seal device for percutaneous puncture closure after a catheterism has been previously demonstrated, but the experience provided has been obtained with 8 Fr devices. At present the device has been modified and its size reduced to 6 Fr. In this pilot study we evaluate the efficacy of the new hemostatic 6 Fr Angio-Seal device and its safety when early deambulation post-diagnostic and/or therapeutic catheterization is established. PATIENTS AND METHODS: Prospective study of 150 consecutive patients randomized either for application of the 6 Fr Angio-Seal device (group A; n = 75), in which early ambulation was indicated, or manual compression (group B; n = 75), with ambulation 12 h after cardiac catheterization. Basal data, including clinical and angiographic characteristics and previous treatment with heparin and platelet aggregation inhibitors were similar in both groups. RESULTS: The time of hemostasia was significantly shorter in group A than in group B (118 +/- 210 s in A vs 1320 +/- 370 s in B; p (3/4) 0,001), and with early ambulation (3,1 +/- 0,4 h in A vs 12,3 +/- 3,1 h in B; p (3/4) 0,001) no local complications were observed. CONCLUSIONS: The 6 Fr Angio-Seal hemostatic device diminished the hemostasia time and early ambulation could be achieved. In this pilot study no complications due to early movilization were observed, but the safety of the new hemostatic device after diagnostic or therapeutic catheterizations needs to be evaluated in greater series.

Absorbable Implants↗

PubMed2003

The incidence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization: a prospective study.

BACKGROUND: Cholesterol embolization syndrome is a systemic disease caused by distal showering of cholesterol crystals after angiography, major vessel surgery, or thrombolysis. METHODS: We prospectively evaluated a total of 1,786 consecutive patients 40 years of age and older, who underwent left-heart catheterization at 11 participating hospitals. The diagnosis of CES was made when patients had peripheral cutaneous involvement (livedo reticularis, blue toe syndrome, and digital gangrene) or renal dysfunction. RESULTS: Twenty-five patients (1.4%) were diagnosed as having CES. Twelve patients (48%) had cutaneous signs, and 16 patients (64%) had renal insufficiency. Eosinophil counts were significantly higher in CES patients than in non-CES patients before and after cardiac catheterization. The in-hospital mortality rate was 16.0% (4 patients), which was significantly higher than that without CES (0.5%, p < 0.01). All four patients with CES who died after cardiac catheterization had progressive renal dysfunction. The incidence of CES increased in patients with atherosclerotic disease, hypertension, a history of smoking, and the elevation of baseline plasma C-reactive protein (CRP) by univariate analysis. The femoral approach did not increase the incidence, suggesting a possibility that the ascending aorta may be a potential embolic source. As an independent predictor of CES, multivariate regression analysis identified only the elevation of pre-procedural CRP levels (odds ratio 4.6, P = 0.01). CONCLUSIONS: Cholesterol embolization syndrome is a relatively rare but serious complication after cardiac catheterization. Elevated plasma levels of pre-procedural CRP are associated with subsequent CES in patients who undergo vascular procedures.

Acute Kidney Injury↗

PubMed1985

Correlation of continuous wave Doppler velocities with cardiac catheterization gradients: an experimental model of aortic stenosis.

The purpose of this study was to use a canine preparation of experimental aortic stenosis to compare estimates of pressure gradient derived from continuous wave Doppler ultrasound with gradients measured directly by catheterization. Aortic stenosis was created in six mongrel dogs by placing an elastic band around the aorta. Eighty-eight different pressure gradients, ranging from 5 to 160 mm Hg, were produced by variable tightening of the aortic band. Pressure gradients were measured by micromanometer-tipped catheters placed in the left ventricle and aorta. Doppler spectral signals were simultaneously obtained using a 2.0 MHz nonimaging transducer placed directly on the surface of the ascending aorta. Doppler and pressure recordings were analyzed using a custom-designed software program to measure maximal instantaneous, mean and peak to peak gradients, as well as ejection and acceleration times. Maximal instantaneous Doppler gradient showed an excellent linear correlation with maximal instantaneous catheterization gradient (r = 0.98, SEE = 5.3 mm Hg). The correlation of Doppler-estimated maximal gradient to peak to peak catheterization gradient was also linear (r = 0.97, SEE = 6.2 mm Hg) but resulted in a systematic overestimation of pressure drop (mean overestimation = 9.0 mm Hg). Measurement of the Doppler gradient at mid-systole resulted in a more accurate correlation with the peak to peak catheterization gradient (r = 0.98, SEE = 6.1 mm Hg) and eliminated the problem of overestimation.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1985

Surgical repair of uncomplicated atrial septal defect without "routine" preoperative cardiac catheterization.

Whether all patients with atrial septal defect should undergo cardiac catheterization before surgical correction is controversial. Of 152 patients of all ages with surgically documented isolated atrial septal defect (ostium secundum, ostium primum and sinus venosus types) who underwent preoperative two-dimensional echocardiography between January 1978 and December 1983, there were 55 (36%) (group 1) who did not have preoperative cardiac catheterization. These 55 patients are compared with the 97 patients (64%) who did have preoperative catheterization studies (group 2). Group 1 patients were younger (mean age 22 versus 36 years) and did not have clinical evidence of other associated cardiac disorders. Forty-four (80%) of the group 1 patients had typical findings for atrial septal defect on cardiac examination, chest radiograph and electrocardiogram compared with 16 (16%) of group 2 patients (p less than 0.001). The most frequent reasons for cardiac catheterization in group 2 patients were documentation of diagnosis, usually because of atypical clinical findings, and exclusion of associated cardiac abnormalities. Contrast echocardiography, radionuclide shunt studies and Doppler echocardiography were used as additional confirmatory tests in 36 patients (65%). In 19 patients (35%), two-dimensional echocardiography was the only confirmatory test. There were no false positive two-dimensional echocardiographic studies. There were no operative deaths or significant perioperative complications in any of the patients. At a mean follow-up of 28 months (range 6 to 64), there was one late death (3 1/2 years postoperatively) in a 61 year old man with chronic congestive heart failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1997

Coronary revascularization and cardiac catheterization in the United States: trends in racial differences.

OBJECTIVES: We sought to determine whether racial differences in rates of coronary artery bypass graft surgery (CABG), percutaneous transluminal coronary angioplasty (PTCA) and cardiac catheterization decreased after 1980. BACKGROUND: Many reports of racial differences in utilization of CABG have been published since 1982. However, changes in the relative utilization of revascularization over time have received little attention. METHODS: Data from the National Hospital Discharge Survey were examined for the years 1980 through 1993. Estimated numbers of procedures performed in nonfederal U.S. hospitals were used to compute age-adjusted rates per 100,000 population by year and race for patients 35 to 84 years old. RESULTS: In patients 35 to 84 years old, the rate of CABG increased in blacks and whites between 1980 and 1993. Between 1986 and 1993, there was little change in the black/white ratio of age-adjusted rates (0.23 in 1980 through 1985 combined, 0.38 in 1986 and 0.43 in 1993). An apparent increase from 0.23 in 1980 through 1985 combined may have been due to sampling variation. Despite rapid increases in rates of PTCA in both races, no increase in the black/white ratio was noted (0.57 in 1993). However, the rate of inpatient cardiac catheterization increased more rapidly in blacks than in whites. This resulted in an increase in the black/white ratio of age-adjusted rates from 0.42 in 1980 to 0.91 in 1993. CONCLUSIONS: Rates of CABG, cardiac catheterization and especially PTCA increased between 1980 and 1993, a period during which racial disparities in the procedures became widely known. Despite apparent increases in the black/white ratio for inpatient cardiac catheterization, large racial disparities in the utilization of CABG and PTCA persist and require further evaluation and possible intervention.

Adult↗

PubMed1998

Complications associated with pediatric cardiac catheterization.

OBJECTIVES: The aim of this study was to determine the relative risks of pediatric diagnostic, interventional and electrophysiologic catheterizations. BACKGROUND: The role of the pediatric catheterization laboratory has evolved in the last decade as a therapeutic modality, although remaining an important tool for anatomic and hemodynamic diagnosis. METHODS: A study of 4,952 consecutive pediatric catheterization procedures was undertaken. RESULTS: Patient ages ranged from 1 day to 20 years (median 2.9 years). One or more complications occurred in 436 studies (8.8%) and were classified as major in 102 and minor in 458, with vascular complications (n=189; 3.8% of procedures) the most common adverse event. Arrhythmic complications (n=24) were the most common major complication. Death occurred in seven cases (0.14%) as a direct complication of the procedure and was more common in infants (n=5). Independent risk factors for complications included a young patient age and undergoing an interventional procedure. CONCLUSIONS: Complications continue to be associated with pediatric cardiac catheterization. Efforts should be directed to improving equipment for flexibility and size, and finding alternative methods for vascular access. Patient age and interventional studies are risk factors for morbidity and mortality.

Adolescent↗

PubMed1983

[Catheterization of the axillary vein in intensive care. Analysis of a series of 151 cases].

In order to lower the risks of infection and other complications during prolonged venous catheterization, percutaneous axillary venepuncture is advocated as an access route to the superior vena cava. This study relates the results of 151 attempts. Most of the patients were tracheostomized and under controlled ventilation. Catheterization was successful in 79% of the cases (119 cases). In 92 cases access to the superior vena cava was sought and in 27 cases the pulmonary artery. No major complication was observed. Bacterial contamination of the catheter tip was found in 21% of cases. Percutaneous catheterization of the axillary vein appeared to be a safe and reliable technique, especially for prolonged catheterization in high risk patients.

Adolescent↗

PubMed1989

[Tolerance of femoral vein catheterization].

The femoral vein is a convenient venous access site which has remained relatively neglected since earlier reports of major complications. However, over the last 10 years, its beneficial use for various purposes (mainly haemodialysis) justifies a reexamination of the value of femoral venous catheterization. The ease of femoral catheterization and its complications were prospectively studied in 92 intensive care patients. Of the 113 attempts made by physicians, 75% of whom were inexperienced, 103 (91.2%) were successful. Insertion resulted in 17 (15%) arterial punctures and 5 local hematomas. Seventy catheters were left in place for an average of 8.8 days. No clinical manifestations of thrombosis were observed. Bilateral phlebography was carried out before removal of the catheter in 70 cases; 45 (64%) of these controls were normal. Of the remaining 25 pathological phlebograms, there were 11 (15.7%) fibrin sleeves, 2 (2.8%) partial thromboses of the common femoral vein which could be directly linked to the venous cannulation, and various abnormalities not directly due to the catheterization (superficial femoral vein thrombosis (4), thrombosis of calf or popliteal veins (18]. One case of catheter septicaemia occurred. Microorganisms were present in 15 (18.3%) of 82 catheter cultured tips. Percutaneous catheterization of the femoral vein might therefore be considered as a good venous access route. It can be successfully used by inexperienced physicians. There is no serious risk of injury to surrounding structures and the risks of thrombosis and infection are acceptable in comparison with other routes.

Adolescent↗

PubMed1995

The determinants of successful self-catheterization programs in children with myelomeningoceles.

Myelomeningocele is a birth defect that results in lifelong consequences for the child and family. One of the abnormalities that results from the defect is a neurogenic bladder. Most children with myelomeningoceles will require a clean intermittent catheterization (CIC) program for continence. Yet, many children do not have success with these programs. The purpose of this report is to identify in the literature components of a successful self-catheterization program. The importance of proper urinary management in children with myelomeningoceles will be discussed. Physiological, developmental, and motivational qualities that are present in successful self-catheterization programs will be identified. The importance of knowing when the child is ready to learn, how to know when the child is ready to learn, and different styles of teaching self-catheterization will be discussed. Finally, nursing implications for children on CIC programs will be described.

Adolescent↗