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PubMed2002

Long-term fertility prognosis following selective salpingography and tubal catheterization in women with proximal tubal blockage.

BACKGROUND: The possibility of conception following selective salpingography and tubal catheterization is believed to decline sharply a few months after the procedure. This observation may be due to the relatively small number of patients and short follow-up of previous studies. Furthermore, couples with other causes of infertility apart from proximal tubal blockage have usually been excluded. METHODS: Survival analysis of conceptions of 218 consecutive infertile women with proximal tubal blockage who underwent selective salpingography and tubal catheterization was performed. There were no exclusion criteria. Follow-up ranged from 16 to 56 months. RESULTS: A total of 47.2% of spontaneous conceptions and 43.2% of all conceptions, apart from those achieved by IVF or ICSI treatments, occurred after the first 12 months following selective salpingography and tubal catheterization. The decline in the possibility of pregnancy during the study period (conception hazard rate) was only minimal. CONCLUSIONS: In a population of infertile women with proximal tubal blockage, a significant proportion of conceptions occur after the first 12 months following selective salpingography and tubal catheterization. The presence of any additional causes of infertility in the couple should not be regarded as an absolute contraindication to the procedure.

Catheterization↗

PubMed1993

An historical cohort study of cardiac catheterization during childhood and the risk of cancer.

This study aimed to determine whether cancer risk was elevated among patients exposed to radiation from diagnostic cardiac catheterization during childhood. The study cohort included 3915 children who underwent at least one cardiac catheterization at a major children's hospital in Toronto, Canada, between 1950 and 1965, were < or = 18 years at the time of the procedure, and were residents of Ontario. Follow-up of the cohort was done by linkage to the Ontario Cancer Registry up to 1986. A total of seven cancer deaths were observed (O), compared with 5.7 expected (E) based on provincial cancer rates (mortality ratio [O/E] = 1.2; 90% confidence interval [CI] : 0.6-2.3). In the analysis of cancer incidence, 13 cancers were detected, compared with 17.3 expected (O/E = 0.75; 90% CI : 0.4-1.2). These mortality and incidence ratios were not statistically significantly elevated. Detailed analyses were conducted according to age at exposure, age at diagnosis, sex, number of procedures, year of first catheterization, and latent period. Detected deviations in risk were confined to an early period of exposure, indicating that later practices of cardiac catheterization were not associated with increased risk. In general, there was no statistically significant excess risk of cancer among the cohort.

Adolescent↗

PubMed2001

Clinical experience of percutaneous femoral venous catheterization in critically ill preterm infants less than 1,000 grams.

BACKGROUND: Venous access is relatively difficult in preterm infants. Central venous catheterization is indicated for pressure monitoring, drug therapy, and nutrition supplementation, which are often critical in the anesthetic management of infants undergoing major surgery. METHODS: In 49 critically ill preterm infants weighing less than 1,000 g, the femoral vein was cannulated using a 22-gauge Angiocath (25 mm; Beckton Dickinson, Sandy, UT). A 2.5-ml syringe was attached to the Angiocath, and the Angiocath was advanced with constant negative pressure over the syringe. When blood return was observed, the cannula was advanced. When free blood reflux was achieved, a J wire was inserted, followed by a 24-gauge central venous catheter. RESULTS: The overall catheterization success rate was 79.6% (39 of 49 attempts). The time required for successful catheterization was less than 10 min in 18 cases (46.2%), 10-20 min in 17 cases (43.6%), and 20-30 min in 4 cases (10.3%). In the successful group, 1 catheter tip was positioned in the vein of the liver (2.6%), 2 were in the common iliac vein (5.1%), 6 were in the right atrium (15.4%), and 30 were in the infracardiac inferior vena cava (76.9%). Complications included hematoma in six cases (12.2%), arterial puncture in five cases (10.2%), bleeding in two cases (4.1%), and transient bradycardia in two cases (4.1%). CONCLUSIONS: The results indicate that percutaneous femoral venous catheterization is a reliable and valuable technique for critically ill preterm infants weighing less than 1,000 g.

Catheterization, Central Venous↗

PubMed1980

Complications of vascular catheterization in the critically ill. A prospective study.

Invasive hemodynamic procedures are increasingly used for monitoring critically ill and injured patients. The results of a prospective study on complications of 210 vascular catheterizations in 116 critically ill patients are reported. A total of 80 central venous (CV), 71 pulmonary artery (PA), and 59 arterial (A) catheterizations were performed during an interval of 6 months. Catheters were inserted by percutaneous techniques for all but seven of the procedures. CV catheters were associated with complications in 3.7%. However, complications were encountered in 10% of the PA catheterizations and 13.5% of systemic A catheterization. It appears that in a group of patients with observed hospital mortality of 36%, invasive monitoring is associated with a significant complication rate.

Adolescent↗

PubMed1984

Complications of vascular catheterization in critically ill children.

Invasive hemodynamic monitoring is widely used in the care of critically ill children. In a prospective study, a total of 330 arterial catheters, 397 central venous catheters, and 47 pulmonary artery catheters were placed in 467 children, between February 1981 and September 1982. Complications observed included: bleeding in seven of 774 vascular catheterizations, arterial obstruction in three of 377 arterial catheterizations, and sepsis in 11 of 774 vascular catheterizations. Of the 21 complications noted, 71% occurred in children less than 5 yr of age. A total of 19 (4.1%) children suffered complications of bleeding, arterial obstruction, and/or sepsis. In contrast, the overall mortality in this group of patients was 16%. The risk of morbidity from vascular catheterization appeared justified in this group of critically ill children.

Adolescent↗

PubMed1986

Bacteriuria in the catheterized surgical intensive care patient.

A prospective microbiologic evaluation of the urine was conducted on 100 catheterized ICU patients. Eight subjects had positive initial bladder urine cultures and were eliminated from further study. The remaining 92 patients were catheterized for up to 22 days, mean 4.8 +/- 4.3 (SD). During the first 5 days, 57 (62%) patients completed the surveillance protocol; seven (12.3%) of these had bladder bacteriuria. Of 20 patients with positive urine cultures, six had microorganisms in the collection bag urine alone. The remaining 14 had organisms both in the bladder and in the bag urine. The urine collection bag was the apparent source of microorganisms in the bladder urine in only three cases. The daily incidence of new cases and the cumulative rate of bladder bacteriuria remained below 7% and 22%, respectively, during the first week of catheterization. These rates are similar to those previously reported for various other patient groups outside the ICU setting. Frequent microbiologic monitoring of the urine seems to be unnecessary for most ICU patients because of the short duration of catheterization.

Adult↗

PubMed1989

Jugular venous bulb catheterization in infants and children.

Cross-brain oxygen extraction may be altered by coma, hyperventilation, hypothermia, or barbiturates, and has been demonstrated in adults and more recently in children to be related to functional neurologic recovery after a variety of brain injuries. However, measurement of cross-brain oxygen extraction in children is currently not a part of routine clinical care, partly because there have been no published attempts relating the technique of jugular venous bulb (JVB) catheterization and its complication in children. We catheterized the JVB to measure cerebral venous oxygen content and calculate cross-brain oxygen extraction in 26 deeply comatose neonates and children ranging in age from a few hours to 14 yr. Bedside catheterization using the Seldinger technique was successful in 25 children, with standard venous cutdown necessary in the remaining child. All JVB catheterizations were performed with parental consent and during continuous monitoring of the intracranial (ICP) or fontanelle, as well as arterial, pressure. ICP was not significantly altered by the cannulation procedure in any of the children studied, although the cannulation occurred early in the child's course when ICP was well controlled. Inadvertent carotid artery puncture with bleeding controlled by local pressure occurred in four children, and catheter malposition was confirmed on lateral skull xray in two others. Jugular venous bulb catheters remained in place for 2 to 7 days (average 3) and malfunction or obstruction of the catheter did not occur. Organisms were grown from three of 26 catheter tips submitted for culture, with peripheral blood cultures also positive for the same organisms in two of these.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1990

Jugular bulb catheterization: experience with 123 patients.

Jugular bulb catheterization (JBC) provides cerebral venous access for titration of brain-specific therapy. Little has been written about the catheterization procedure. We prospectively studied the time, number of punctures, success rate, and complications during JBC for a 24-month period in our ICUs. One hundred twenty-three patients (mean age 6.7 yr, range 12 hours to 21 yr) underwent JBC. Procedure time was 15.6 +/- 5.0 (SD) min. Median number of skin punctures was two. All but four were successful on first attempt. Three of the remaining were catheterized on second attempt. Inadvertent carotid puncture occurred in 3%. No other significant complications were noted. Radiography confirmed proper position in 97%. Duration of indwelling venous catheters was 2.5 +/- 1.6 days. All catheters functioned well until removal. We conclude that our technique of JBC is safe and highly successful. It compares favorably with previous, smaller series and with standard anterograde internal jugular catheterization in both children and adults.

Brain↗

PubMed2000

Evaluation of a thoracic bioimpedance cardiac output monitor during cardiac catheterization.

OBJECTIVE: To evaluate the accuracy and precision of an advanced thoracic bioimpedance cardiac output monitor by comparing it with conventional thermodilution. DESIGN: Prospective data collected from 47 patients undergoing routine cardiac catheterization. The new bioimpedance system differs from its predecessors in electrode system configuration, advanced signal processing, use of a modified Kubicek equation, and a reliable estimate of left ventricular ejection time from the time derivative bioimpedance signals. SETTING: A cardiac catheterization laboratory in a university affiliated teaching hospital. PATIENTS: A series of 47 relatively homogenous patients undergoing routine cardiac catheterization for suspected cardiac disease. MEASUREMENTS AND MAIN RESULTS: The data from the first 20 patients was used to determine optimal values for coefficients in the bioimpedance cardiac output equations. The coefficients found were used when the system was tested in the subsequent 27 patients. For the last 27 patients, a total of 80 simultaneous pairs of cardiac output measurements were made by conventional thermodilution and by thoracic bioimpedance. The mean difference between the two methods was -0.31 L/min and the standard deviation of the differences was (0.76 L/min). The correlation coefficient was r2 = .72 (p < .001). CONCLUSIONS: The correlation between conventional thermodilution and thoracic bioimpedance cardiac output estimates was good and the standard deviation of the differences was lower than that reported for commercially available devices. The system can be used in the cardiac catheterization lab for reliable and continuous noninvasive measurement of cardiac output.

Cardiac Catheterization↗

PubMed1977

Postpartum surveillance for urinary tract infection: patients at risk of developing pyelonephritis after catheterization.

Asymptomatic postpartum bacteriuria occurred in ten of 354 patients not catheterized (2.8%) and in 19 of 313 patients who were catheterized (6.1%). Obstetric lacterations were commonly associated with bacteriuric patients who were not catheterized. Primigravidas as a total group were more likely to have significant bacteriuria. Nine of 23 patients with urinary retention (39.1%), requiring catheterization for longer than 24 hours, developed asymptomatic bacteriuria; urinary tract infection tended to be progressive in these patients, ascending from lower to upper urinary tract involvement. Using the fluorescent antibody (FA) test, antibody-coated bacteria were demonstrated in specimens from five of these nine patients (56%), indicating silent renal infection.

Antibodies, Bacterial↗

PubMed2000

Internuclear ophthalmoplegia after coronary artery catheterization and percutaneous transluminal coronary balloon angioplasty.

A retrospective chart review was performed for identification of patients with isolated internuclear ophthalmoplegia (INO) postcardiac catheterization from two neuro-ophthalmology units. Of the 110 patients with a diagnosis of INO who were evaluated during the observation period, five patients (4.5%) demonstrated relatively isolated INO occurring in the perioperative period of a cardiac endovascular procedure. These five patients underwent diagnostic catheterization alone (three patients), balloon angioplasty (one patient), or stent placement (one patient). All patients improved, with resolution of diplopia in primary position after a mean period of 82 days. The occurrence of INO in the postcardiac catheterization setting is not uncommon, and it appears to be related to dorsal pontine ischemia. The pontomesencephalic medial longitudinal fasciculus is supplied by small-caliber perforating end-arteries from the basilar trunk, which increases selective vulnerability of this area. Cardiac catheterization may precipitate microemboli involving these vessels, leading to internuclear ophthalmoplegia.

Aged↗

PubMed2005

The utility of bladder catheterization in total hip arthroplasty.

The use of a urinary bladder catheter in patients having a total hip arthroplasty is controversial. Universal insertion of an indwelling catheter before a total hip arthroplasty, and insertion of a catheter postoperatively as necessary, are accepted variations of care. From 1993 to 1999, 719 patients having primary, unilateral total hip arthroplasties were randomized by surgeons into two groups: a group of patients who had universal preoperative insertion of an indwelling bladder catheter (340 patients) and an observation group who had catheterization as needed (379 patients). Catheterization was required for 295 of these 379 patients (77.8%). Patients were followed up using a total hip arthroplasty database, which recorded all complications. Six patients (1.8%) in the universal catheter insertion group had a urinary tract infection develop. Nine patients (2.4%) in the catheter as necessary group had a urinary tract infection develop. There was no significant difference in incidence of urinary tract infections between the two groups. Female gender and increasing age were associated with a higher incidence of urinary tract infection in both groups. The average length of stay in the hospital for the universal catheter group was 4.8 days, and the average length of stay for the catheter as necessary group was 4.5 days. There was no significant difference in length of stay in the hospital between the two groups. The universal catheter group had an average 590 dollars higher hospital cost for their total hip arthroplasties, which was significant. Routine preoperative bladder catheterization may not be warranted in patients having total hip arthroplasties. Postoperative catheterization as necessary may be more cost effective.

Adult↗

PubMed2004

Complications of clean intermittent catheterization in boys and young males with neurogenic bladder dysfunction.

PURPOSE: We evaluate the risk for urethral lesions and epididymitis in boys with neurogenic bladder dysfunction treated by clean intermittent catheterization (CIC) for a minimum of 10 years. MATERIALS AND METHODS: The medical records of 28 males with neurogenic bladder dysfunction followed from the start of CIC until the age of 15 to 20 years were reviewed. RESULTS: CIC had been performed for a median of 16 years (range 10 to 21). Overall CIC was used for 438 years (265 before and 173 after puberty). During 76% of the years a noncoated polyvinyl chloride catheter with lubrication was used and in 24% of years a hydrophilic coated polyvinyl chloride catheter was used. The catheter size was 12C or greater in 43% of the cases. Independence from self-catheterization occurred during 37% of the CIC years. Of the patients 19 experienced at least 1 episode of difficulty inserting the catheter and/or had macroscopic hematuria on a total of 42 occasions. Major urethral lesions were seen on cystoscopy in 7 patients on 9 occasions (5 false passages, 1 superficial recess, 2 meatal stenoses, 1 urethral stricture). Major urethral lesions were not associated with puberty and did not occur during self-catheterization or with use of catheters 12C or greater. Epididymitis was seen in only a 12 year-old boy. CONCLUSIONS: The overall rate of complications was low. The incidence of major urethral lesions did not increase during puberty. Self-catheterization and 12C catheter or greater seemed to be protective against major lesions.

Child↗

PubMed2004

Evaluation of poly-N-acetyl glucosamine as a hemostatic agent in patients undergoing cardiac catheterization: a double-blind, randomized study.

BACKGROUND: This is the first blinded, randomized, placebo-controlled clinical trial to evaluate the efficacy of poly-N-acetyl glucosamine (p-GLcNAc) in improving hemostasis in patients undergoing cardiac catheterization. METHODS: Patients were randomly assigned to have either a placebo-treated (n = 17) or a p-GlcNAc-treated (n = 16) 3 x 3-cm patch topically placed at the femoral insertion site at the completion of their catheterization procedure with a mechanical pressure clamp applied over it. The amount of pressure was measured. RESULTS: Although the placebo group had slightly higher clamp pressure applied to the femoral arterial puncture site at the end of the catheterization procedure (189 +/- 47 vs. 149 +/- 49 mm Hg, p = 0.042), the time to effective hemostasis (16 +/- 7 vs. 10 +/- 3 minutes, p = 0.01) was decreased in the p-GlcNAc group by 37%. CONCLUSION: The application of p-GlcNAc patches improved hemostasis at the arterial puncture site in patients undergoing cardiac catheterization.

Acetylglucosamine↗

PubMed2005

Arterial embolization and prophylactic catheterization for the treatment for severe obstetric hemorrhage*.

BACKGROUND: To evaluate indications, efficacy, and complications associated with arterial embolization and prophylactic balloon catheterization in the management of obstetric hemorrhage at a university hospital. METHODS: Twenty-two women underwent arterial embolization between February 2001 and November 2003 for the treatment for primary postpartum hemorrhage resulting from abnormal placentation (n=11), uterine atony (n=7), paravaginal laceration (n=3), and disseminated intravascular coagulopathy (n=1). Blood loss was between 3.2 and 15 l. In seven patients, abnormal placentation was diagnosed prenatally and in these patients balloon catheterization was performed prophylactically before elective cesarean section. RESULTS: Of the seven patients, who underwent prophylactic catheterization, embolization was successful in five resulting in adequate hemostasis. Hysterectomy was performed in three, in two patients for uncontrolled hemorrhage and in one patient for placental invasion to bladder. There were no complications associated with prophylactic catheterization and embolization. The other 15 patients were treated in an emergency setting. In eight patients, embolization was performed as a primary surgery, and it was successful in six. In the other seven patients, hysterectomy was performed as an emergency surgery, but bleeding continued. Of these, in six patients, hemostasis was achieved with embolization. Complications associated with emergency embolization were observed in three patients. These were thrombosis of left popliteal artery, vaginal necrosis, and paresthesia of the right leg. CONCLUSIONS: Arterial embolization is of significant value in treating obstetric hemorrhage. Prophylactic insertion of balloon catheters before cesarean section seems to be a safe and effective method in controlling anticipated bleeding. In patients with persistent bleeding following cesarean section and hysterectomy, embolization could be a primary procedure before re-surgery.

Adult↗

PubMed1996

Percutaneous chronic epidural catheterization in the rabbit.

BACKGROUND: Although several epidural catheterizations in small animals have been reported, all of them were performed surgically and no percutaneous method has been reported. We have established a technique for percutaneous chronic epidural catheterization in rabbits. METHODS: Following pentobarbital anesthesia, the animals (n = 15) were fixed in a prone position using a fixing apparatus. A 19-gauge Tuohy needle was inserted in the lumbar region at an angle of about 30 degrees to the skin with the paramedian approach and advanced into the epidural space with the loss-of-resistance method. A 23-gauge Nylon catheter was advanced cephalad in the epidural space and the distal tip was extruded from the neck following the subcutaneous tunnelling. The effects of 0.5 ml of 1% lidocaine injected through the catheter were observed for 10 days. RESULTS: No behavioral or neurological abnormalities were observed after the catheterization except for one case of catheterization in the epidural vessel. Motor paralysis of hind-limbs became manifest at 1-2 min after injection of 0.5 ml of 1% lidocaine through the catheter, and lasted 15-25 min. Autopsy revealed that the catheter was located in the lumbar epidural space in all animals and the distribution of methylene blue was consistent with that of lidocaine. CONCLUSION: This rabbit model can be used to investigate the effects of epidurally administered drugs.

Animals↗

PubMed2006

Abnormal glucose metabolism and features of the metabolic syndrome are common in patients presenting for elective cardiac catheterization.

BACKGROUND: Abnormalities of glucose metabolism and the metabolic syndrome, including excess bodyweight, are potentially modifiable risk factors for cardiac morbidity and mortality. This study aimed to determine the prevalence of these in a group of patients presenting for elective cardiac catheterization or percutaneous intervention. METHODS: Data were prospectively collected on 297 consecutive patients presenting for elective cardiac catheterization or percutaneous intervention at a single tertiary referral centre. Demographic data, risk factors, medications and coronary angiogram results were recorded. Fasting lipids, fasting glucose, HbA1c levels were measured and if necessary an oral glucose tolerance test was carried out. Logistic regression and contingency table analysis examined associations of these with ethnicity. RESULTS: Impaired glucose metabolism (diabetes, impaired glucose tolerance or impaired fasting glucose) was present in 46.1% with our screening programme detecting previously unknown impaired glucose metabolism in 22.9%. Impaired glucose metabolism was strongly associated with non-European ethnicity (P < 0.0001). The metabolic syndrome was present in 49.2%. When defined by ethnic specific cut-offs, overweight or obesity was present in >80% of patients in all ethnic groups. CONCLUSION: There is a very high prevalence of impaired glucose metabolism and the metabolic syndrome in patients presenting for cardiac catheterization. Impaired glucose metabolism is particularly prevalent in the Polynesian and the Indian and the Sri Lankan ethnic groups. Screening of patients undergoing elective cardiac catheterization identifies a significant number of patients with undiagnosed impaired glucose metabolism and should be carried out routinely.

Aged↗

PubMed2005

Elective cesarean section without urethral catheterization.

AIM: To determine the feasibility and safety of carrying out elective lower-segment cesarean section without urethral catheterization. METHODS: A prospective comparative study was carried out at a private hospital in Colombo, Sri Lanka. A pilot study involving 50 women was carried out to measure the volume of urine obtained at the beginning and at the end of cesarean section, using an indwelling catheter. In the main study, surgery was carried out without urethral catheterization on 344 women who had voided within the previous hour. RESULTS: The mean volume of urine collected at the beginning and at the end of surgery was 25.5 and 42.8 mL, respectively. This volume was calculated to be accommodated in spheres of 4.0 and 4.6 cm in diameter, respectively. In the main study, 73% had the bladder distended to a level <3 cm from the lower cut edge of the rectus sheath. In the remaining 27% it was above this level, but covered completely by Doyen's retractor. There were no cases of accidental cystotomy. The difference in the mean time taken for surgery in the two groups was not significant (P=0.30). Distress catheterization was required in two (0.58%). The rest voided after a mean of 8.76 h (SD=2.37). The majority (68.2%) voided in the toilet. The difference in the urinary infection rates between the two groups (6%vs 0.58%) was statistically significant (P <0.05). CONCLUSIONS: Cesarean section without urethral catheterization does not compromise the safety or ease of surgery. It reduces the risk of urinary infection.

Cesarean Section↗