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PubMed1985

Evaluation of urinary catheterization and urinary incontinence in a general nursing home population.

The medical records of 412 residents of three southeastern Massachusetts nursing homes were reviewed to examine the frequency and medical management of urinary incontinence and the indications for chronic urinary catheterization. The mean age of the patients was 84.1 years. In this study 9.7% of the patients were managed with a urinary catheter, while an indication for catheterization was recorded in the medical records of only 27.5% of these patients. Half of the noncatheterized nursing home patients were transiently or permanently incontinent of urine, but were not catheterized. Incontinent patients without catheters were more likely to require assistance in toileting (75.5 v 26.1%) or to have bacteriuria (60.1 v 26.1%) than continent patients. Despite the frequency of urinary incontinence, this problem was included in the medical problem list of less than 5% of the incontinent nursing home patients. The authors conclude that urinary incontinence is a frequent medical problem in the nursing home population, but it is rarely recorded and evaluated as a medical problem. Furthermore, indications for urinary catheterization frequently are also not recorded. An explanation for this practice was not determined, but possibilities include a lack of physician knowledge of the evaluation and management of incontinence and a nonaggressive approach to such patients, given their other medical problems.

Aged↗

PubMed1989

Intermittent urethral catheterization in the elderly.

Thirty-five elderly patients receiving intermittent urethral catheterization in a Veterans Administration Hospital and attached nursing home care unit were prospectively studied for development of bacteriuria and/or urinary tract infection. Thirty-one of the 35 patients (88.6%) developed urinary tract colonization. The mean time from initiation of catheterization to development of colonization was 5.7 +/- 1.3 days. Persistent bacteriuria with one or several different microorganisms developed in 17 patients. The most common colonizing organisms were coagulase negative staphylococci, Klebsiella pneumoniae, and enterococcus. Four patients (11%) developed symptomatic urinary tract infection. Although urinary tract colonization was common in patients receiving intermittent urethral catheterization, especially in those with poor functional status, infection was uncommon. Based on these results, intermittent urethral catheterization appears to be a safe and effective method of bladder drainage in elderly male patients when performed with sterile techniques over short periods of time in the nursing home or hospital setting.

Aged↗

PubMedDate not supplied

Destructive lesions of the proximal sesamoid bones as a complication of dorsal metatarsal artery catheterization in three horses.

OBJECTIVE: To describe focal destructive lesions of the proximal sesamoid bones (PSBs) as a complication of dorsal metatarsal artery catheterization performed for direct blood pressure monitoring during equine general anesthesia. STUDY DESIGN: Retrospective study. ANIMALS: Three client-owned horses. METHODS: A dorsal metatarsal artery was catheterized in each of 3 horses for direct blood pressure monitoring during anesthesia. Radiography, ultrasonography, synoviocentesis, and arthroscopy were used to diagnose postoperative lameness that occurred in the limb used for blood pressure monitoring. RESULTS: Horses developed severe lameness, localized to the fetlock region of the catheterized limb within 21 days of surgery. Antibiotic therapy was administered. Surgical debridement was possible in 1 horse. Two horses that had lesions that were inaccessible, failed to respond to medical management and were euthanatized. The 3rd horse that had surgical debridement of affected bone, survived. Changes in hospital protocol, by improving aseptic technique during catheter insertion and use of new manometer tubing and heparinized saline for each arterial catheter inserted in the dorsal metatarsal artery, have eliminated this complication. CONCLUSIONS: Diagnosis and treatment of destructive lesions of the PSB were difficult. Strict aseptic technique should be followed during insertion of arterial catheters. CLINICAL RELEVANCE: Focal destructive lesions of the PSB subsequent to dorsal metatarsal arterial catheterization is a rare but serious complication of equine anesthesia.

Animals↗

PubMed1992

Permanent pacemaker implantation in the cardiac catheterization laboratory versus the operating room: an analysis of hospital charges and complications.

Permanent pacemakers may be implanted in operating rooms, special procedure laboratories, or cardiac catheterization laboratories. Previous investigators have shown no difference in efficacy or complications in the operating room versus the cardiac catheterization laboratory. We retrospectively analyzed the hospital bills of 30 patients undergoing permanent pacemaker implantation at our institution. Group I was 15 consecutive patients implanted in the operating room and group II was 15 consecutive patients implanted in the cardiac catheterization laboratory, all by the same operators. Hospital charges that were specific to the site of implantation were analyzed. Physician charges for implantation, anesthesiologist, and radiologist charges were not analyzed. There were no in-hospital complications in either group. The mean charges for group I were $1,856.00 and group II were $1,075.00 (P < 0.001). We conclude that implantation of permanent pacemakers in the cardiac catheterization laboratory is associated with significantly lower hospital charges compared to implantation in the operating room and has an equally low complication rate.

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PubMed1999

Left ventricular lead insertion using a modified transseptal catheterization technique: A totally endocardial approach for permanent biventricular pacing in end-stage heart failure.

This article describes a new technique of LV lead insertion, using transseptal catheterization performed through the right internal jugular vein, to obtain a totally endocardial biventricular chronic pacing in end-stage heart failure. Three patients with QRS widening (> 180 ms) linked to complete left bundle branch block (n = 2) or right ventricular pacing (n = 1) were included in this preliminary study. Catheterization was performed under fluoroscopy and transesophageal echocardiography guidance. Transseptal catheterization was achieved by puncture of the right internal jugular vein at the base of the neck and by using a Brockenbrough needle, the tip curve of which was more curved than the standard model. A flexible long sheath was advanced in the left atrium through the interatrial septum and then a unipolar electrode was placed easily in the LV. The proximal tip of the LV lead was tunneled from the neck to the subclavian area and connected to the ventricular channel of a dual (n = 1) or simple (n = 2) chamber pacemaker. Efficient acute sensing (V wave amplitude = 13 +/- 3 m V) and pacing (acute pacing threshold = 0. 7 +/- 0.4 V) were obtained in the three patients. Early loss of capture occurred in two patients requiring lead replacement. Functional status dramatically improved in all three patients. At 6-month follow-up, biventricular pacing was maintained in all patients (mean threshold 1.4 V) who were free of clinical embolic event with oral anticoagulation therapy. This modified technique of jugular transseptal catheterization appears promising for the development of left heart pacing.

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PubMed1998

Nonfluoroscopic transseptal catheterization: safety and efficacy of intracardiac echocardiographic guidance.

INTRODUCTION: Recently, there has been a revival in the use of transseptal catheterization due to the development of balloon mitral valvuloplasty and radiofrequency catheter ablation. Complications of transseptal puncture, although rare, can be serious and life-threatening. In the present study, we evaluated the use of intracardiac echocardiography (ICE) as the sole imaging modality to guide transseptal puncture and catheterization. METHODS AND RESULTS: In each animal, 10 transseptal punctures were performed guided solely by ICE. The standard approach to transseptal catheterization using a Brockenbrough needle and long vascular sheath was used except for the use of ICE instead of fluoroscopy. A 6.2-French/12.5-MHz and 9-French/9-MHz ICE catheter was used for imaging. At the end of each study, pathologic evaluation was performed. Transseptal puncture was performed safely, guided solely by ICE, in each of 100 attempts (five attempts guided by each ICE catheter in 10 dogs). While the fossa ovalis was easily visualized with both ICE catheters, the 9-French/9-MHz catheter offered an enhanced field of view. On pathologic evaluation, there was no evidence of perforation of either the right or left atrium outside of the fossa ovalis. CONCLUSION: Both ICE catheters used in this trial allowed for excellent visualization of the fossa ovalis and safe transseptal puncture. Intracardiac echocardiography may be a better imaging modality than fluoroscopy for guiding transseptal catheterization, especially in less experienced hands.

Animals↗

PubMed1991

Transesophageal echocardiography with color Doppler during interventional catheterization.

Echocardiography has been used during interventional cardiac catheterization for guidance of the procedure and assessment of results. However, limited echocardiographic windows and logistical difficulties make conventional echocardiography during interventional catheterization impractical and of limited value. Transesophageal echocardiography (TEE) with Doppler color flow mapping is more useful than conventional echocardiography for guidance of interventional catheterizations. Device closure of congenital atrial and ventricular septal defects (ASDs and VSDs) and of postoperative residual interatrial and interventricular communications, balloon valvuloplasty, and Brockenbrough atrial septal puncture with ASD creation have been performed under combined fluoroscopic and TEE guidance. Transesophageal echocardiography can be performed continuously throughout the procedure, allowing simultaneous fluoroscopic and echocardiographic assessment of catheter position. Localization of individual device arms during transcatheter device closure of ASDs and VSDs is easier and more accurate when TEE is used, resulting in a lower incidence of incorrect device positioning. Doppler color flow mapping is used to determine number, location, and size of defects, to detect residual shunts after device closure, and to assess valve insufficiency after balloon valvuloplasty and other procedures. Combined TEE and fluoroscopic guidance of interventional procedures, with echocardiographic assessment of results, reduces the amount of radiation and contrast used during the procedure, allowing performance of additional interventional procedures during the same catheterization. Transesophageal echocardiography is indicated during interventional procedures in which simultaneous Doppler color flow mapping and precise localization of catheter, balloon and/or device position will result in a higher success rate and decreased morbidity.

Adolescent↗

PubMed1976

Umbilical vein catheterization and portal hypertension.

Portal hypertension is a rarely encountered late complication of umbilical vein catheterization. A survey of the 38 cases previously published is presented together with an additional case report. It is concluded that catheterization for more than 2 days carries an increased risk of thrombosis, and that umbilical artery catheterization should be preferred in the majority of cases due to a reduced risk of complications. The correct position of the catheter tip must always be controlled by fluoroscopy or X-ray. Infusion of hypertonic solutions with unphysiological pH should be restricted and umbilical vessel catheterization should only be carried out in severe cases. Pretreatment of the catheters with heparin possibly reduces the hazards.

Catheterization↗

PubMed1987

Expression of type 1 fimbriae may be required for persistence of Escherichia coli in the catheterized urinary tract.

Long-term urinary catheterization results in polymicrobial bacteriuria and is complicated by fever, bacteremia, acute pyelonephritis, and death. Escherichia coli is a common urine isolate from catheterized patients and can persist for months. We hypothesized that fimbria-mediated adherence contributes to its persistence. For 1 year, urine specimens were collected from 51 patients greater than or equal to 65 years of age who were catheterized for greater than or equal to 30 days. E. coli was isolated at greater than or equal to 10(5) CFU/ml from 447 (36%) of 1,230 weekly urine specimens from 26 patients. Week 1 isolates from 52 definable episodes were tested for hemagglutination, hybridization with gene sequences from the pil and pap operons, in vitro adherence to catheter material, binding of 125I-labeled Tamm-Horsfall protein, hemolysin and colicin V production, and serum resistance. The proportions of isolates of short (1 week only), medium (2 to 11 weeks) and long (greater than or equal to 12 weeks) episodes of bacteriuria which expressed type 1 fimbriae as assayed by mannose-sensitive hemagglutination were 59, 65, and 92%, respectively. Isolates with the pil operon (the genome for type 1 fimbriae) from episodes lasting greater than 1 week expressed mannose-sensitive hemagglutination more frequently (P = 0.011) than pil-positive isolates from episodes of less than or equal to 1 week. Isolates from episodes of greater than 1 week also bound significantly more Tamm-Horsfall protein than isolates from episodes of less than or equal to 1 week (P = 0.044). Although nearly half of the isolates produced P fimbriae, an important virulence factor for the development of pyelonephritis, no correlation with persistence could be made. Overall, the E. coli isolates expressed traits similar to those of strains that caused cystitis. Type 1 fimbriae appear to be important for the persistence of E. coli in the long-term-catheterized urinary tract.

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PubMed2004

Transfemoral catheterization of carotid arteries with real-time MR imaging guidance in pigs.

All procedures and protocols were approved by the institutional animal care and use committee of Columbia University. To determine whether transfemoral catheterization of the carotid arteries can be performed entirely with real-time magnetic resonance (MR) imaging guidance, the authors catheterized the carotid arteries in six domestic pigs by using active-tracking catheters and guidewires and MR tracking software created for neurovascular procedures. The carotid arteries were successfully catheterized 24 times, on average within 5 minutes after insertion of the catheter into the femoral artery. Results demonstrated the feasibility of performing transfemoral catheterization of the carotid arteries with active MR tracking devices in a conventional MR imaging unit.

Animals↗

PubMed1993

Obstetric hemorrhage: prophylactic and emergency arterial catheterization and embolotherapy.

The role of arterial catheterization and embolotherapy was evaluated in 18 patients with postpartum hemorrhage or a risk of hemorrhage. Nine patients underwent emergency arterial catheterization for unanticipated postpartum hemorrhage due to uterine and vaginal tears and/or placental abnormalities. Bleeding was controlled with embolization with gelatin sponge in eight patients, while bleeding in one patient stopped spontaneously during angiography. Nine patients underwent prophylactic arterial catheterization before cesarean section or for abnormalities associated with risk of hemorrhage. Two subsequently underwent embolization before surgery, and embolization in two others was performed intraoperatively in response to serious bleeding. Bleeding in the other five was controlled by the usual surgical means. Arterial embolotherapy in these patients was an effective means of controlling postpartum hemorrhage. Prophylactic arterial catheterization has a role in patients with an increased risk for obstetric hemorrhage.

Angiography↗

PubMed1994

Fallopian tube disease: limited value of treatment with fallopian tube catheterization.

PURPOSE: Therapeutic role of fallopian tube catheterization was prospectively studied in patients with bilateral fallopian tube obstruction. MATERIALS AND METHODS: Catheterization was performed in 42 patients with bilateral obstruction; 36 of the patients (67 fallopian tubes) underwent recanalization. RESULTS: Fifty-two tubes with 54 proximal obstructions were successfully recanalized (technical success rate, 96%), 36 with selective catheterization and 16 with coaxial techniques. Among 13 tubes blocked at the distal portion of the tube, six tubes were negotiated. Perforation or subintimal injury occurred in three tubes, and one patient eventually had a tubal pregnancy. During follow-up of 3 months to 4 years, five patients had conceived, including the patient with a tubal pregnancy and one patient who experienced spontaneous abortion during the first trimester. CONCLUSION: Fallopian tube catheterization is technically highly successful and diagnostically useful. However, its role in treating fallopian tube diseases is limited, and patients with distally blocked tubes are not good candidates for this procedure.

Adult↗

PubMed1988

Effect of aortic arterial catheterization on tissue glycogen content.

Measurements of hemodynamics and blood metabolites in rats are often made by insertion of a small polyethylene (PE-50) catheter into the aorta via the carotid artery. Although the effect of this type of procedure on animal body weight has been described, little information exists regarding the quantitative and temporal effects of this procedure on liver and skeletal muscle glycogen concentration. Relative to the control group (group C), liver glycogen concentration was reduced by 56% 24 h after catheterization (group CN). With respect to liver glycogen concentration, it was apparent that a postcatheterization recovery period of variable duration (2-8 days; group CNR) based on attainment of a normal food consumption-to-body weight ratio (FdWt/BdWt) was more effective than was a fixed 6-day recovery period (group CN6). This was probably due to the large between-animal variability in recovery times required to reach normal FdWt/BdWt values. After aortic catheterization, FdWt/BdWt was a reasonable predictor of postprocedural liver (y = 2,601x + 43.9; r = 0.72; P less than 0.01) and diaphragm muscle glycogen concentration (y = 146.3x + 14.0; r = 0.57; P less than 0.05). Aortic catheterization did not affect the glycogen concentration in the other skeletal muscles examined. Since the results of certain types of experiments can be significantly influenced by liver glycogen concentration, the use of FdWt/BdWt on 24-h food intake as a general indicator of recovery after instrumentation via aortic catheterization is proposed.

Animals↗

PubMed2000

Glide wires for delayed catheterization of severely obstructed ureters.

OBJECTIVE: Failure to retrogradely catheterize an obstructed ureter may require a nephrostomy. We describe an endoscopic technique to catheterize a severely obstructed ureter when the obstruction does not permit passage of a ureteral catheter over a wire. METHODS: Using a cystoscope, a wire is passed beyond the obstruction. When the attempt to insert a ureteral catheter over the wire fails, the wire is left in place, fixed externally to a Foley catheter. A second attempt to insert a ureteral catheter is carried out 24-48 h later. RESULTS: The procedure was performed in 5 patients. Ureteral catheterization, which was initially impossible, was performed successfully and without complications. CONCLUSIONS: Maintaining a wire in place over a short period of time facilitates a subsequent ureteral catheterization.

Adult↗

PubMed2005

A simple and effective regimen for prevention of radial artery spasm during coronary catheterization.

Radial artery spasm occurs frequently during the transradial approach for coronary catheterization. Premedications with nitroglycerin and verapamil have been documented to be effective in preventing radial spasms. Verapamil is relatively contraindicated for some patients with left ventricular dysfunction, hypotension and bradycardia. We would like to know whether nitroglycerin alone is sufficient for the prevention of radial artery spasm. We conducted a randomized controlled trial to compare the spasmolytic effect between heparin alone, heparin plus nitroglycerin and heparin plus nitroglycerin and varapamil during transradial cardiac catheterization. In this study, a total of 406 patients underwent transradial cardiac catheterization and intervention. After successful cannulation and sheath insertion of radial arteries, 133 patients in group A received 3,000 units of heparin, 100 microg of nitroglycerin and 1.25 mg of verapamil via sheath, 135 patients in group B received 3,000 units of heparin and 100 microg of nitroglycerin, and 93 patients in group C received 3,000 units of heparin. Five patients in group A (3.8%), 6 patients in group B (4.4%) and 19 patients in group C (20.4%) showed radial spasms. There is no statistically significant difference between groups A and B (p = 0.804), but there are strong statistically significant differences between groups A and C (p = 0.001) and groups B and C (p = 0.003). Intra-arterial premedication with 100 microg nitroglycerin and 3,000 units of heparin is effective in preventing radial spasms during transradial cardiac catheterization.

Aged↗

PubMed1995

Predictors of the effect of heparin during cardiac catheterization.

This study was designed to determine if the activated partial thromboplastin time (aPTT) present at the end of a diagnostic cardiac catheterization was correlated with specific patient or procedure characteristics. No relationship between time from heparin bolus and the aPTT was found. Age, weight and body surface area were found to influence the aPTT at catheterization completion (p < 0.05). Patient sex, height, smoking status, hematocrit, and type and volume of contrast used were not correlated with aPTT at the end of catheterization. This suggests possible usefulness of the age and weight of patients to guide the dose of heparin used at cardiac catheterization.

Age Factors↗

PubMed2003

Real-time magnetic resonance imaging-guided coronary catheterization in swine.

BACKGROUND: We tested the hypothesis that real-time magnetic resonance imaging (MRI) can guide coronary artery catheterization in swine via a percutaneous femoral artery approach. METHODS AND RESULTS: In 12 pigs, we accessed femoral arteries percutaneously. We used 6- or 7-French coronary Judkins catheters filled with dilute 4% gadolinium (Gd) contrast agent and coaxially inserted 0.030-inch diameter active guidewires as endovascular devices. For catheter tracking, we used a 2-dimensional (2D) inversion recovery-prepared spoiled gradient echo sequence at a temporal resolution of 7 frames/s. For guidewire tracking, we used 2D steady-state free precession imaging at a temporal resolution of 9 frames/s. Coronary artery catheterization under MRI guidance was successful in 12/12 pigs. Successful coronary catheterization was verified by obtaining MR angiographic images after direct catheter-based injections of dilute Gd. CONCLUSIONS: Real-time MRI-guided catheterization of coronary arteries in swine is feasible via a percutaneous femoral artery approach. Selective coronary MR angiography can then be performed with dilute contrast agent injections.

Animals↗

PubMed1977

Angiographic determination of arterial patency after percutaneous catheterization in infants and small children.

Patency of the femoral artery of infants and children who previously had percutaneous arterial catheterization at a weight of less than 25 kg was studied angiographically. During the study period, 118 patients had repeat arterial catheterization. 48 from the opposite leg. Femoral artery occlusion was found in four patients, while 44 of the 48 studied from the opposite leg had complete patency. At the later study, all four with blockage were asymptomatic and possessed good pedal pulses, while two had decreased femoral pulsations. When events surrounding initial catheterization were retrospectively analyzed, three of four had decreased pedal pulsations beyond six hours. It is concluded that 3-8% of patients weighing less than 25 kg have arterial occlusion after catheterization. This complication may be entirely asymptomatic, but these patients will require continued observation for possible late vascular problems.

Arterial Occlusive Diseases↗