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PubMedDate not supplied

[Color-coded Doppler in the diagnosis of vascular complications following heart catheterization].

To determine the value of color Doppler in the diagnosis of vascular complications resulting from cardiac catheterization 5 consecutive patients, with the clinical suspicious of vascular iatrogenesis potentially requiring surgical repair, were analyzed. In 2 patients a femoral mass developed after a diagnostic catheterization but 3 patients underwent previously an interventional catheterization technique. In 3 patients color Doppler readily visualized a systolic jet originated in the femoral artery entering an anterior echo-free cavity, and a reversal flow in diastole, suggesting a femoral pseudoaneurysm. In 1 patient the clinical diagnosis of arteriovenous fistulae was confirmed by color Doppler which demonstrated a continuous turbulent flow within the femoral vein. In the remaining patient a diagnosis of simple femoral haematoma was made after the demonstration of a relatively echogenic structure overlying the femoral artery and vein but not interfering with their flows. In the 3 patients with femoral pseudoaneurysms and in the patient with arteriovenous fistulae the diagnosis was confirmed by angiography and during surgery. Our preliminary findings underscore the value of color Doppler, using the technology currently available in echocardiographic laboratories, in the differential diagnosis of vascular complications after cardiac catheterization.

Aged↗

PubMed2006

Urinary catheterization may not be necessary in minor surgery under spinal anesthesia with long-acting local anesthetics.

BACKGROUND: This prospective study was designed to compare the incidence of urinary retention after spinal anesthesia between 0.5% hyperbaric bupivacaine and 0.5% hyperbaric tetracaine in patients who underwent minor orthopedic and general surgeries. METHODS: Eighty patients aged 18-40 were randomly assigned to receive either hyperbaric bupivacaine or tetracaine for spinal anesthesia. Intravenous fluids were administered for maintenance of basal requirement, replacement of blood loss and prevention of hypotension. The highest level of analgesia, regression time of sensory block to L5 level, length of time from spinal injection to spontaneous urinary voidance, and volume of perioperative fluid administered were recorded. RESULTS: Of the 80 patients who received either hernioplasty, fistulectomy, hemorroidectomy or orthopedic surgery, two were catheterized (2.5%) because of urinary retention. They were administered less than 800 mL of fluid intraoperatively. Intraoperative blood loss was less than 100 mL in all cases. There were no statistical differences in demographic data, types of surgery, sensory blockade and perioperative fluid administration between the two groups. Although the regression time of sensory blockade with tetracaine (means +/- SD, 259.3 +/- 39.6 min) was significantly longer than that of bupivacaine (225.0 +/- 38.6 min, P < 0.01), the time elapsing from the spinal injection to the first spontaneously voiding after surgery did not show statistical difference between two groups (433.9 +/- 89.1 vs. 411.0 +/- 98.3 min, P = 0.286). CONCLUSIONS: Our results show that, in younger surgical patients who did not receive large amount of fluid intraoperatively, the incidence of urinary retention was low, although prolonged sensory blockade by both long-acting local anesthetics was evident. Thus, urinary catheterization should not be a routine must for every patient undergoing minor surgery with long-acting spinal local anesthetics. From the viewpoint of financial expense, avoidance of complication and annoyance of urinary catheterization, careful observation of urinary bladder fullness in the form of lower abdominal distension, discomfort, bradycardia, or vomiting after surgery is superior to routine retention urinary catheterization just for ease with work in younger patients under-going minor surgery under long-acting spinal local anesthetics.

Adult↗

PubMed1991

[Urinary infection in patients with short-term bladder catheterization].

BACKGROUND: The aim of the study was to assess the number of urinary tract infections, the time between catheterization and the development of bacteriuria, the route taken by the microorganisms and the clinical relevance of infection in patients with bladder catheterization during a short time. METHODS: 83 patients were evaluated by urine culture from the bladder, urethra, the connection of the catheter and the collecting system, and the collecting bag, on a daily basis during the 5 initial days, with clinical and microbiological follow up to 7 days after the removal of the catheter. RESULTS: 32% of patients developed bacteriuria. The mean interval between catheterization and the development of bacteriuria was 4.1 days. 45% of them were detected within 48 hours after catheter insertion. In 50% the causative organisms were detected in the urethra at least 24 hours previously. In no case the microorganism isolated from the connection between the catheter and the collecting system was subsequently isolated form bladder urine. Bacteriuria disappeared spontaneously in 27% of cases. Antibiotic therapy was necessary in 42%. CONCLUSIONS: In the study population most urinary infections were due to previous urethral colonization and subsequent dragging into the bladder, in many cases at the same time of catheterization. A non-negligible number of bacteriurias disappeared spontaneously.

Adult↗

PubMedDate not supplied

Mechanical complications of subclavian vein catheterization. A prospective study.

Subclavian vein catheterization, a timesaving, convenient and easy method of central venous access is not free of complications. In this report 150 consecutive infraclavicular subclavian vein catheterization attempts were evaluated with regard to noninfectious complications. 95.3% of the patients were successfully catheterized. While the overall complication rate was 29.3%, major complications occurred in 2.6%. The complication rate in right-sided attempts (35.5%) was significantly higher than in left-sided attempts (12.5%) (p less than 0.01). All of the major complications occurred in right-sided attempts. Left sided attempts seem to be safer unless specific contraindications exist. Malpositionings were the most common complications (16%) and were easily identified and managed by routine postprocedure chest X-rays. The mortality rate was 0%. As a result we think that this procedure will still remain as a valuable central venous catheterization method in experienced hands with proper indications and prompt treatment in the case of complications.

Adolescent↗

PubMed1978

Localization of insulinomas and islet cell hyperplasias by pancreatic vein catheterization and insulin assay.

Percutaneous transhepatic portal vein catheterization and transfemoral portal and caval catheterizations were performed under local anesthesia in five patients with symptoms of organic hypoglycemia. During the investigation, results of pancreatic phlebography revealed the pancreatic venous anatomy. Blood obtained from the celiac artery, caval branches and pancreatic veins was assayed for insulin by two different radioimmunoassay methods. Pathologically high, pancreatic arteriovenous insulin differences in two patients with insulinomas and in two patients with islet cell hyperplasia. In one of the patients with an insulinoma, one of the assays failed to detect the tumor insulin. This inconsistency still remains unexplained. Angiography revealed a pancreatic abnormality in only two patients. During operation, two of the tumors were found upon palpation and inspection. Pancreatic resections were performed according to the findings of pathologic hormone differences in all five patients. Immunocytochemistry revealed that three of the patients had insulin-producing tumors and two had local islet cell hyperplasia. Catheterizations performed two months postoperatively confirmed the radicality of the operation in all patients, with the possible exception of one patient. In one patient, a recurrance was detected by catheterization ten months postoperatively.

Adenoma, Islet Cell↗

PubMed1990

An ambulatory approach to outpatient pediatric cardiac catheterization.

Outpatient procedures are growing rapidly in all health care facilities. Insurance companies, health maintenance organizations, and DRGs are dictating shorter lengths of stay in the hospital for cardiac catheterizations. An option for low-risk children with cardiac disease is outpatient cardiac catheterization. For a successful outpatient cardiac catheterization, an ambulatory program needs to be in place to provide an efficient, cost-effective, and caring environment for the child and family. With the expansion to the ambulatory setting, the clinical nurse's role and responsibilities have widened. Nursing assessment, intervention, and teaching is ongoing with specific standards in place to deliver quality patient care. Use of the outpatient setting will continue to increase and will accommodate patients cost effectively. The key to the success of the outpatient pediatric cardiac catheterization is to include the family in the health care team approach, which will result in quality patient care with high patient and family satisfaction.

Ambulatory Surgical Procedures↗

PubMed1990

Percutaneous catheterization of the axillary vein in infants and children.

The axillary vein was evaluated as an alternative access site for central venous catheterization in critically ill infants and children. Children were placed in the Trendelenberg position (when possible) with arm abducted 100 to 130 degrees. The vein was entered parallel and inferior to the artery. Success rate for catheterization was 79% (41/52). Catheter diameter range was 3 to 8.5 F and catheter length range was 5 to 30.5 cm. Median patient weight was 7.0 kg (3.0 to 59 kg). Median age was 0.91 years (14 days to 9 years). All central lines ended in the subclavian, innominate, or superior vena cava. Median catheter duration was 8 days (2 to 22 days). A total of 338 patient catheter-days were studied. Central venous pressure was successfully monitored in five of five attempts. Complications with insertion (3.8% of attempts) included one pneumothorax and one hematoma. Complications during catheter duration (9.8% of catheters, 1.1% per catheter-day) included one instance each of venous stasis, venous thrombosis, catheter sepsis, and parenteral nutrition infiltration. No complication contributed to a patient mortality. Success and complication rates were comparable with those in jugular catheterization studies in children. The axillary approach is an acceptable route for central venous catheterization in critically ill infants and children.

Axillary Vein↗

PubMed1989

[Cost-effectiveness analysis of two-dimensional/Doppler echocardiography, cardiac catheterization and angiography in the diagnosis of congenital heart disease].

To compare the costs and effectivenesses of 2-dimensional/Doppler echocardiography (2D/DE), cardiac catheterization (CC) and angiography (CA) in the evaluation of cardiac anatomy in patients with congenital heart disease, these three kinds of examinations were performed in 100 patients before operation. The 100 patients had 120 separate cardiovascular abnormalities, of which 100 (83.3%) were prospectively identified by 2D/DE. The sensitivity and specificity of 2D/DE were: ASD, 87.9% and 100%; VSD, 97.9% and 96.1%; PDA, 86.7% and 98.2%, Tetralogy of Fallot, 6 of 6 patients; the overall sensitivity and specificity of the less common defects, 31.6% and 95.8%. Ninety-seven (80.8%) were prospectively identified by catheterization. The sensitivity and specificity of catheterization were: ASD, 87.9% and 100.0%; VSD, 80.9% and 94.6%; PDA 93.3% and 96.6%; Tetralogy of Fallot, 6 of 6 patients, the less common defects, 52.6% and 95.5%. Forty-five (81.8%) were prospectively identified by angiography in 55 patients. The sensitivity and specificity of angiography: ASD, 5 of 7 patients, VSD, 88.0% and 94.3%; PDA, 2 of 2 patients; Tetralogy of Fallot, 5 of 5 patients; the less common defects, 68.8% and 100.0%. The economic evaluations were performed. The costs of the depreciation (including equipments and houses), hospital bed, water and electricity, management and staffs' wage were: 2D/DE, RMB 46.09 per patient; catheterization, RMB 314.17 per patient; angiography, RMB 314.17. The ratios of cost to outcome (cost per correct diagnosis) of 2D/DE, CC and CA were: 55.33, 388.82 and 384.07 respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1989

Clean, intermittent catheterization of infants with neurogenic bladder.

Clean, intermittent catheterization was instituted in 38 babies with myelodysplasia who were thought to be at risk for upper urinary tract deterioration because of neurogenic bladder dysfunction. There were 19 patients 2 weeks to 12 months of age, 11 were 1 to 2 years of age, and 8 were older than 2 years. Effectiveness of clean, intermittent catheterization was determined by maintenance of upper urinary tract stability. Upper urinary tracts improved or remained stable in 13 of 16 infants (81%) with reflux and 16 of 18 infants (89%) with detrusor-sphincter dyssynergia. Bacteriuria was present in 16 (42%), with only 2 infants (5%) having a febrile episode; no infant required hospitalization because of urinary tract infections. No further complications were identified in infants who were cleanly and intermittently catheterized. Most families found clean, intermittent catheterization of their infants easy to master and not stressful, and their children adjusted to it at an early age.

Bacteriuria↗

PubMed1989

[Heart catheterization: experience with 1000 examinations].

Catheterization of the right and left heart by the percutaneous technique, incl. Rashkind's septostomy, was performed in 1000 patients with body weights from 2 kg and above between 1977 and 1984. The technique of the examination is described. The patients belonged to the following age groups: 1st day to one year--28%, 1-5 years--28.6%, 6-15 years--31.9%, above 15 years--11.5%. The authors recommend to reduce the incidence of complications by continuous monitoring of the blood pressure during catheterization by means of an arterial catheter. As to complications, they recorded three deaths within 24 hours after catheterization: 2 infants and one adult patient, i.e. a mortality rate of 0.3% as compared with 1.5-3% reported in the literature. As to serious dysrhythmias, there was once ventricular tachycardia and one ventricular fibrillation. In two patients during angiocardiography the contrast substance was injected into the myocardium. Cardiac tamponade was described twice. In one infant on the second day after catheterization a thrombus was removed from the femoral artery. A computer proved useful for the calculation of haemodynamic data.

Adolescent↗

PubMed1979

Percutaneous transhepatic catheterization technique of the portal venous system.

The most widespread technique for catheterization of the portal venous system is the percutaneous transhepatic with selective catheterization of the portal tributaries. The procedure is most often used for portography in patients with liver cirrhosis, but can also be used for pharmacoligic, metabolic and hemodynamic studies. By selective catheterization of the gastrooesophageal veins varices can be obliterated. Selective catheterization of the pancreatic veins with blood sampling for hormone assay may diagnose and localize endocrine pancreatic tumours.

Catheterization↗

PubMed1987

[Autonomic cardiovascular regulation and permanent catheterization in normotensive conscious (WKY) and spontaneously hypertensive (SHR) rats].

In cardiovascular research, methods of indwelling catheterism have been frequently described. In the present work, we used normotensive and SHR rats to compare carotid catheterism to left ventricular catheterism, this last method being proposed by some investigators for cardiac index measurement. Our results of plasma catecholamines and autonomous nervous system activity show that ventricular catheterism results in an important disturb in cardiovascular regulation and question its validity to study cardiac function.

Acetylcholine↗

PubMed1988

[Malpositions and complications following central venous catheterization in relation to the access site].

Malpositions and complications following central venous catheterization largely depend on the site of venous approach. Malpositions are very common after subclavian vein catheterization, and even more common after left jugular vein catheterization. On the contrary, their incidence after right jugular puncture is very low. Among complications, pneumothorax is quite common after subclavian vein catheterization, and migration of the catheter towards the heart after right jugular puncture. Vascular damages may occur in any approach: their early detection on chest radiographs very much depends on a rigorous technique. Radiology plays an important role in the early detection of malpositions and complications, which is greatly facilitated by a few ml of contrast medium injected through the catheter.

Axillary Vein↗

PubMed1986

Two-dimensional/Doppler echocardiography and its relationship to cardiac catheterization for diagnosis and management of congenital heart disease.

The impact of echocardiography on cardiac catheterization in an individual patient with congenital heart disease depends on a number of factors, including the availability of an echocardiographer who is experienced in congenital heart disease and of appropriate "state of the art" equipment, and willingness of clinicians and surgeons to accept echocardiographic data. The latter is influenced by factors such as completeness of the echocardiographic data, familiarity with tomographic cardiac anatomy, and the perceived risk of an invasive procedure. The combined use of echocardiography and catheterization will have an increasing impact on the management of these patients, significantly altering the indications and extent of a catheterization procedure. This will lead to a more goal-directed examination. The relationship between catheterization and 2-D/Doppler echocardiography should not be adversarial, but complementary. Increasingly, noninvasive techniques will support or complement the invasive procedure, particularly as echo technologies for invasive applications are further developed.

Cardiac Catheterization↗

PubMed1986

[Venous thrombosis in central venous catheterization: incidence and promoting factors].

The frequency of venous thrombosis during central vein catheterization was prospectively studied in a group of 51 patients (53 catheterizations) during a 10-month period. 12 catheterizations (23%) resulted in thrombosis as revealed by phlebography. Of these, 11 were due to catheters whose site of entry was the upper limb. No other favoring factors (osmolality of the infused fluids, length or catheterization etc.) were detected. Ideally, to avoid thrombosis, central venous catheters should be inserted via the jugular or the subclavian vein, while bearing in mind that these other routes are not devoid of complications either.

Adolescent↗

PubMed1985

Long-term follow-up of patients having cardiac catheterization and cardiac operation. Small community hospital results before and after surgery program.

We followed, for a mean period of 67 months, 710 unselected consecutive cases of cardiac catheterization. Catheterizations were done on 298 patients without an in-house cardiac surgery team. When a cardiac operation was required, patients in this group were referred to a distant university medical center and were followed up after 49 and again at 103 months. After the community hospital's surgical team was established, 412 patients were catheterized and follow-up carried out for 45 months. Results show that patients in a community hospital without an in-house cardiac surgery team can be catheterized with low risk, then transferred safely to a distant center for surgical treatment without interim mortality and with good long-term results.

Adolescent↗

PubMed1986

[Complications and results following transseptal or retrograde transaortic catheterization of the left ventricle in patients with aortic valve stenosis].

Retrograde transvalvular left heart catheterization was successful in 46 cases out of 71 consecutive patients with severe valvular aortic stenosis. In 16 patients the transseptal route was used and in the remaining 9 patients surgery was performed without left ventricle pressure recordings. There were no differences in aortic valve area or in pressure gradients in pure stenosis (n = 29) whether retrograde catheterization succeeded or not. In combined aortic valve disease with prevalence of stenosis (n = 42) transaortic catheterization succeeded less frequently in patients with higher pressure gradients. The complication rate increased with duration of catheterization, but without adverse consequences for any patient.

Adult↗

PubMed1985

Functional recovery of the bladder in patients with spinal cord injury--prognosticating programs of an aseptic intermittent catheterization.

Ninety patients with spinal cord injury were managed by aseptic intermittent catheterization program I (preventing the over-distension of the bladder) and program II (allowing overdistension) in which recovery of bladder function and the clinical effects were comparatively investigated. Using program I, cases with positive BCR restored the automaticity of the bladder on average 8 weeks after injury. When urinary incontinence first occurs during aseptic intermittent catheterization, urinary training may be commenced since the bladder has then recovered from spinal shock. Cases with no BCR do not restore automatic bladder contraction. Program II delayed or weakened the recovery of bladder function considerably. Patients with incomplete lesions and sacral sparing, particularly those with urinary sensation, should be managed by program I which does not impair recovery of the bladder. It is possible to prevent urinary incontinence and infection, if paraplegics with complete lesions are managed by program II. The percentage of urinary infection was 22.6 +/- 16.0% (N = 90) during aseptic intermittent catheterization (non-touch technic) among whom no statistically significant difference between those with trigger voiding (22.2 +/- 17.2%, N = 57) and those with self-catheterization (23.2 +/- 14.0%, N = 33) was found.

Adolescent↗