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PubMed1977

[Complications of puncture catheterization of the subclavian vein in infants less than 1-year-old].

Autopsies of 61 infants under one year of age with catheterization of subclavian veins revealed in 27 cases complications of catheterization found both isolated and in various combinations. Their nature and frequency differed from those in adults. Noteworthy was a large number of hematomas of anterior mediastinum and parietal thrombi of the right atrium. Severe complications due to the penetration of the catheter into the pleural cavity or to hear perforation were more frequent. Among catheterization complications, emboly of vessels of the greater circulation through patent oval fenestra is possible. The occurrence of severe infectious complications in some cases is associated with the unobservance of the existing contraindications. The high frequency of complications observed at autopsies must be considered in deciding for indications for subclavian vein catheterization in infants under one year of age.

Catheterization↗

PubMed1978

Umbilical vessel catheterization; the immediate risks with the venous route.

Seven cases of heart arrest or pronounced bradycardia during 308 correct catheterizations of the umbilical vein in the first hours of life are reported. The indications for the catheterization were: 1. unsuccessful catheterization of the umbilical arteries in newborns with respiratory distress or post-asphyxia syndrome; 2. exchange transfusions for severe neonatal hyperbilirubinemia or sepsis; 3. monitoring the central vein pressure in severely compromised shocky newborns. Cardiac massage was always effective, at least temporarily, in restoring the heart activity. However, only three infants survived. Two of them had normal follow-up reported at 6 and 12 months respectively. The immediate risks and the necessary precautions for carrying out umbilical vein catheterization in severely ill newborns in the first hours of life are stressed.

Asphyxia Neonatorum↗

PubMed1983

Central venous catheterization for parenteral nutrition. Experience at Groote Schuur Hospital.

The aim of this study was to determine the incidence of complications of catheterization for total parenteral nutrition (TPN) in patients of the Parenteral Nutrition Unit of Groote Schuur Hospital. During the 2-year study period, 218 central venous catheters were inserted in 170 patients. The preferred technique of percutaneous infraclavicular subclavian venepuncture with subsequent subcutaneous tunnelling using a silicone elastomere catheter is described. The incidence of major complications of catheter insertion was 4,5% (pneumothorax 4, subclavian artery puncture 6). There was a 2,7% incidence of catheter malpositioning (requiring repositioning) at initial insertion. The mean duration of catheterization was 12,9 days. During this period there was a 6,9% incidence of mechanical complications (occluded lines 13, extravascular infusion 2). Catheter-related sepsis was suspected in 37 cases (16,9%) and all these catheters were removed, but in only 7 cases (3,2%) was the sepsis proved to be catheter-related. There was no correlation between the duration of catheterization and the development of catheter-related sepsis. Furthermore, there was no increase in the incidence of catheter sepsis in patients with sepsis before catheterization.

Catheterization↗

PubMedDate not supplied

Reducing post-catheterization bladder dysfunction by reconditioning.

The purpose of this study was to determine the effect of reconditioning upon bladder dysfunction caused by prolonged catheterization. Eight women undergoing surgery with baseline residual urine volumes (RUVs) not greater than 25 ml and catheterization durations of 36 to 106 hours qualified as subjects. Immediately prior to catheter removal, the four treatment group subjects received reconditioning, a procedure in which their catheters were clamped for three hours followed by five minutes of urinary drainage. This cycle was repeated twice more, totaling nine hours, ten minutes. The four control group subjects received no reconditioning. After catheter removal, reconditioned subjects resumed natural micturition significantly sooner than non-reconditioned subjects (t = -2.82, df = 6, p less than 0.05). A t test showed no significant differences between the groups in post-indwelling catheterization RUVs following the first micturition, probably due to the small number of subjects, since the control group's mean post-catheterization RUV increased to a physiologically abnormal level (42.25 ml), while the reconditioned group's mean RUV stayed within normal limits. This study should be repeated to test for statistical significance in larger samples.

Adult↗

PubMed1978

[Selective catheterization of peripheral arteries for the monitoring of patients in intensive care units].

In critical ill patients, determination of blood gases is a crucial part of patient evaluation and management. In intensive care situations many blood-gas determinations are required in a single day. The introduction of an arterial catheter into a small peripheral artery is an invaluable technique that allows continuous blood-sampling. During the past three years we had catheterized either the radial, ulnar or the pedal artery in 450 instances. The arterial catheter was left in place from 1 to 15 days. There were no serious complication. Haemorrhage due to accidental opening of the catheter occurred in three occasions. No case of ischaemia was encountered after a single artery catheterization. Temporary ischaemia of the upper limb appeared in three patients after simultaneous catheterization of both ulnar and radial arteries. The infection rate was nil. Arterial catheterization and maintenance of indwelling catheter for repeated blood-samples is a simple and safe procedure with minimal complications, invaluable in the management of critical ill patients.

Acid-Base Equilibrium↗

PubMed1982

Internal thoracic vein cannulation as a complication of central venous catheterization.

Central venous catheterization is utilized in resuscitation and evaluation of the severely ill patient. It is also employed for total parenteral nutrition. The list of potential complications is extensive and includes catheter malposition, with its attendant morbidity, as the most frequent complication. Inaccurate venous pressure measurements and mediastinal phlebitis have been cited as natural sequelae of inadvertent catheterization of the internal thoracic (mammary) vein (ITV). The histories of four patients who had ITV cannulation are analyzed as to indications for central venous catheterizations, site of insertion, time of delayed recognition, and attendant complications. In addition, the records of 150 consecutive patients who underwent central venous line placement were reviewed to determine the number of lines placed (242), the number and percentage of postcatheterization chest films obtained with standard posterior-anterior (P-A) and lateral technique (70, 29%), the number and incidence of catheterization-associated complications (78, 32%), and the number and incidence of ITV cannulation (5, 2%). No untoward results were seen as a result of this complication in the nine patients discovered, although the potential for morbidity was present. Subtle changes on portable chest films and standard technique P-A and lateral films remain the best protection against complications associated with ITV cannulation.

Adult↗

PubMed1978

[Cardiac catheterization of neonates and young infants using a flow-directed balloon catheter (author's transl)].

In cardiac catheterization with the Swan-Ganz-flow-directed balloon catheter the aorta or, in transposition of the great arteries, the pulmonary artery was entered from the left ventricle with a special heart catheterization technique in 68 neonates and young infants. In the same way selective aortography was performed in 29 of these patients. This catheterization technique has the following advantages: 1. the complete evaluation of complex cardiac anomalies even in neonates, 2. selective aortography avoiding the retrograde arterial catheterization, 3. reducing the risk of cardiac perforation or myocardial staining due to the contrast injection using the usual semirigid catheters. Balloon rupture or knotting are specific but avoidable complications.

Age Factors↗

PubMed1981

[Use of new internal jugular vein catheterization modified by using of a "catheter around the needle" (author's transl)].

Although widely used, subclavian catheterization has lost popularity to the benefit of internal jugular vein judged more secure. Numerous technics have been described. Since two years we use internal jugular vein catheterization according to the description of Boulanger et al. modified by using a "Catheter around the needle" type device 13 cm long and 1.65 mm wide. 122 patients have experienced 125 catheterizations which were performed on the right side in 96.8 p. cent of the cases. More than 50 p. cent of the patients was conscious at the time of venepuncture. 118 attempts were successful. In 7 cases failure was due either to impossibility of puncture (4 times) or catheterization (3 times). The sole complication was accidental arterial puncture (5 times, 4 p. cent). 4 of them at the time of failure of venepuncture. Training has an important role in the occurrence of failures and complications. They were much more frequent during the twenty first attempts. According to us this technic can reduce incidence of accidental arterial puncture. The risk of pneumothorax is low in spite of the length of the needle. But because of the length and relative stiffness of the catheter the tip is always located in the superior vena cava when the right side has been chosen.

Adolescent↗

PubMed1978

Intermittent catheterization: long-term follow-up.

Intermittent catheterization for bladder retraining after spinal cord injury has been in common use in the United States for only the last 10 years. It was initiated at the Ohio State University Hospitals in 1972. In a retrospective evaluation of the effectiveness of intermittent catheterization in 100 spinal cord injured patients, 94 were found to have been discharged catheter-free, ie, without a catheter and off intermittent catheterization. After 3 to 4 years of follow-up, 63 patients were found to have remained catheter-free, 15 were no longer catheter-free and 16 had been lost to follow-up. From an analysis of the data from the study (reasons for failure, complications, etc) and comparison with those from other studies, it is suggested that a prospective study be devised to evaluate intermittent catheterization more effectively.

Adolescent↗

PubMed1980

Management of brachial artery occlusion after cardiac catheterization.

Our management of patients with suspected brachial artery injury following cardiac catheterization and the results of operative management in 42 patients are reported. From this review the following suggestions or conclusions are made: 1) The absence of a distal radial pulse or a 30-mm Hg difference in forearm pressures four hours after brachial artery catheterization is indicative of a pathologic occlusion at the site of catheterization. 2) Adequate anticoagulation with heparin should be used during the observation period. 3) When indicated, reexploration of the brachial artery should be performed in the operating room using local anesthesia. 4) Resection of a segment of injured brachial artery with an end-to-end anastomosis using interrupted sutures gives good results. Attempts at "plastic" repair without resection were ususlly accompanied by reobstruction. 5) Arterial pressures in both arms, as monitored with a Doppler instrument before and after exercise, were of value in evaluating these patients pre- and postoperatively. 6) No preoperative arteriograms were required. 7) Restoration of adequate circulation was achieved in 97 per cent of patients operated on for brachial artery injury within 24 hours of cardiac catheterization and using the techniques described. 8) The good operative results and low morbidity suggest early repair for all confirmed brachial artery injuries.

Arterial Occlusive Diseases↗

PubMed1995

[Chemotherapy through selective pelvic artery catheterization complicated by mural thrombosis].

Through catheter on uterine artery digital subtractive angiography (DSA) intraarterial infusion of chemotherapeutic agents for the treatment of malignant trophoblastic diseases can raise local drug concentration, improve therapeutic results and reduce general side-effects. But mural thrombosis, a possible complication of intra arterial catheterization, should not be overlooked. This study reports 2 cases of mural thrombosis complication in selective pelvic artery catheterization for chemotherapy. The incidence, relevant factors to its occurrence such as technique of catheterization and the duration of catheter retention, as well as measures of prevention and treatment of mural thrombosis are discussed together with review of literature. With regards to prevention of mural thrombosis, stress is being laid on the importance of the technique of catheterization. Preliminary comments on the problem of heparin administration as a preventive measure of mural thrombosis are made.

Adult↗

PubMed1995

On-site catheterization laboratory and prognosis after acute myocardial infarction. Israeli Thrombolytic Survey Group.

BACKGROUND: Since the introduction of thrombolytic therapy for patients with acute myocardial infarction, the use of coronary angiography has substantially increased. We sought to determine whether the presence of on-site coronary angiographic facilities influenced the utilization of coronary procedures in patients with acute myocardial infarction hospitalized in Israel's coronary care units. METHODS: A prospective survey was conducted in January and February 1992 in the 25 coronary care units operating in Israel, 15 of which had on-site catheterization facilities. Data on demographics, clinical features, thrombolytic therapy, and the type of coronary diagnostic or therapeutic procedures performed during the current in-hospital stay were recorded. Mortality, both in-hospital and 1 year after discharge, was assessed for all patients in the survey. RESULTS: One thousand fourteen consecutive patients with acute myocardial infarction were hospitalized during the survey, 307 (30%) of whom were admitted to 10 coronary care units without and 707 of whom were treated in hospitals with on-site coronary angiography facilities. Demographic and baseline characteristics were similar in both groups. Thrombolytic therapy was provided equally (46%) to patients admitted to hospital with and without catheterization laboratories. Patients admitted to hospitals with these laboratories underwent coronary angiography (26%) and percutaneous transluminal angioplasty and/or coronary artery bypass grafting (12%) in greater numbers than counterparts admitted to hospitals without such laboratories (10% and 5%, respectively). Hospital and cumulative 1-year mortality rates were 11% and 18%, respectively, in patients admitted to hospitals with on-site catheterization facilities vs 10% and 17%, respectively, in the patient group admitted to the other hospitals. Patients receiving thrombolytic therapy had similar hospital mortality rates unrelated to the availability of coronary catheterization laboratories. CONCLUSION: This national survey showed that the availability of invasive coronary facilities led to increased use of diagnostic and therapeutic coronary procedures among patients with acute myocardial infarction. There was no difference in hospital or 1-year mortality rates in patients admitted to hospitals with or without on-site coronary angiographic facilities.

Aged↗

PubMed1994

[Percutaneous transluminal therapy of local arterial vascular occlusion after heart catheterization studies].

We analyzed the incidence and management of a vascular occlusion at the arterial puncture site following diagnostic or interventional cardiac catheterization. During the study period 26,245 cardiac catheterization procedures were performed for diagnostic (n = 18,895) or interventional (n = 7350) purposes at our institution. A total number of 35 arterial occlusions (0.13%) was identified. In the early phase of our analysis 14 patients (40%) with peripheral vascular obstruction after cardiac catheterization underwent surgical repair. Three patients (9%) could be treated conservatively. In 18 patients (51%) acute vascular occlusion could be managed by additional intravascular manipulations: 18 patients underwent successful percutaneous transluminal balloon dilatation, in nine patients in combination with intravascular thrombolysis. In three patients additional stent-implantation was necessary in the presence of a large occlusive dissection. The procedure was primarily successful in 16/18 patients. No significant complication occurred. In two patients reocclusion led to operative thrombectomy and patch reconstruction in one and to a second catheter-based approach in the other patient. Both reinterventions were successful. Thus, in experienced hands catheter-based therapy of acute arterial obstruction following diagnostic or interventional cardiac catheterization is very effective and should be considered as therapy of first choice in these patients.

Aged↗

PubMed1994

[Ultrasonographic survey of the effect of umbilical arterial catheterization in newborn infants].

BACKGROUND: Incidence of aortic thromboses in the neonatal period is significantly increased after umbilicar artery catheterization. POPULATION AND METHODS: Fourty neonates (GA: 34.7 +/- 7.2 wks and birth weight: 2377 +/- 786 g) were prospectively studied in order to assess frequency and natural history of aortic thromboses due to umbilical artery catheterization. Investigation was based on serial real-time ultrasonography (2.3 times/week). Presence of aortic thrombus was correlated with the existence of clinical complications and the results of biological findings (prothrombin and fibrinogen levels; hematocrit) and platelet number. RESULTS: Aortic thrombosis was found in six patients (15%); it was clinically asymptomatic in two (5%). A vascular wall-fixed catheter was shown in ten infants (25%); this finding was associated with thrombosis in five cases and preceded thrombosis in one other. The presence of thrombus and/or abnormal position of the catheter was not correlated with gestational age, birth weight, duration of catheterization, blood hemostasis and results of bacteriological cultures of the tip of the catheter. CONCLUSIONS: Ultrasonographic control must be repeated after umbilical artery catheterization. It permits evaluation of renal flux and can lead to removal of catheter and/or peculiar therapeutic measures.

Aorta↗

PubMed1994

Post-cesarean section urinary tract infection: a comparison between intermittent and indwelling catheterization.

Catheterization, which is widely accepted as an important factor to urinary tract infection, is routinely done during cesarean section. This randomized study was conducted to compare the incidence of urinary tract infection between patients who underwent cesarean section using intermittent catheterization and indwelling catheterization, at the Department of Obstetrics and Gynecology, Ramathibodi Hospital from August 1991 to December 1991. Sixteen of 51 patients (31.4%) of the intermittent group and 9 of 47 patients (19.1%) of the indwelling group developed urinary tract infection. The difference was not statistically significant. Of the patients in the intermittent group 39.2 per cent were found to have postoperative urinary retention requiring recatheterization, whereas all cases in the indwelling group could void after its removal. Klebsiella pneumoniae was the commonest isolated organism. Indwelling catheterization was concluded to be the favourable method.

Catheters, Indwelling↗

PubMed1994

Use of a mechanical pressure device for hemostasis following cardiac catheterization.

BACKGROUND: Peripheral vascular complications that can occur after cardiac catheterization are costly and cause patient discomfort. OBJECTIVES: To determine the difference in frequency of vascular complications in a convenience sample of cardiac catheterization patients who had mechanical pressure vs digital pressure for postprocedural hemostasis. METHODS: A quasi-experimental design was used. The study group consisted of 100 patients on whom a mechanical clamp was used to effect hemostasis; the control group consisted of 100 patients who received digital pressure for hemostasis. Data from the control group were obtained retrospectively through review of cardiac catheterization charts. RESULTS: The two groups showed statistically significant differences for the number of catheters used, mean time elapsed between arterial entry and catheter removal, and compression time. There was no significant difference in complication rate between the groups. DISCUSSION: Complications including hematoma formation, arterial occlusion, ischemia and traumatic neuropathy were monitored. CONCLUSIONS: The mechanical pressure device is a safe, cost-effective alternative to digital pressure for hemostasis following cardiac catheterization. Further studies are needed to verify these results and the effectiveness of the device following other percutaneous intra-arterial procedures.

Cardiac Catheterization↗

PubMedDate not supplied

[Internal jugular vein catheterization performed by resident and staff physicians].

OBJECTIVES: To analyse complications in the catheterization of the internal jugular vein using the Boulanger technique and to establish a rating of difficulty and risk when the procedure is carried out by physicians in training. MATERIAL AND METHODS: This was a prospective study of 296 internal jugular vein (IJV) catheterizations by the Boulanger technique carried out by physicians in training (group R2 and group R3-4) or by departmental staff physicians (group staff). Time taken for venous catheterization, rate of success and complications were recorded for each physician performing the procedure. RESULTS: The complication most often observed (11.4%) was puncture of the carotid artery (14.3% group R2, 10% group R3-4 and 8.2% staff), followed by arrhythmia upon insertion of the metal guide (1.6%). There were no instances of pneumothorax or hemothorax, nor any other of the early complications considered infrequent. Success ranged from 68.8% for group R2 to 85.7% for staff. Mean time used in group R2 was 238.7 seconds, while for staff it was 118.3 seconds. CONCLUSION: We suggest that the Boulanger technique for catheterization of the internal jugular vein is a good one and is not particularly hazardous when performed by resident physicians in training.

Adolescent↗

PubMedDate not supplied

[Is the use of prophylactic antibiotics of benefit in patients undergoing heart catheterization?].

The use of antibiotics in patients who undergo cardiac catheterization, by percutaneous approach, using re-sterilized catheters, is controversial, and there is not clear information in this regard. We investigated the frequency of bacteremia during cardiac catheterization and the evidence of later infection, using re-sterilized material. We studied 227 consecutive patients over one year, and we obtained 200 blood cultures of the beginning and the end of the procedure. All the cultures were negative and there was not evidence of clinical infection in the year following the study. These results indicated that bacteremia is rare during cardiac catheterization, if aseptic technics are followed. Based on these result we do not recommend the use of antibiotics in patients undergoing cardiac catheterization. The sex, age, type of heart disease and re-sterilized material do not alter this recommendation.

Adolescent↗