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PubMedDate not supplied

Undergoing cardiac catheterization: the effects of informational preparation and coping style on patient anxiety during the procedure.

OBJECTIVE: To examine the effects of coping styles and preparatory informational treatments on patient anxiety during cardiac catheterization. DESIGN: Prospective, experimental, random assignment, repeated measures design. SETTING: Canadian, university-affiliated, large urban hospital. SUBJECTS: 145 adult patients (107 men and 38 women) scheduled for their first cardiac catheterization. Age range was from 34 to 78 years. Mean educational level was 10.72 years. OUTCOME MEASURES: Subject's coping style, "monitoring" (information seeking) or "blunting" (information avoiding) was assessed by means of Miller's Behavioral Style Scale. Subjects' anxiety was assessed using three measures: (1) a self-report measure, the Subjective Units of Distress (SUDS) Scale; (2) a behavioral measure, the Cardiac Catheterization Adjustment (CA) Scale; and (3) physiologic measures, heart rate and systolic and diastolic blood pressure. INTERVENTION: After coping style assessment, monitors and blunters were randomly assigned to receive one of three preparatory informational treatments: (1) videotaped procedural modeling information, (2) videotaped procedural-sensory modeling information, and (3) procedural-sensory information booklet. RESULTS: Analysis of variance techniques applied to the anxiety data revealed the following: (1) significant changes in self-reported patient anxiety occurred as a function of occasion rather than preparatory informational treatment or coping style, (2) subjects receiving the three preparatory informational treatments demonstrated significantly different behavioral adjustments during cardiac catheterization, and (3) most subjects demonstrated heart rate and blood pressure readings in the normal range; however, significant changes in cardiovascular reactivity were found to be associated with contrast dye insertion. CONCLUSIONS: Subjects who received the videotaped modeling treatments demonstrated greater behavioral adjustment than patients who received the information booklet. Questions remain as to whether the procedural modeling treatment is more efficacious than the procedural-sensory modeling treatment. Increases in subjects' SUDS levels were found to be associated with changes in ideational content. Changes in blood pressure and heart rate were attributed to physiologic and psychologic factors. Coping style did not appear to significantly influence any of the measures of patient anxiety.

Adaptation, Psychological↗

PubMed1993

[The complications associated with the performance of heart catheterizations (diagnostic and therapeutic). The results in the Hemodynamics Laboratory of Hospital de Santa Marta].

OBJECTIVES: To evaluate the morbidity and mortality with cardiac catheterization (diagnostic and intervention). DESIGN: Retrospective analysis of complications occurring within 24 h of a cardiac catheterization, in three consecutive years (1989-1991). SETTING: Patients admitted to the Haemodynamic Laboratory of Santa Marta Hospital-Lisbon. PATIENTS: 4014 patients submitted to diagnostic and interventional procedures. MATERIALS AND METHODS: Registry analyze in order to obtain the following data: pathology, age, vascular approach and complications of cardiac catheterization. RESULTS: In three years there were 4014 cardiac procedures. 53.6% were performed in patients with coronary artery disease, 20% with valvular heart disease, 8.1% with congenital heart disease, 16.1% with others pathologies and 2.2% revealed normal vessels in coronary angiography. The incidence of ischemic heart disease was progressively higher in the studied years: 51.9% in 1989, 52.4% in 1990 and 55.2% in 1991. Data from population age showed the same tendency: mean age was 51, 53 and 55 years, respectively. Femoral approach was attempted in 95% of the studies, and the axillary in 2.15%. Complications of diagnostic and interventional cardiac procedures occurred in 3% of the patients. Dead occurred in 0.14%; arrhythmia, 0.37%; vascular, 0.14%; vasovagal/pyrogen reactions, 0.73%; myocardial infarction, 0.05%; and others, 1.58%. CONCLUSION: The diagnostic and interventional cardiac catheterization in experienced laboratories are a safe procedure with a reduced incidence of major complications.

Cardiac Catheterization↗

PubMed1993

[Intermittent self-catheterization in multiple sclerosis].

Intermittent self-catheterization was taught to 70 patients with multiple sclerosis (MS) between 1.9.1989 and 31.1.1992 in Masku Neurological Rehabilitation Centre. All of them were interviewed in April 1992. Altogether 62 (89%) returned the questionnaires. The aims of the study were 1) to define the compliance of the patients to the treatment, and 2) to assess the effect of the catheterization on the quality of life of the patients. The conceptual framework used for the study was self care concept. Bladder symptoms had been present for seven years (mean) and the average time after the diagnosis of MS was ten years. Twenty eight (28) patients discontinued the treatment after having catheterized for 11 months in average. The main reason (50%) for discontinuation was normalization of the bladder function. The patients reported reduction in urgency symptoms, incontinence of urine and difficulties in emptying the bladder. All these changes were statistically significant. The number of urinary infections was slightly increased (not reaching statistical significance). However, the infections caused less subjective discomfort during the treatment than before it. The urinary symptoms interfered with the personal activities of the patients in a variety of ways. As many as 79% of the respondents reported that their quality of life was improved by the intermittent self-catheterization. The treatment allowed the patients to resume their personal, social -- and in some cases occupational--activities of daily living. Significant improvement was reported in f.e. family life, marital relationships, sexual life and the quality of night sleep.

Adult↗

PubMed1995

[Subdural catheterization uncovered by severe hypotension during epidural plus general anesthesia].

We experienced three cases of accidental subdural catheterization during epidural combined with general anesthesia. In each case, epidural catheterization was performed before induction of general anesthesia. Aspiration through the catheter and a response to a test dose were negative. Then anesthesia was induced with thiamylal IV and the trachea was intubated with vecuronium IV. Hypotension, which was not easily treated by vasopressors and volume load, occurred after administration of 3 to 8 ml mepivacaine with 1: 200,000 epinephrine through the catheter. We examined position of the catheter by injecting iohexol 240 and confirmed subdural catheterization after surgery. It is often difficult to identify subdural placement of an epidural catheter under general anesthesia since signs of massive sensory blockade are masked by general anesthesia. In each case, we suspected malpositioning of the catheter by severe hypotension due to sympatholysis which was difficult to treat. Subdural catheterization is a complication of epidural anesthesia that probably occurs more frequently than previously recognized and is usually unpredictable during general anesthesia.

Anesthesia, Epidural↗

PubMed1996

Chronic radiodermatitis following cardiac catheterization.

BACKGROUND: Fluoroscopy and cineradiography used during coronary angiography expose patients to some of the highest doses of ionizing radiation in diagnostic radiology. The possibility of radiation-induced damage has been discussed by several authors in the past. However, to the best of our knowledge, chronic radiation dermatitis caused by exposure to x-rays during cardiac catheterization has not been described. OBSERVATIONS: We describe 4 patients in whom chronic radiodermatitis developed following multiple cardiac catheterizations and coronary angioplasties. The cumulative radiation doses to which these patients were exposed were retrospectively calculated to be a mean of 24.6 Gy per patient, with a range of 11.4 to 34.9 Gy. CONCLUSIONS: Chronic radiodermatitis is a threat in patients undergoing multiple cardiac catheterizations and angioplasties. In susceptible patients, radiation doses as small as 11.4 Gy, which can sometimes be emitted during 1 or 2 procedures, are potentially harmful. Awareness and protective measures against this long-term side effect of cardiac catheterization should be encouraged.

Aged↗

PubMed1995

Repair of femoral pseudoaneurysm after cardiac catheterization: utility of extraperitoneal iliac control.

Femoral artery lesions may occur after cardiac catheterization or percutaneous transluminal coronary angioplasty (PTCA). The incidence of pseudoaneurysm following transfemoral catheterization ranges from 0.21 to 6.25%. Among 3162 cardiac catheterization procedures thirteen (0.41%) patients presented a femoral pseudoaneurysm requiring surgical repair. The Authors reported their technical consideration about the utility of extraperitoneal iliac control during surgical repair of femoral artery pseudoaneurysm due to cardiac catheterization.

Aneurysm, False↗

PubMed1996

Reducing time in bed after cardiac catheterization (TIBS II)

BACKGROUND: More than 500,000 cardiac catheterizations are done annually in the United States for both the diagnosis and treatment of patients with coronary artery disease. A femoral artery catheter insertion site is usually used for these procedures, and postprocedure protocols call for prolonged bed rest with restricted patient movement. Time-in-bed standards vary widely, from 3 to 12 hours after cardiac catheterization to more than 24 hours of bed rest after angioplasty. Bed rest with restricted movement causes patient discomfort, increases nursing workload, and prolongs length of hospital stay. OBJECTIVE: To determine if there would be a significant difference in the incidence of bleeding from femoral artery insertion sites between cardiac catheterization patients who remained in bed for 4 hours and those who remained in bed for 6 hours after sheath removal. METHODS: An experimental-control group design was used with a convenience sample (N = 86) of adult patients undergoing diagnostic coronary angiography. Patients were randomly assigned to remain in bed for 4 hours (experimental) or 6 hours (control) after arterial sheath removal. Both groups had pressure dressings and sandbags in place over the insertion site during time in bed. RESULTS: There was no significant difference in the incidence of bleeding related to out-of-bed activity between the groups (chi-square = .31, df = 1). CONCLUSIONS: Requisite time in bed after cardiac catheterization can be safely decreased from 6 to 4 hours. This change has implications for enhancing patient comfort and decreasing both length of hospital stay and healthcare costs.

Aged↗

PubMed1996

[Urinary tract infection prevention in catheterized patients. Prevalence National Study: preliminary studies at the Pinerolo Hospital].

Urinary tract infection incidence can be a possible indicator of the quality of health care in hospital. It is now clear that some kind of health care, practice and particular organizational and structural orders change the risk of UTI during hospitalizations. One third of hospital infections can be prevented by carrying out specified rules and guidelines. About 80% of UTI are a consequence of bladder catheterism. According to Major Health Institute, our Hospital takes part in a Study Group on the incidence and prevention of UTI related to bladder catheterism. Preliminary results show how much surgery activity still weighs in the cases of necessity of catheterism. Differently, urinary retention and incontinence and diuresis monitoring have a minor incidence. However the incidence of UTI after bladder catheterism is very high in our study (until 85%) also and hence the subsequent necessary antimicrobical therapy.

Cross Infection↗

PubMedDate not supplied

Plasma thrombomodulin concentrations in infants and children undergoing cardiac catheterization.

Circulating plasma thrombomodulin (TM) is an endothelial cell marker which may reflect endothelial injury. To find out to what extent diagnostic cardiac catheterization irritates vascular endothelium we conducted a prospective study in 91 children. Soluble TM concentrations, along with thrombin generation, were measured before, at the end of and 24 hours after cardiac catheterization. Compared to starting values, TM concentrations showed a clearly significant increase at the end of cardiac catheterization and returned to pretreatment values 24 hours later. Thrombin generation followed a similar pattern. Five out of the 91 children demonstrated resistance to activated protein C (APCR). With respect to the remaining 86 children, all five APCR cases showed increased thrombomodulin concentrations along with enhanced thrombin generation. Data from this study indicate that increased TM concentrations after cardiac catheterization in children are a sign of short-term endothelial damage. Furthermore, together with enhanced thrombin generation, elevated plasma concentration of soluble TM may reflect this receptor's possible anticoagulant properties.

Adolescent↗

PubMed1997

Intermittent self-catheterization by quadriplegic patients via a catheterizable Mitrofanoff channel.

PURPOSE: Neurogenic bladder due to cervical spinal cord injury is often best managed by clean intermittent catheterization. Limited upper extremity function makes patients with quadriplegia dependent on caregivers for clean intermittent catheterization. The Mitrofanoff umbilical appendicovesicostomy provides easy access to the bladder in patients with all types of access difficulty. We evaluated the Mitrofanoff umbilical appendicovesicostomy in 7 patients with quadriplegia. MATERIALS AND METHODS: Four men and 3 women with cervical spinal cord injury underwent the Mitrofanoff umbilical appendicovesicostomy with appendix (5) or ileum (2). RESULTS: All patients are continent and able to self-catheterize via the umbilical stoma. In 1 patient with an ileal Mitrofanoff umbilical appendicovesicostomy umbilical incontinence was repaired surgically and stomal stenosis developed in 1, which required stomal revision. All patients use the stoma regularly. Four patients have moved out of care facilities and are living more independently. CONCLUSIONS: The Mitrofanoff catheterizable channel is a valuable option for bladder management in patients with quadriplegia. Clean intermittent self-catheterization allows these patients independent function and facilitates their return to productive lives outside care facilities.

Adult↗

PubMed1998

Plasma lipoprotein profiles change significantly during cardiac catheterization.

Most patients in acute myocardial infarction (AMI) undergo emergent coronary angiography (CAG). However, when to analyze lipoprotein profiles in AMI is not clear. To determine whether lipoprotein profiles change during catheterization, we measured serum lipid and apolipoprotein concentrations in 65 patients (51 men and 14 women) before and after catheterization. Heparin was injected at 50 units/kg for CAG and 200 units/kg for percutaneous transluminal coronary angioplasty (PTCA). We found that cholesterol and triglyceride decreased by 9.4% (P < 0.001) and 53.1% (P < 0.001), respectively, after catheterization. Apolipoproteins also decreased significantly. Variables decreased two to five times more after PTCA than after CAG. Lipoprotein lipase mass was higher after PTCA (267.8 +/- 135.3 micrograms/L) than after CAG (93.3 +/- 48.4 micrograms/L; P < 0.05). In conclusion, lipoprotein profiles change during catheterization. We recommend avoiding analysis of lipoprotein profiles after emergent CAG in AMI.

Adult↗

PubMed1998

[Chronic radiodermatitis after heart catheterization: the contributing role of ciprofibrate (Lipanor)?].

BACKGROUND: Radiodermatitis after cardiac catheterization procedures has been reported in only a few cases in the literature. This side effect may not however be uncommon after long or repeated endocavitary explorations. CASE REPORT: We observed a case of chronic radiodermatitis which developed after cardiac catheterization, in a patient treated with corticosteroids and ciprofibrate for lupus. The patient had undergone only one heart catheterization. A second catheterization performed when the patient had stopped ciprofibrate did not provoke new lesions. DISCUSSION: This observations would suggest that ciprofibrate could participate as a radiosensitizing factor in the development of radiodermatitis.

Cardiac Catheterization↗

PubMed1998

The effect of early ambulation on hematoma formation and vascular complications following 7 French diagnostic cardiac catheterization.

OBJECTIVE: To assess the feasibility and safety of early ambulation 3 to 4 h after diagnostic 7 French cardiac catheterization. DESIGN: Randomized, single-blind assignment to one of 3, 4 or 6 h ambulation postcardiac catheterization groups. SETTING: Tertiary care community hospital in an urban region. PATIENTS: Eight hundred and seventy-four consecutive inpatients and out-patients presenting for routine diagnostic cardiac catheterization. INTERVENTION: Hematoma formation and other vascular complications recorded at the time of discharge and 24 h later. MAIN RESULTS: No significant difference in hematoma formation rates was noted among patients mobilized at 3 h (3.6%), 4 h (4.8%) or 6 h (3.2%). Late hematoma formation occurred in 2.3% of patients. Other vascular complications were very rare. Reported rates of hematoma formation varied significantly (P < 0.05) among physicians, ranging from 0.9% to 8.0%. CONCLUSIONS: Early ambulation of patients 3 to 4 h after routine diagnostic 7 French cardiac catheterization is both safe and feasible. These findings could result in more efficient recovery bed utilization, reduced nursing costs and improved patient compliance with bed rest.

Anticoagulants↗

PubMed2006

Fully MR-guided hepatic artery catheterization for selective drug delivery: a feasibility study in pigs.

PURPOSE: To demonstrate the feasibility of hepatic catheterization for selective delivery of therapeutic agents using a clinical MRI scanner for real-time image guidance. MATERIALS AND METHODS: Experiments were performed in three domestic pigs (70-80 kg) using a clinical 1.5-T MR scanner. After abdominal three-dimensional contrast-enhanced MR angiography (3D-CE-MRA) was performed, endovascular devices with susceptibility markers were tracked with passive tracking techniques. Catheters were maneuvered into the primary and secondary hepatic arteries. Selective catheterization was verified using selective time-resolved CE angiography. Paramagnetic microspheres were administered to a different region for each liver. The resulting biodistributions were investigated using MR images. RESULTS: Successful selective hepatic catheterization was repeatedly demonstrated using passive tracking techniques. 3D-CE-MRA significantly aided the interventional procedure by showing the vascular anatomy, and maximum-intensity projections (MIPs) were used as roadmaps during the interventions. In all cases, microspheres were successfully delivered to the selected regions. The catheters were visualized at a maximum frame rate of five frames per second, allowing a good depiction of the devices and a reliable catheterization of the hepatic arteries. CONCLUSION: Fully MR-guided real-time navigation of endovascular devices permits complex procedures such as selective intra-arterial delivery of therapeutic agents to parts of the liver.

Animals↗

PubMed2006

Trans-septal catheterization in the electrophysiology laboratory: data from a multicenter survey spanning 12 years.

OBJECTIVES: We report the data from the Italian Survey on trans-septal catheterization (TSP-C) for catheter ablation of arrhythmias in the left heart that covered 2003 and previous years. BACKGROUND: Over the last decade the use of TSP-C in the electrophysiology laboratory has greatly increased. Recent data on number of procedures, accomplishment rate, and complications related to this procedure are lacking in a large cohort of patients. METHODS: Thirty-three centers participated in the survey. The data collected retrospectively for 2003 included the number of procedures, indications, methods, and the number and reason for unaccomplished cases along with complications. Retrospective data collected for previous years included the annual number of procedures and cumulative data concerning indications, accomplishments, and complications. RESULTS: Since 1992, 5,520 TSP-C procedures were used in arrhythmia ablation, with the peak increase in the use occurring in 2001. Trans-septal catheterization was performed for atrial fibrillation (AF) ablation in 78.3% of the procedures in 2003. The electrophysiologist independently performed the procedure in 29 of 33 centers. Trans-septal catheterization was successfully performed in 99.1% of the cases; the main reason for TSP-C not being performed was related to fossa ovalis/atrial septum anatomy. Complications were low both in 2003 and in the previous years (0.79% and 0.74%, respectively). CONCLUSIONS: Trans-septal catheterization in the electrophysiology laboratory is associated with a high success and low complication rate. The use of TSP-C has progressively increased over the last decade and is currently used primarily for AF ablation. Although possible, severe complications were rare.

Arrhythmias, Cardiac↗

PubMed1997

Intrathecal catheterization alone induces neuroimmune activation in the rat.

Intrathecal (i.t.) catheterization in the rat has been used extensively for drug delivery in various experimental paradigms. These indwelling i.t. catheters have been associated with inflammatory processes and tissue reactions external to the spinal cord in numerous clinical and animal studies. The purpose of this study was to determine whether i.t. catheter placement produced glial activation and changes in specific cytokine expression, i.e. neuroimmune activation, within the spinal cord which might cause altered sensory processing. Rats underwent i.t. catheterization or sham surgery and were killed at 3 or 14 days postsurgery (n> or =3 per group). Spinal cord segments were taken at the cervical level, tip of the catheter and distal to the catheter (thoracic levels). Immunohistochemistry was used to examine spinal localization of the cytokines, interleukin (IL)-6, IL-10 and glial activation (OX-42 for microglia and anti-glial fibrillary acidic protein for astrocytes). At 3 and 14 days after i.t. catheterization, there was an elevation in OX-42 and GFAP expression as compared to control (n=3) and sham surgery (n=4) groups. IL-10-like immunoreactivity was significantly increased in both the dorsal and ventral horns 14 days after i.t. placement as compared to the sham and normal groups. Conversely, IL-6-like immunoreactivity was not significantly different from sham or normal groups. These cytokine findings are discussed in the context of a differential role of specific cytokines in the potential generation of pain states or in the production of analgesia. This study demonstrated that i.t. catheterization induces robust neuroimmune activation that manifests as increases in glial markers and specific cytokine expression. This method should be controlled for, or alternate methods used for, drug delivery in nociceptive animal models that require spinally administered agents.

Journal Article↗

PubMedDate not supplied

Systemic and local effects associated with long-term epidural catheterization and morphine-detomidine administration in horses.

OBJECTIVE: The purpose of this study was to determine the systemic and local effects associated with long-term epidural catheterization and epidural morphine-detomidine administration in horses. STUDY DESIGN: Development of systemic or local effects was assessed by placing caudal epidural catheters in study horses and administering injections through the catheters every 12 hours for 14 days. ANIMALS: Ten horses with epidural catheters that received daily injections; six uncatheterized horses presented for euthanasia. METHODS: Horses received either 0.2 mg/kg morphine sulfate and 30 micrograms/kg detomidine hydrochloride or an equivalent volume of physiologic saline solution through epidural catheters. Systemic effects were compared between control and treatment horses by measuring physical parameters and hay and water consumption, as well as by evaluating major organs after euthanasia. Local effects were studied by examining cerebrospinal fluid and by grading representative samples of the spinal cord and surrounding tissues histologically for inflammation and fibrosis. Local effects were compared between control and treatment horses, as well as between catheterized (control plus treatment) horses and uncatheterized horses. RESULTS: No significant difference was identified in daily variables or hay and water consumption between control and treatment horses. No growth was obtained from cerebrospinal fluid cultures. No significant difference in cerebrospinal fluid values or spinal tissue inflammation or fibrosis grades was shown between control and treatment horses. However, when compared with uncatheterized horses, cerebrospinal fluid red blood cell values were marginally higher and protein concentrations were significantly higher in the catheterized group. Lumbosacral and sacral spinal tissue segment inflammation grades, and sacral segment fibrosis grades were significantly higher in catheterized horses. CONCLUSIONS: Long-term epidural administration of a morphine-detomidine combination is not associated with apparent adverse systemic effects in horses. Localized inflammation and fibrosis seem to be catheter-related. CLINICAL RELEVANCE: Potential systemic and local effects are important considerations with long-term administration of a morphine-detomidine combination through indwelling epidural catheters for alleviation of chronic musculoskeletal pain in horses.

Analgesics↗

PubMed1999

Urinary Bladder Catheterization of Female Mice and Rats.

Catheterization of the urinary bladder of rats and mice is necessary for a variety of clinical and experimental reasons. The anatomy of the female mouse and rat is unique in that the urinary orifice is external and just anterior to the vaginal opening. This characteristic makes the bladder of these species easier to catheterize than that of other species. Methods cited in the literature do not adequately describe techniques that facilitate ease of urinary bladder catheterization (1). We describe a simple technique for urinary catheterization in adult female mice and rats.

Journal Article↗