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PubMed2005

[Which is more useful for central venous catheterization? A comparison between a 22 gauge metal needle (Argyle) and a 24 gauge plastic cannula with a metal needle (Insyte)].

BACKGROUND: Central venous catheterization is commonly performed by puncturing the internal jugular vein. However, placement of central venous catheters is not without risk. We compared the Argyle and the Insyte in terms of usefulness and incidence of complications during central venous catheterization. METHODS: Twenty adult patients for cardiac operation were randomly allocated into two groups; 10 patients in the Argyle group (Group A) and 10 patients in the Insyte group (Group B). RESULTS: In both groups, no kinking or stucking of the guide wire occurred during insertion. No accidental puncture of the carotid artery occurred in Group B, while it occurred in one case in Group A. The time required for insertion of the guide wire was not significantly different between the two groups, though it tended to be shorter in Group B than in Group A (19.3 +/- 14.6 sec vs 34.6 +/- 34.0 sec). On ultrasonography, the Argyle was observed to compress the internal jugular vein and to be prone to penetrate both anterior and posterior walls. CONCLUSIONS: Using the Argyle makes it a little more difficult to place the needle in the appropriate venous lumen. We conclude that central venous catheterization with the Insyte was quicker and safer than with the Argyle.

Adult↗

PubMed1991

Vascular complications of cardiac catheterization.

Femoral artery injury after diagnostic and therapeutic cardiac catheterization is a frequently encountered clinical problem. This study reviews 150 femoral artery injuries that occurred in 16,350 patients over a 5-year period. A prospective computerized cardiac catheterization data bank was used to determine significant risk factors associated with the occurrence of vascular injury. Logistic regression analysis revealed that congestive heart failure, female gender, and percutaneous transluminal coronary angioplasty or valvuloplasty procedure were significantly associated with occurrence of vascular injury. Greater age, smaller body surface area, and smaller weight were also associated with injury. Recommendations for management include an aggressive approach to obstruction even if local vascular reconstruction is required. False aneurysms are studied by ultrasonography, and small ones may be observed expectantly. Larger aneurysms and aneurysms that persist beyond a few days are managed by use of general or regional anesthesia and by gaining proximal control of the iliac artery. Arteriovenous fistulas resulting from catheterization are rarely hemodynamically significant and often close spontaneously. Thus repair should be delayed.

Age Factors↗

PubMed1990

[Current risk of heart catheterization study and angiocardiography in children. A prospective study].

Parental permission for cardiac catheterization assumes detailed information about the character and frequency of all potential and inevitable threatening complications despite of maximal care. However, data on this subject were derived mainly from older and/or retrospective studies. In order to evaluate the actual risk we performed a prospective study lasting 11 months. All complications occurring during the 24 h following this invasive procedure were recorded. During 462 consecutive cardiac catheterizations in 421 patients (including 24 balloon-atrio-septostomies and five myocardial biopsies) there were complications requiring treatment in 18.2% of all examinations. There was no lethal complication. The following complications were documented: arrhythmia 6.5%, acidosis 6.1%, problems due to catheterizing an arterial or venous vessel 3.9% and 0.4% respectively; acute blood loss 1.5%, and problems concerning the probe in general 1.1%. In a frequency of less than 1% we encountered hypoxic spells, myocardial ischemia, hypoventilation/respiratory failure, febrile reaction, and allergic reactions due to contrast media. Contrary to data of the literature we could show a significant reduction of the risks involved in this examination. The following factors have contributed to this improvement: 1) a more careful patient selection for this invasive procedure; 2) a more experienced examiner; 3) better monitoring during the procedure; 4) a more detailed diagnostic work-up prior to the examination; and 5) better premedication of the patient.

Acidosis↗

PubMed1989

[Vascular injuries during percutaneous catheterization of the lower neck in children].

Four cases of vascular injuries of subclavian artery in children are reported after 414 percutaneous catheterization between 1980 and 1986. The first case reported is a 2 month old child with a right subclavian aneurysm after punction, witch be treated by a successful resection-anastomosis. Three others children, 12, 13, and 14 years old have been catheterized by a jugular approach for one and by a subclavian approach in the others. In this three cases the diagnosis was made by an important hemothorax requiring a drainage. In one case, the recovery was obtain only by drainage, in the two others a surgical approach was necessary with a suture of the subclavian artery in one and a ligation in the other case. The diagnosis of these vascular lesion is difficult = an hemothorax must be drained quickly and a persistent bleeding require a surgical treatment by a cervical route associated with a cleidotomy for the subclavian control. All catheterization in children must be realized by operator with a good practice and an adapted material. The jugular route must be preferred to the subclavian route in children.

Adolescent↗

PubMed1989

Caring for patients undergoing therapeutic cardiac catheterization.

Since the advent of pediatric interventional catheterization, the necessity of multiple cardiac surgeries has been reduced. Therefore, the morbidity and mortality of multiple thoracotomies in infancy is also minimized. The role of the critical care nurse in the cardiac catheterization laboratory has become a necessity and a challange. With courage and skill, the risk of interventional catheterization can be minimized and the results are rewarding.

Cardiac Catheterization↗

PubMed1993

Management of urethral stricture in patients practising clean intermittent catheterization.

Clean intermittent catheterization (CIC) is used commonly to treat patients with impaired bladder emptying. We treated 6 male patients who were experiencing difficulty with intermittent catheterization. Retrograde urethrography demonstrated stricture of the urethra in all of them and a false passage as well in one patient. Treatment consisted of urethral dilatation using filiform and followers in 4 patients and optical internal urethrotomy in the remaining 2 patients followed by urethral stenting using a 16 Fr. Teflon Foley catheter in all. The stenting Foley catheter was removed after 2 weeks. Subsequently 5 of the 6 patients had resumed CIC regimen to empty their urinary bladder. The sixth patient with a false passage could not perform CIC and suprapubic cystostomy was performed. During a follow-up of 6 of 18 months, none of these five patients developed recurrence of urethral stricture and all are practising CIC without any difficulty. Analysis of our data revealed that forceful manipulation during catheter insertion and significant urethral bleeding during catheterization are important contributory factors for the development of urethral stricture in patients practising CIC.

Adult↗

PubMed2003

Applications and complications of subclavian vein catheterization for hemodialysis.

OBJECTIVE: To study the indications, complications and duration of 605 subclavian catheters inserted over a period of 4 years as venous access for the management of renal failure in local setup. DESIGN: Cross-sectional descriptive study. PLACE AND DURATION OF STUDY: Hemodialysis section, Department of Urology and Kidney Transplantation, Lahore General Hospital, Lahore. The study was conducted from October, 1998 to July, 2002. SUBJECTS AND METHODS: All patients coming for dialysis during the period of October 1998 to July 2002 were included information noted on specific form. RESULTS: Among the patients who underwent subclavian vein catheterization, 75.2% patients were suffering from chronic renal failure and 24.7% patients were admitted for acute renal failure. Among chronic renal failure patients, 21.9% catheters had to be replaced due to various complications e.g. thrombosis, infection or kinking of the catheter. The subclavian catheters remained in place for a mean duration of 4 weeks. Early complications encountered were arterial puncture, inability to cannulate the innominate vein, hemothorax, puncture of thoracic duct, hemomediastinum, arrhythmias and pulmonary hematoma in 10.7%, 16.5%, 0.5%, 0.2%, 0.6% and 0.2% of patients respectively. Mortality attributed to the procedure occurred in 0.1 % cases. Delayed complications included early infection in 15% catheterizations while delayed infection occurred in 39 % cases. CONCLUSION: Percutaneous subclavian catheterization is valuable, relatively easy to learn and safe method with acceptable rate of complications for patients necessitating hemodialysis and no established permanent vascular access.

Acute Kidney Injury↗

PubMed1986

Central vein catheterization. Failure and complication rates by three percutaneous approaches.

We prospectively studied the results of 714 attempts at central venous catheterization during an eight-month period in our intensive care department. We compared the rates of failure of catheterization and early complications among three percutaneous approaches: subclavian, anterior jugular, and posterior jugular veins. The procedures were performed by experienced staff or resident physicians and inexperienced interns and residents under teaching supervision. Overall rates of failure and complication were similar for each percutaneous approach within each group of physicians. Overall failure rate was 10.1% for the experienced group and 19.4% for the inexperienced. The complication was 5.4% for experienced and 11% for inexperienced. Among inexperienced physicians, the success rate was 86.7% and the complication rate 7.6% in unconscious patients, whereas in conscious patients these rates were 70.5% and 13.8%, respectively. The inexperienced physicians caused fewer complications in mechanically ventilated than in spontaneously breathing patients. We suggest that inexperienced physicians should first attempt central vein catheterizations in unconscious and mechanically ventilated patients.

Adolescent↗

PubMed1989

Arteriovenous fistulas after cardiac catheterization.

In a review of five Dayton, Ohio, area hospitals during a six-year period, seven patients who were treated for an acquired arteriovenous (A-V) fistula after cardiac catheterization were identified. Four patients had undergone cardiac studies in area hospitals, while three were studied elsewhere. The four A-V fistulas after 23,291 cardiac catheterization procedures in Dayton hospitals represented an incidence of 0.017% for this complication. Congestive heart failure and limb ischemia were the most frequent presenting symptoms that developed from two to ten months after catheterization. Intentional puncture of both the artery and vein of the ipsilateral groin for right- and left-sided heart studies was the probable cause of fistula formation in two cases. Five patients sustained inadvertent injury to both an artery and adjacent vein during percutaneous vascular access. Six A-V fistulas that involved femoral vessels were managed by division of the fistula with lateral repair of the artery and vein. An unusual communication between the right thyrocervical trunk and the internal jugular vein was handled by ligation of the affected vessels. Prompt surgical correction of this unusual complication of percutaneous vascular access is recommended as spontaneous closure is unlikely.

Adult↗

PubMed1992

Duplex scans before subclavian vein catheterization predict unsuccessful catheter placement.

Subclavian catheterization in patients with cancer is associated with up to a 38% incidence of subclavian vein thrombosis. These thrombi seldom recanalize. The persistent occlusion of the subclavian vein may hinder subsequent catheter placement. To determine the frequency of this occurrence and to determine if preoperative duplex scanning could identify these individuals, we performed preoperative duplex scanning in 22 patients who had previously had an indwelling subclavian catheter for chemotherapy. Subsequent subclavian vein catheterization was attempted without knowledge of the results of the duplex scan. Nineteen scans were normal. Of these, 18 patients underwent successful catheter placement. In one patient, catheterization was unsuccessful and an intraoperative venogram showed a focal obstruction of the proximal portion of the subclavian vein. Three scans showed noncompressibility of the vein, and catheter placement was unsuccessful in these three veins. In patients who have had previous subclavian catheters, persistent obstruction of the vein prevents subsequent catheter placement in 14%. Duplex scanning before subsequent catheter placement generally identifies these individuals.

Bone Marrow Transplantation↗

PubMed1997

Reduction of femoral artery bleeding post catheterization using a collagen enhanced fibrin sealant.

As the number of cardiac catheterization procedures increases, so do associated complications and costs. This study suggests that the application of a new collagen enhanced fibrin sealant, Collaseal, may be used effectively to achieve rapid hemostasis at the arterial puncture site following femoral artery catheterization. Results in nine dogs anticoagulated with heparin (activated clotting time 396 +/- 107, mean +/- S.D.) revealed a statistically significant reduction in signs of gross bleeding in the sealant-treated groins as compared to control (2 versus 9, P = .0156). These results indicate that this commercially produced sealant might be used in human patients undergoing cardiac catheterization to decrease complications, lengths of stay, and costs.

Animals↗

PubMed1997

Predictors of arterial thrombosis after diagnostic cardiac catheterization in infants and children randomized to two heparin dosages.

Arterial thrombosis is the most frequent major complication of percutaneous arterial catheterization in children. We prospectively studied the effect of randomized dosage of heparin, 50 IU/kg-group I and 100 IU/kg-group II, on the incidence of arterial thrombosis in 366 children and analysed the various factors which may influence the occurrence of this complication. The age of patients ranged from 17 d to 11 yr (mean age 39.5 +/- 40.9 mo) and mean weight was 11.2 +/- 7.8 kg (range 3 to 39 kg). The incidence of arterial thrombosis was 9.8% in group I and 9.3% in group II (P = NS). There was no statistical difference in precatheterization and procedure variables in the two groups and also in the group with absent pulse (n = 35) to the group with pulse present post cath (n = 331). There were 24.9% infants in our study and 14.3% of these had arterial thrombosis. The loss of pulse was more often seen with more number of attempts at arterial puncture (P < 0.001), absence of back bleed at the end of the procedure (P < 0.001), and increased duration of catheterization (P < 0.01). Use of larger sheath size in a given weight and body surface area of children increased incidence of arterial thrombosis. The administration of heparin 50 IU/kg was equally efficacious to heparin 100 IU/kg. Of the patients with arterial thrombosis, 23 responded with intravenous heparin and 12 needed streptokinase. There was no bleeding or haematoma. Thus our study shows that less attempt for arterial puncture, use of smaller sheath size, maintaining shortest procedure time and ensuring back bleed minimises incidence of arterial thrombosis post catheterization.

Anticoagulants↗

PubMed1997

Pyrogenic reactions in patients undergoing cardiac catheterization associated with contaminated glass medicine cups.

Pyrogenic reactions are potentially life-threatening complications caused by bacterial endotoxin. After two cardiac catheterization patients developed rigors the same day, the procedures were halted and a case control study was conducted. To identify case patients (persons with rigors < or = 3 hr after catheterization during September 25-November 9, 1995), we reviewed medical records of all cardiac catheterization patients who had a blood culture or received intravenous meperidine. Twelve case patients and 40 randomly selected control patients were identified. No specific catheter was associated with case patients, but exposure to intracoronary-nitroglycerin (NTG) was (odds ratio = 12.0; 95% confidence interval 2.2, 75.6). NTG or indocyanine green dye was poured into glass medicine cups previously washed in an enzyme cleaner and then sterilized. The cleaner, used for an entire day, had elevated levels of gram-negative bacteria (> 10(4) colony forming units/mL) and endotoxin (434 endotoxin units [EU]/mL]); the reprocessed cups had no live bacteria but had elevated endotoxin levels (median 2,250 EU). Exposure to contaminated glass medicine cups probably resulted in pyrogenic reactions and contributed to death in two critically ill patients.

Aged↗

PubMed1997

Early ambulation following 6 French diagnostic left heart catheterization: a prospective randomized trial.

Outpatient cardiac catheterization is frequently performed, but the optimal recovery time after sheath removal has not been defined. Left heart catheterization was performed via the femoral artery utilizing 6 French catheters on 323 outpatients. One hundred thirty-five patients were randomized to ambulate at a mean of 2.5 hr (group 1) after puncture site compression, whereas 188 patients were randomized to ambulate at a mean of 4.1 hr (group 2). Telephone follow-up occurred within 48 hr. A small hematoma (< 5 cm) occurred in 2 (1.6%) patients in group 1 and in 4 (2.4%) patients in group 2. These results indicate that it is safe to ambulate patients 2.5 hr following 6 French diagnostic heart catheterization.

Cardiac Catheterization↗

PubMed1997

Radiation exposure to patients undergoing diagnostic and interventional cardiac catheterization procedures.

There has been a recent wave of concern over radiation exposure to patients during cardiac catheterization. Accordingly, we measured the area-exposure product (AEP) to patients undergoing diagnostic and interventional cardiac catheterization procedures. Fluoroscopic and cinefluorographic exposures were determined for 510 patients using an AEP meter. The total AEP was higher in interventional than diagnostic cases (16,289 R.cm2 vs. 10,873 R.cm2, P < 0.00001); multi-lesion than single lesion interventions (20,311 R.cm2 vs. 15,919 R.cm2 P < 0.0001); and in patients with previous coronary bypass surgery (20,403 R.cm2 vs. 14,298 R.cm2, P < 0.00001). The highest AEPs were observed in patients with a prior history of bypass surgery who underwent diagnostic catheterization and multilesion intervention during the same procedure.

Aged↗

PubMed1999

Radiation safety in the cardiac catheterization laboratory: operational radiation safety.

The goal of the catheterization laboratory radiation safety program is to facilitate invasive cardiology while simultaneously reducing staff risks to an acceptable level. Achieving this goal requires a balance between the value of catheterization to the patient and the associated radiation risk to the staff. This article introduces the principles of radiation protection as applied in the catheterization laboratory. Prudent conformance to these principles will appropriately reduce radiation risk. Cathet. Cardiovasc. Intervent. 47:347-353, 1999.

Air Pollution, Radioactive↗

PubMed2000

Transradial cardiac catheterization in elderly patients.

The safety and efficacy of transradial cardiac catheterization in elderly patients is unknown. This study examines procedure success rates for transradial catheterization in appropriately selected patients < 70 (n = 195) and >/= 70 (n = 83) years old. Elderly patients were less likely to be selected for the transradial approach (46% vs. 61%; P = 0.05). Although patients >/= 70 years old were more often female (39.7% vs. 24.1%; P = 0.008) and had a smaller body surface area (1.89 +/- 0.18 vs. 2.01 +/- 0.24 m2; P = 0. 001), procedure success rates did not differ (95.1% vs. 94.8%; P = NS). Procedure-related variables including procedure time (15.4 +/- 12.6 vs. 16.1 +/- 11.6 min; P = NS), amount of radiographic contrast (90.1 +/- 31.9 vs. 86.4 +/- 29.8 cc; P = NS), and number of catheters used (1.5 +/- 0.9 vs. 1.5 +/- 0.7; P = NS) were similar between groups. We conclude that transradial catheterization can be safely and effectively performed in selected elderly patients. Cathet. Cardiovasc. Intervent. 51:287-290, 2000.

Adult↗

PubMed2004

Determinants of ELISA D-dimer sensitivity for unstable angina pectoris as defined by coronary catheterization.

Unstable angina pectoris is associated with elevated D-dimer levels. However, the operating characteristics (sensitivity, specificity, positive and negative predictive value) of the D-dimer assay for the diagnosis of coronary artery disease (CAD) are unknown. Using a prospective, observational design, we collected blood from 54 patients with unstable angina pectoris at admission and assayed for ELISA D-dimer levels. The sensitivity, specificity, and negative and positive prediction values for angiographically determined coronary artery disease were calculated at multiple discriminate levels. All patients underwent coronary catheterization. A statistically significant correlation was noted between ELISA D-dimer levels and age, male sex, hypertension, use of beta-blocker, fibrinogen levels and catheterization findings. No correlation was noted between ELISA D-dimer levels and degree of the coronary artery disease. Best results were provided at a discriminate level of 270 ng/ml, with sensitivity 70%, negative predictive value 72%, and overall accuracy 67%. All discriminate levels, however, provided values too low for diagnosis. In conclusion, ELISA D-dimer assay is a non-sensitive, non-specific test for coronary artery disease as defined by coronary catheterization. However, the assay adds information regarding the severity of disease in patients presenting with acute coronary syndrome.

Angina, Unstable↗