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Results for “Catheterization”

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At least 163 records · Page 9Linked to original sources

PubMed2005

Early cardiac catheterization is associated with lower mortality only among high-risk patients with ST- and non-ST-elevation acute coronary syndromes: observations from the OPUS-TIMI 16 trial.

BACKGROUND: Early cardiac catheterization has been shown to improve outcomes in patients with non-ST-elevation acute coronary syndromes but not yet in those with ST-elevation myocardial infarction (STEMI). The benefit of catheterization in both syndromes may depend on patient risk for adverse clinical outcomes. METHODS: We analyzed the relation between inhospital catheterization and subsequent clinical outcomes based on risk profile in 8286 patients in the OPUS-TIMI 16 Trial of patients with acute coronary syndromes. Using baseline clinical characteristics, patients were stratified into low-, intermediate-, and high-risk groups. The primary end point was 10-month mortality. The STEMI, non-STEMI (NSTEMI), and unstable angina subgroups were analyzed separately. RESULTS: Inhospital cardiac catheterization was performed in 44% of patients. Mortality rates at 10 months were 1.3%, 2.2%, and 11.3% in the low-, intermediate-, and high-risk groups, respectively. Inhospital cardiac catheterization was associated with a trend to lower mortality among the high-risk patients with STEMI (hazard ratios [HR] 0.57, 95% CI 0.33-1.01, P = .052) and NSTEMI (HR 0.65, 95% CI 0.39-1.07, P = .088) but not in those with unstable angina (HR 0.95, 95% CI 0.63-1.43, P = .82). Catheterization was not associated with any significant difference in mortality in the low-risk or intermediate-risk group. The differences among high-risk patients persisted after adjusting for baseline characteristics; inhospital catheterization was associated with significantly lower mortality in high-risk patients with ST and non-ST myocardial infarction (HR 0.65, 95% CI 0.45-0.95, P = .03). CONCLUSIONS: Inhospital cardiac catheterization is associated with lower mortality in high-risk patients and no difference in mortality in low-risk and intermediate-risk patients after STEMI and NSTEMI. These data support the hypothesis that high-risk patients with either STEMI or NSTEMI may benefit from an early invasive strategy. New prospective randomized trials are warranted, particularly in the STEMI population.

Aged↗

PubMed2005

Use of ultrasonography to identify infants for whom urinary catheterization will be unsuccessful because of insufficient urine volume: validation of the urinary bladder index.

STUDY OBJECTIVE: Frequently, attempts to obtain catheter urine samples from infants are unsuccessful because of an empty bladder, with urinary catheterization failure rates reported up to 16%. We seek to validate a sonographic urinary bladder index that will identify patients for whom catheterization will be unsuccessful. METHODS: We conducted a prospective, blinded, observational study enrolling a convenience sample of children younger than 2 years and undergoing urinary catheterization in an urban pediatric emergency department. Failure was defined as a catheterization result of less than 2 mL of urine. Urinary bladder index, a concept we created, is defined as the product of anteroposterior and transverse diameters, expressed in centimeters squared. Sensitivity and specificity were calculated with 95% confidence intervals (CIs). RESULTS: Forty-four patients were enrolled, with a median age of 8 months (range 0.5 to 24 months) and median weight of 7.8 kg (range 1.7 to 17.7 kg). Four children urinated during the procedure and were excluded. Thirty-five had urinary bladder index greater than 2.4 cm2 (range 2.5 to 15.5 cm2 ). All were successfully catheterized. Four children had urinary bladder index less than 2.4 cm2 (range 0 to 1.2 cm 2 ). No adequate samples were obtained from those children. The bladder was not visualized at all in 1 child who was successfully catheterized. Sensitivity of the urinary bladder index to identify failure to obtain 2 mL of urine was 100% (4 of 4; 95% CI 40% to 100%), specificity was 97% (35 of 36; 95% CI 85% to 100%). CONCLUSION: A urinary bladder index less than 2.4 cm2 appears to identify infants for whom urinary catheterization will be unsuccessful because of insufficient urine volume. Ultrasonographic evaluation with urinary bladder index measurement before catheterization may eliminate the incidence of failed procedures.

Female↗

PubMed1979

Urinary tract infections occurring in recent spinal cord injury patients on intermittent catheterization.

During a 28-month interval 70 spinal cord injury patients in the initial rehabilitation hospitalization underwent 5,052 days of intermittent catheterization. Intermittent catheterization was done with a sterile technique and a neomycin-polymyxin irrigant. At the time of transfer to our facility 39 patients were using Foley catheter drainage but no difficulty was encountered when these patients were changed to intermittent cateterization. While on intermittent catheterization 52 urinary tract infections occurred, half caused by gram-positive cocci, 24 by gram-negative bacilli and 2 by Candida albicans. These infections occurred in 38 patients (54 per cent) at an over-all rate of 10.3 infections per 1,000 patient-days of intermittent catheterization. Only 2 infections were symptomatic and these occurred in patients on pass who unilaterally discontinued intermittent catheterization. Only 6 infections were not cured by antimicrobial therapy. Urinary tract infection was less common in patients who had incomplete spinal cord injuries. Infections caused by organisms susceptible to the irrigant containing neomycin-polymyxin occurred almost exclusively in patients catheterized 3 or fewer times daily. Infection was rare after 3 months on intermittent catheterization. Intermittent catheterization with our technique poses little infection hazard and can be introduced readily in acute spinal cord injury patients before transfer to specialized facilities.

Adult↗

PubMed1997

Real-time ultrasound-guided femoral vein catheterization during cardiopulmonary resuscitation.

STUDY OBJECTIVE: To compare the use of real-time-ultrasound guidance with the standard landmark-oriented approach for obtaining femoral vein catheterization in patients requiring intravenous access during CPR. METHODS: Prospective, randomized, paired subject-controlled clinical trial in the setting of an urban teaching county hospital emergency department. The study comprised a convenience sample of 20 patients presenting with apnea and pulselessness in the ED. Each patient received bilateral femoral lines, one by ultrasound guidance and one by the landmark approach (control). Randomization determined which technique and which side would be attempted first. The following parameters were recorded: time to initial flash of blood, time to completion of catheterization, number of needle passes, and rate of arterial catheterization. CPR and Advanced Cardiac Life Support protocols were continued during both procedures. RESULTS: Real-time ultrasound-guided catheterization had a higher success rate (90% versus 65%, P = .058), a lower number of needle passes (2.3 +/- 3 versus 5.0 +/- 5, P = .0057), and a lower rate of arterial catheterization (0% versus 20%, P = .025) than the standard landmark-oriented approach. Ultrasound was also slightly faster in time to blood flash and in time to catheterization. An incidental finding of interest was that real-time ultrasound demonstrated the presence of femoral vein pulsations during CPR. CONCLUSION: Real-time ultrasound-guided femoral vein catheterization was faster and produced a lower rate of inadvertent arterial catheterization and a higher rate of success during CPR than the standard landmark-oriented approach. Also, ultrasound demonstrated that palpable femoral pulsation during CPR is venous rather than arterial.

Adult↗

PubMed1999

A comparison of U.S. and Canadian cardiac catheterization practices in detecting severe coronary artery disease after myocardial infarction: efficiency, yield and long-term implications.

OBJECTIVES: We sought to compare U.S. and Canada's post-myocardial infarction (MI) cardiac catheterization practices in the detection of severe coronary artery disease (CAD). BACKGROUND: Little is known about the efficiency with which the aggressive post-MI catheterization strategy observed in the U.S. detects severe CAD compared with the more conservative strategy observed in Canada. METHODS: From the U.S. and Canadian patients who had participated in the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Arteries trial (n = 22,280, 11.5% Canadian), we examined the frequency of in-hospital cardiac catheterization, the prevalence of severe CAD observed at catheterization (diagnostic efficiency) and the total number of MI patients with severe CAD identified (diagnostic yield). RESULTS: The rate of catheterization in the U.S. was more than 2.5 times that in Canada (71% vs. 27%, respectively, p < 0.001). With identical prevalences of severe CAD at catheterization (17%) in the two countries, the higher frequency of catheterization in the U.S. resulted in the identification of more than two and a half times as many cases of severe CAD compared with Canada (12 severe CAD cases identified per 100 post-MI patients in the U.S., vs. 4.6 per 100 in Canada). If considered in isolation, we estimated that these differences in severe disease detection might effect a small long-term survival advantage in favor of the U.S. strategy (estimated 5.0 lives saved per 1,000 MI patients). CONCLUSIONS: Canada's more restrictive post-MI cardiac catheterization strategy is no more efficient in identifying severe CAD than the aggressive U.S. strategy, and may fail to identify a substantial number of post-MI patients with high risk coronary anatomy. The long-term impact of these differences in practice patterns requires further evaluation.

Canada↗

PubMed2003

Is ovarian and adrenal venous catheterization and sampling helpful in the investigation of hyperandrogenic women?

OBJECTIVE: To audit our practice of performing ovarian and adrenal venous catheterization and sampling in hyperandrogenic women who fail to suppress their elevated androgen levels following a 48-h low-dose dexamethasone suppression test (LDDST). We considered the technical success rate of catheterization, the extra information obtained in addition to the standard biochemical tests and imaging findings, and the impact of sampling on management decisions. DESIGN: A retrospective analysis of the results of all ovarian and adrenal venous catheterizations performed at St Bartholomew's Hospital, London, in the years 1980-1996. PATIENTS AND METHODS: Baseline ovarian and adrenal androgens were measured in all women presenting with symptoms and signs of hyperandrogenism. Those patients who failed to suppress their elevated testosterone (T), androstenedione (A4) and/or dehydroepiandrosterone-sulphate (DHEAS) levels following a LDDST to within the normal range or to less than 50% of the baseline value were investigated further with adrenal computed tomography (CT), ovarian ultrasound, and ovarian and adrenal venous catheterization and sampling. RESULTS: Results were available in 38 patients. The overall catheterization success rate was: all four veins in 27%, three veins in 65%, two veins in 87%. The success rate for each individual vein was: right adrenal vein (RAV) 50%, right ovarian vein (ROV) 42%, left adrenal vein (LAV) 87% and left ovarian vein (LOV) 73%. Eight patients were found to have tumours by means of imaging (adrenal CT and ovarian ultrasound), three adrenal and five ovarian, seven of which underwent operation. In six of these patients the clinical presentation was suggestive of the presence of a tumour; in addition, the combination of imaging findings allowed the detection of suspicious adrenal and ovarian masses in all eight cases. The five patients with ovarian tumours had serum testosterone levels > 4.5 nmol/l. In a further eight patients, laparotomy was performed based on a combination of diagnostic and therapeutic indications; in two of these patients the catheterization results were suggestive of an ovarian tumour. All these eight patients were shown histologically to have polycystic ovarian syndrome (PCOS), and no occult ovarian tumour was identified. None of the patients with nontumourous hyperandrogenism had a baseline testosterone level in excess of 7 nmol/l (median 4.4 nmol/l, range 2.5-7 nmol/l). CONCLUSIONS: Our results suggest that ovarian and adrenal venous catheterization and sampling should not be performed routinely in women presenting with symptoms and signs of hyperandrogenism, even if they fail to suppress their elevated androgen levels to a formal 48-h LDDST. All patients presenting with symptoms and signs of hyperandrogenism and elevated androgen levels, and where the suspicion of an androgen-secreting tumour is high, should have adrenal CT and ovarian ultrasound imaging to detect such a tumour. Venous catheterization and sampling should be reserved for patients in whom uncertainty remains, as the presence of a small ovarian tumour cannot be excluded on biochemical and imaging studies used in this series alone. Its use should be restricted to units with expertise in this area.

Adrenal Gland Neoplasms↗

PubMed1980

Use of the cardiac-catheterization laboratory in a defined population.

We evaluated trends in the use of the cardiac-catheterization laboratory from 1973 through 1977 in a well-circumscribed population in southeastern Minnesota. A total of 346 patients (248 male and 98 female patients) underwent coronary arteriography, left ventriculography, or cardiac catheterization, and there were 369 visits to the catheterization laboratory. The total number of catheterization-laboratory visits per 10,000 population increased from 4.3 in 1973 to 11.5 in 1977. According to individual category, the rates for coronary arteriography increased more than fourfold during the five-year period, whereas the rates for cardiac catheterization period, whereas the rates for cardiac catheterization showed no substantial change. On the basis of the 1977 rate for all visits to the catheterization laboratory and under conditions similar to those in this community, a population of approximately 230,000 would be required to ensure use of a catheterization laboratory at the suggested minimum level of 300 adult examinations per year.

Angiography↗

PubMed2005

Absence of bias against smokers in access to coronary revascularization after cardiac catheterization.

OBJECTIVE: Many consider smoking to be a personal choice for which individuals should be held accountable. We assessed whether there is any evidence of bias against smokers in cardiac care decision-making by determining whether smokers were as likely as non-smokers to undergo revascularization procedures after cardiac catheterization. DESIGN: Prospective cohort study. Subjects and setting. All patients undergoing cardiac catheterization in Alberta, Canada. MAIN MEASURE: Patients were categorized as current smokers, former smokers, or never smokers, and then compared for their risk-adjusted likelihood of undergoing revascularization procedures (percutaneous coronary intervention or coronary artery bypass grafting) after cardiac catheterization. RESULTS: Among 20406 patients undergoing catheterization, 25.4% were current smokers at the time of catheterization, 36.6% were former smokers, and 38.0% had never smoked. When compared with never smokers (reference group), the hazard ratio for undergoing any revascularization procedure after catheterization was 0.98 (95% CI 0.93-1.03) for current smokers and 0.98 (0.94-1.03) for former smokers. The hazard ratio for undergoing coronary artery bypass grafting was 1.09 (1.00-1.19) for current smokers and 1.00 (0.93-1.08) for former smokers. For percutaneous coronary intervention, the hazard ratios were 0.93 (0.87-0.99) for current smokers and 1.00 (0.94-1.06) for former smokers. CONCLUSION: Despite potential for discrimination on the basis of smoking status, current and former smokers undergoing cardiac catheterization in Alberta, Canada were as likely to undergo revascularization procedures as catheterization patients who had never smoked.

Alberta↗

PubMed1996

Comparative value of Doppler echocardiography and cardiac catheterization for management decision-making in patients with left-sided valvular regurgitation.

OBJECTIVE: The purpose of this study was to examine the value of non-invasive clinical and Doppler echocardiographic findings, compared to cardiac catheterization, in management decision-making for patients with left-sided valvular regurgitation. METHODS: One hundred and thirty-five consecutive patients with left-sided valvular regurgitation who underwent cardiac catheterization and detailed Doppler echocardiography were prospectively studied. Two independent groups of experienced cardiologists, given clinical information combined with either Doppler echocardiographic or cardiac catheterization data, decided to operate, not to operate, or remained uncertain. RESULTS: In 63 (81%) of 78 patients with mitral regurgitation, there was agreement on the decision for valve surgery or medical treatment between Doppler echocardiography and cardiac catheterization. Valve repair was performed in 22 patients, which agreed with the echocardiographic decision. In the remaining 15 patients, although the severity and type of mitral valve lesions and left ventricular functional status were confirmed by Doppler echocardiography, the clinical decision was uncertain; additional information concerning coronary anatomy (13 patients) and pulmonary artery pressure (one patient) or both (one patient) was required. In 47 of 57 patients (82%) with aortic regurgitation, there was agreement on their management as a result of Doppler echocardiography and cardiac catheterization findings. In 10 patients, the clinical decision reached with the help of Doppler echocardiography alone was uncertain and coronary (seven patients), left ventricular (two patients) angiography or aortography (one patient) were requested. Overall, there were no conflicting clinical decisions made by the two methods in patients with either mitral or aortic regurgitation. CONCLUSIONS: In every patient in whom it was considered that a decision could be reached by echocardiography alone (more than 80% of patients) there was 100% agreement from the cardiac catheterization assessment group on the management decision. Therefore, in patients with significant mitral or aortic regurgitation where echocardiographic data is adequate, cardiac catheterization can be safely omitted from the investigative process for surgery. Where echocardiographic indices are conflicting, or significant coronary artery disease is suspected, cardiac catheterization is required.

Adult↗

PubMed1994

Pulmonary artery catheterization in critically ill patients: a prospective analysis of outcome changes associated with catheter-prompted changes in therapy.

OBJECTIVE: To evaluate physician accuracy in predicting patients' hemodynamic profiles, associated morbidities, rates of change in therapy resulting from catheterization, and the outcome variations associated with such change before the insertion of a pulmonary artery catheter. DESIGN: Prospective, descriptive, cohort study with no interventions. SETTING: Medical intensive care unit (ICU) of a university hospital. PATIENTS: One hundred twelve catheterizations performed in 112 patients without acute myocardial infarction. In 43 cases, catheterizations were indicated because of circulatory shock that was unresponsive to two standard therapeutic measures. MEASUREMENTS AND MAIN RESULTS: Before catheterization, physicians were asked to predict the hemodynamic profile of the patients who were to be catheterized, and to provide a plan for therapy. After catheterization, each patient's chart was reviewed and compared with precatheterization predictions. Hemodynamic profiles were correctly predicted in only 56% of the cases. Information obtained from pulmonary artery catheters prompted changes in therapy in 58% of all cases and in 63% of patients in shock who were unresponsive to standard therapy. Modifications varied among hemodynamic profiles, from 33% (fluid overloaded) to 87% (hypovolemia). Complications occurred in 11 catheterizations, but only two complications required therapy (pneumothorax [n = 1] and one episode of arrhythmia). No systemic infection occurred, and all blood cultures sampled through catheters before the catheters were withdrawn were sterile. In the entire group of patients, those patients in whom catheterization induced a change in therapy and those patients in whom no change in therapy occurred had similar precatheterization characteristics and mortality rates. However, in the subgroup of patients in shock that was unresponsive to standard therapy, the mortality rate was significantly lower when the assessment of hemodynamic data led to a change in therapy (59% vs. 100%, p = .009), despite identical precatheterization characteristics. CONCLUSIONS: Prompted by assessment of pulmonary artery catheter measurements in patients with circulatory shock who were unresponsive to standard therapeutic measures, a change in therapy for these patients was associated with an improved prognosis, independent of other variables influencing outcome.

Adult↗

PubMed1997

Indications for and outcomes of clean intermittent catheterization in children with normal genital sensation.

PURPOSE: Clean intermittent catheterization is generally accepted by parents and children with neurogenic bladder. We analyzed the indications for and feasibility of clean intermittent catheterization in children with normal genital sensation. MATERIALS AND METHODS: We reviewed the records of 2 girls and 15 boys 15 months to 15 years old (mean age 8 years) on clean intermittent catheterization with normal genital sensation. Indications for clean intermittent catheterization were urinary retention and poor urodynamic compliance with or without hydronephrosis. Parents evaluated the protocol via a questionnaire and the children were studied with age appropriate standard instruments to assess the consequences of clean intermittent catheterization on psychological development. RESULTS: There were no medical complications related to clean intermittent catheterization. Four of the 7 children with urinary retention and 7 of the 10 with poor bladder compliance continued the protocol. There was no difference in the results of psychological testing for patients who had success or failure (mean followup 5 years). Parent and patient comfort levels were most important for the success of clean intermittent catheterization. CONCLUSIONS: Our results show that clean intermittent catheterization is feasible in children with normal genital sensation but successful in only two-thirds.

Adolescent↗

PubMed2003

Effectiveness of lidocaine lubricant for discomfort during pediatric urethral catheterization.

PURPOSE: Many children with urinary tract infections and vesicoureteral reflux require catheterization. Catheterization can be a painful experience, and a desire to avoid this experience may affect patient care. We evaluated the effectiveness of lubricant containing lidocaine for minimizing patient pain and distress during catheterization. MATERIALS AND METHODS: We conducted a prospective, double-blind, placebo controlled trial. Twenty children (16 girls and 4 boys, mean age 7.7 years) had urethral lubricant with or without lidocaine placed within 10 minutes before urethral catheterization. In all children pre-procedure anxiety, and pain and distress during catheterization were recorded. Pre-procedure anxiety was measured using a visual analog scale, pain was measured with the Oucher Pain Scale and distress was recorded by 2 independent observers with a simple 7-point Likert-type scale. RESULTS: There were no significant group differences for age, number of previous catheterizations or pre-procedure anxiety. The group receiving lubricant with lidocaine had significantly lower pain (21 +/- 19.69 versus 65.5 +/- 26.29) and distress (2.65 +/- 1.97 versus 4.7 +/- 2.07) (p = 0.001 and 0.007, respectively). CONCLUSIONS: The use of lubricant with lidocaine significantly decreases pain with pediatric urethral catheterization and is recommended with pediatric catheterizations.

Anesthetics, Local↗

PubMed2006

Emergent use of extracorporeal membrane oxygenation during pediatric cardiac catheterization.

OBJECTIVES: The goal of this study was to evaluate the utility of extracorporeal membrane oxygenation (ECMO) to resuscitate patients following critical cardiac events in the catheterization laboratory. DESIGN: Retrospective review of medical records. SETTING: Cardiac intensive care unit and cardiac catheterization laboratory at a tertiary care children's hospital. PATIENTS: Pediatric patients cannulated emergently for ECMO in the cardiac catheterization laboratory (n = 22). INTERVENTIONS: ECMO was initiated emergently in the cardiac catheterization laboratory for progressive hemodynamic deterioration due to low cardiac output syndrome or catheter-induced complications. MEASUREMENTS AND MAIN RESULTS: Twenty-two patients were cannulated for ECMO in the catheterization laboratory between 1996 and 2004. Median age was 33 months (range 0-192), median weight 14.8 kg (2.4-75), and median duration of ECMO 84 hrs (2-343). Indications included catheter-induced complication (n = 14), severe low cardiac output syndrome (n = 7), and hypoxemia (n = 1). Three patients (14%) were cannulated in the catheterization laboratory before catheterization for low cardiac output or hypoxemia. During cannulation, 19 patients (86%) were receiving chest compressions; median duration of cardiopulmonary resuscitation was 29 mins (20-57). Eighteen patients (82%) survived to discharge (five of whom underwent cardiac transplantation) and four (18%) died. Of 19 patients who received cardiopulmonary resuscitation during cannulation, 15 (79%) survived to discharge and nine (47%) sustained neurologic injury. There was no significant difference between survivors and nonsurvivors in age, weight, duration of cardiopulmonary resuscitation or ECMO support, pH, or lactate levels. CONCLUSIONS: ECMO is a technically feasible and highly successful tool in the resuscitation of pediatric patients following critical events in the cardiac catheterization laboratory.

Adolescent↗

PubMed1994

Long-term urethral catheterization increases risk of chronic pyelonephritis and renal inflammation.

OBJECTIVE: To determine the prevalences of chronic pyelonephritis and chronic renal inflammation in elderly nursing home patients at the time of death and to assess correlation with urethral catheterization and other putative risk factors. DESIGN: Prospective assessment of risk factors with the prevalences of chronic pyelonephritis and renal inflammation at autopsy. SETTING: A 240-bed long-term care facility. PARTICIPANTS: All residents > or = 65 years old who died and were autopsied during a 2-year period. MEASUREMENTS: Antemortem assessment of risk factors for renal inflammation, including a search for any urethral catheterization in the person's life. Prospective assessment of urethral catheterization, catheter obstruction, and use of anti-inflammatory medications and urine cultures. Urinary tract pathology was assessed for gross and microscopic evidence of inflammation and urinary tract stones. RESULTS: The duration of catheterization was significantly associated with increasing prevalence of bacteriuria, polymicrobial bacteriuria, chronic pyelonephritis, and chronic renal inflammation. The prevalence of chronic pyelonephritis at death was 10 percent (5/52) for patients catheterized > 90 days during their last year of life and zero (0/65) when catheterized < or = 90 days (P < 0.02; Fisher's exact test). Chronic pyelonephritis was significantly associated with renal stones and hydronephrosis. The prevalence of chronic renal inflammation without chronic pyelonephritis was significantly greater than that of chronic pyelonephritis: the prevalence was 43 percent (20/47) when catheterized > 90 days and 18 percent (12/65) when < or = 90 days (P < 0.05). Chronic renal inflammation was associated with hydronephrosis, ureteral dilatation, acute pyelonephritis and diastolic hypertension. CONCLUSION: Chronic pyelonephritis and chronic renal inflammation are associated with long-term catheterization.

Age Factors↗

PubMed1994

A technique for rapid transfemoral catheterization of the coronary sinus with multielectrode catheters.

To minimize procedural and fluoroscopic times and avoid the risks of vascular injury and pneumothorax, some investigators have advocated elimination of routine placement of a coronary sinus (CS) catheter during electrophysiological procedures. We hypothesized that expedient and reproducible CS catheterization could be performed with minimal patient risk by utilizing a femoral vein approach. Fifty consecutive patients referred for radiofrequency ablative procedures underwent attempted CS catheterization using a 6-French steerable, quadripolar catheter via a femoral vein. Procedures were performed utilizing single-plane fluoroscopy without contrast angiographic aid by operators experienced in the technique. Successful catheterization was defined by the attainment, in < 15 minutes, of a stable catheter position with the distal electrode at or beyond the lateral margin of the heart. Successful catheterization of the CS was achieved in 47 (94%) patients. Selective pacing of the left atrium without patient discomfort was possible in all, eliminating the need for a right atrial pacing catheter. The median time to successful catheterization was 1.4 minutes (range 0.3-14.7). Only six patients required > 5 minutes. The median fluoroscopic time required was 1.2 minutes (range 0.3-12.7). No clinical variable was predictive of catheterization failure or time to successful catheterization. No complications were observed as a result of this technique. This prospective evaluation demonstrates that catheterization of the CS via a femoral vein approach is highly successful, expedient, and safe. The ability to selectively pace the left atrium may eliminate the requirement for a right atrial catheter.

Adult↗

PubMed1997

Long-term outcome in acute myocardial infarction patients admitted to hospitals with and without on-site cardiac catheterization facilities. MITI Investigators. Myocardial Infarction Triage and Intervention.

BACKGROUND: Previous studies have documented the strong association between availability of on-site cardiac catheterization facilities and increased use of coronary angiography in patients with acute myocardial infarction (AMI). Although these studies have shown little influence of the availability of catheterization labs on hospital mortality, no long-term follow-up has been reported. METHODS AND RESULTS: From a cohort of 12,331 AMI patients admitted to 19 Seattle area hospitals, we compared long-term outcome in 7985 patients admitted to hospitals with and 4346 patients admitted to hospitals without on-site catheterization labs. During the index hospitalization, patients admitted to hospitals with on-site catheterization were more likely to undergo coronary angiography (67.1% versus 39.3%, P<.0001), coronary angioplasty (32.5% versus 13.2%, P<.0001), or coronary bypass surgery (12.5% versus 9.5%, P<.0001). At 3-year follow-up, patients admitted to hospitals with on-site catheterization labs were more likely to undergo postdischarge angiography (19.2% versus 15.2%, P=.0001) and coronary angioplasty (11.6% versus 8.2%, P<.0001). This was associated with approximately $2500.00 per patient in higher cumulative costs. Despite this higher rate of procedure use, there was no association between admission to a hospital with on-site catheterization facilities and lower long-term mortality (multivariate hazard ratio, 1.0; 95% CI, 0.93 to 1.1., the hazard being associated with admission to hospitals with on-site catheterization facilities). CONCLUSIONS: In an urban area with unconstrained patient transfer mechanisms and high overall cardiac procedure use rates, AMI patients admitted to hospitals without on-site catheterization facilities were managed with fewer procedures during hospitalization and follow-up. This more conservative treatment approach was not associated with any observed increase in long-term mortality.

Aged↗

PubMed1998

Impact of an educational program on bilateral heart catheterization practice patterns.

The value and necessity of performing right heart catheterizations for coronary artery disease have been increasingly questioned. Preliminary analyses of the procedure among Medicare and Medicaid patients in New York State revealed significant inter-hospital variations in the frequencies with which such catheterizations were performed. These data suggested that right heart catheterizations (RHC) were being performed routinely. Medicare and Medicaid claims data for bilateral catheterizations were analyzed before and after an educational intervention program involving the state's 53 catheterization laboratories. The educational intervention was multifaceted and consisted of disseminating suggested guidelines established with the assistance of the New York State Chapter of the American College of Cardiology, the Committee on Cardiovascular Disease of the Medical Society of the State of New York, and the Cardiac Advisory Council of the New York State Department of Health. Posteducational intervention assessments were made over a 4-year period. The baseline data for 1992 demonstrated that 10 (18.4%) laboratories had performed RHC routinely (70-100%) on Medicare and Medicaid patients undergoing catheterization. In contrast, 34 (64.2%) laboratories performed RHC in less than 20% of their Medicare cases, whereas 39 (73.5%) did so among Medicaid cases. Eighteen (34%) laboratories performed RHC in less than 10% of Medicare cases. These data indicated that there was significant inter-hospital variation in the frequency with which RHC was performed. Beginning in 1993, ongoing educational meetings and conferences were held with all laboratories, but especially with the 10 that were at the high end of the RHC performance level. As a result of this ongoing intervention, the rate of RHC among Medicare patients fell from 89/100,000 in 1992 to 65/100,000 beneficiaries in 1996. From another perspective, the percentage of catheterized Medicare patients undergoing RHC fell from 30.5% in 1992 to 17.4% in 1996. The decline among the 10 laboratories was even more dramatic; the percentage of catheterized Medicare patients undergoing RHC fell from 89.1% in 1992 to 31.6% in 1996. The parallel drop for Medicaid patients over the same time period was from 92.8 to 32.7%. The results of the study indicate that many previously performed RHC in patients with coronary artery disease were routine and not medically indicated. The dramatic decreases in RHC documented in this study over a 4-year period demonstrate the success of quality improvement efforts jointly undertaken by providers and a peer review organization.

Age Distribution↗

PubMed1994

Temporal trends and factors associated with pulmonary artery catheterization in patients with acute myocardial infarction.

STUDY OBJECTIVE: To examine changes over time in the utilization of and factors associated with pulmonary artery (PA) catheterization in patients hospitalized with acute myocardial infarction (AMI). DESIGN: Nonconcurrent prospective study carried out in 16 teaching and community hospitals in Worcester, Mass, in seven time periods between 1975 and 1990. A total of 5,480 patients hospitalized with validated AMI comprised the study sample. RESULTS: Use of PA catheterization increased from 1975 to 1984 with a consistent decline thereafter in all patients with AMI studied. Among the 2,441 patients with complicated AMI, use of PA catheterization increased from 1975 through 1988 with a decline in use in 1990. For the combined study periods, 14.7 percent of all patients with AMI studied and 25.4 percent of those with complicated AMI underwent PA catheterization. After adjusting for other potentially confounding factors through use of a logistic regression analysis, younger patients, those with a history of angina, those with Q-wave AMI, those who died, and those patients developing congestive heart failure or cardiogenic shock during the acute hospitalization were significantly more likely to undergo PA catheterization than respective comparison groups among all patients with AMI studied. Younger age, occurrence of Q-wave AMI, and having died during the short-term hospitalization were associated with receipt of PA catheterization in patients with complicated AMI. CONCLUSIONS: The results of this multihospital, community-based study provide insight into changes over time in the use of PA catheterization and patient-related factors associated with receipt of PA catheterization in the setting of AMI.

Aged↗