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PubMed1999

Cardiac catheterization in Germany. Diffusion and utilization from 1984 to 1996.

OBJECTIVE: To describe the diffusion of cardiac catheterization technologies and time trends of their use according to setting and geographic region in Germany during a 13-year period. It is hypothesized that the cardiac catheterization technology has matured from an experimental state to a broadly accepted technology. METHODS: Data come from the annual survey of the German Society for Cardiovascular Research. All German cardiac catheterization units are requested to provide data on volume and type of catheterization procedures. Data are available from 1984 to 1996. Number and type of procedure, type of unit, diagnoses, and complications are all recorded. The overall response rate is 90%, on average. RESULTS: The total number of catheterization units was 324 in 1996, or an average of 3.69 units per 1 million population. In 1996, all of the East German Länder and districts were below average. Utilization of cardiac catheterization procedures increased exponentially during the study period. The number of angiographies rose from about 45,000 in 1984 to more than 450,000 in 1996; the number of angioplasties increased almost by a factor of 50 to 125,000 procedures in 1996. Inverse correlations between the rates per million population of either coronary angiographies or PTCAs and mortality rates from ischemic heart disease were observed at the level of the German Länder. CONCLUSION: Further studies taking patient characteristics, long-term outcomes, and other factors in account are necessary to clarify the large geographic variations and the negative relationship between utilization rates and coronary heart disease mortality found in this study.

Adult↗
PubMedDate not supplied

Children's and adolescents' experiences while undergoing cardiac catheterization.

PROBLEM: To explore the experiences of children and adolescents undergoing a cardiac catheterization. SUBJECTS: Caucasian children and adolescents (N = 24), 9-17 years, male and female, undergoing cardiac catheterization. METHOD: Exploratory design utilizing content analysis. The authors used an interview guide with 4 subsections to elicit self-reports of knowledge, perceptions, emotions, and evaluations. FINDINGS: Major themes were anticipatory anxiety, pain, invasion of privacy, and being comforted. Many children had misconceptions or lack of knowledge of the procedure. CONCLUSIONS & IMPLICATIONS FOR NURSING: Nurses' knowledge of the impact on children and adolescents of a cardiac catheterization room, high-technology equipment, and invasive procedures may increase their sensitivity to children's and adolescents' perceptions of the experiences and promote individualized nursing care.

Adolescent↗
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

An ambulatory approach to outpatient pediatric cardiac catheterization.

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

Ambulatory Surgical Procedures↗
PubMed1984

Significance of elevated MB creatine kinase in patients after cardiac catheterization.

To clarify the etiology of elevations in plasma MB creatine kinase (CK) in patients after cardiac catheterization, we studied 32 consecutive patients undergoing cardiac catheterization and coronary arteriography. Total CK and MB CK were within the normal range in all patients prior to catheterization. Total CK activity rose from a mean of 61.46 +/- 33.8 IU/1 (SD) to 141 +/- 105 in the first sample after catheterization (p less than .005) and 121.6 +/- 92.4 in the second catheterization sample (p less than .0005). The MB CK activity also rose from a mean of 3.2 +/- 1.6 IU/1 prior to catheterization to a maximum value of 5.0 +/- 2.9. The mean increase in MB CK, though statistically significant (p less than .005), was only 1.8 IU/1. Only one patient's value for MB CK rose to outside of the normal range (greater than 12) likely due to cardiac injury. Thus, our data document that marked elevations in MB CK after cardiac catheterization are unusual. They likely represent cardiac muscle injury rather than MB CK released due to skeletal muscle injury induced by the catheterization itself.

Adult↗
PubMed2001

Racial differences in the use of cardiac catheterization after acute myocardial infarction.

BACKGROUND: Several studies have reported that black patients are less likely than white patients to undergo cardiac catheterization after acute myocardial infarction. The role of the race of the physician in this pattern is unknown. METHODS: We analyzed data from the Cooperative Cardiovascular Project, a study of Medicare beneficiaries hospitalized for acute myocardial infarction in 1994 and 1995, to evaluate whether differences between black patients and white patients in the use of cardiac catheterization within 60 days after acute myocardial infarction varied according to the race of their attending physician. RESULTS: Our study cohort consisted of 35,676 white and 4039 black patients with acute myocardial infarction who were treated by 17,550 white and 588 black physicians. Black patients had lower rates of cardiac catheterization than white patients, regardless of whether their attending physician was white (rate of catheterization, 38.4 percent vs. 45.7 percent; P< 0.001) or black (38.2 percent vs. 49.6 percent, P<0.001). We did not find a significant interaction between the race of the patients and the race of the physicians in the use of cardiac catheterization. The adjusted mortality rate among black patients was lower than or similar to that among white patients for up to three years after the infarction. CONCLUSIONS: Racial differences in the use of cardiac catheterization are similar among patients treated by white physicians and those treated by black physicians, suggesting that this pattern of care is independent of the race of the physician.

Aged↗
PubMed1991

Comparison of cardiac catheterization and Doppler echocardiography in the decision to operate in aortic and mitral valve disease.

Clinical decisions utilizing either Doppler echocardiographic or cardiac catheterization data were compared in adult patients with isolated or combined aortic and mitral valve disease. A clinical decision to operate, not operate or remain uncertain was made by experienced cardiologists given either Doppler echocardiographic or cardiac catheterization data. A prospective evaluation was performed on 189 consecutive patients (mean age 67 years) with valvular heart disease who were being considered for surgical treatment on the basis of clinical information. All patients underwent cardiac catheterization and detailed Doppler echocardiographic examination. Three sets of two cardiologist decision makers who did not know patient identity were given clinical information in combination with either Doppler echocardiographic or cardiac catheterization data. The combination of Doppler echocardiographic and clinical data was considered inadequate for clinical decision making in 21% of patients with aortic and 5% of patients with mitral valve disease. The combination of cardiac catheterization and clinical data was considered inadequate in 2% of patients with aortic and 2% of patients with mitral valve disease. Among the remaining patients, the cardiologists using echocardiographic or angiographic data were in agreement on the decision to operate or not operate in 113 (76% overall). When the data were analyzed by specific valve lesion, decisions based on Doppler echocardiography or catheterization were in agreement in 92%, 90%, 83% and 69%, respectively, of patients with aortic regurgitation, mitral stenosis, aortic stenosis and mitral regurgitation. Differences in cardiac output determination, estimation of valvular regurgitation and information concerning coronary anatomy were the main reasons for different clinical management decisions. These results suggest that for most adult patients with aortic or mitral valve disease, alone or in combination, Doppler echocardiographic data enable the clinician to make the same decision reached with catheterization data.

Adult↗
PubMed1990

Vein patch angioplasty for brachial arterial occlusion after cardiac catheterization.

Brachial artery thrombosis may be encountered after cardiac catheterization using the Sones technique. Differing opinions have been reported regarding the optimal management of this injury. During the past five years, 20 patients have had surgical repair of the brachial artery after trauma from cardiac catheterization. Satisfactory results have been obtained in the majority of cases with local arterial thrombectomy and debridement with vein patch angioplasty. Arterial resection or vein bypass was needed in unusual cases. This injury should be repaired acutely to avoid long-term functional disability in all patients who present with a pulseless upper extremity.

Acute Disease↗
PubMed1993

The association between on-site cardiac catheterization facilities and the use of coronary angiography after acute myocardial infarction. Myocardial Infarction Triage and Intervention Project Investigators.

BACKGROUND: During the past decade the use of coronary angiography after acute myocardial infarction has substantially increased. Among the possible contributing factors, the increasing availability of cardiac catheterization facilities was the focus of our investigation. METHODS: We investigated whether the availability of cardiac catheterization facilities at an admitting hospital was associated with the likelihood that a patient would undergo coronary angiography. After adjusting for age, sex, cardiac history, and cardiac complications during hospitalization, we evaluated this association in 5867 consecutive patients with acute myocardial infarction admitted to 19 Seattle-area hospitals. We also assessed the association between the presence of on-site cardiac catheterization facilities and in-hospital mortality. RESULTS: Patients admitted to hospitals with on-site cardiac catheterization facilities were far more likely to undergo coronary angiography (odds ratio, 3.21; 95 percent confidence interval, 2.81 to 3.67) than patients admitted to hospitals where transfer to another institution would be required to perform cardiac catheterization. Admission to a hospital with on-site facilities was more strongly associated with the use of coronary angiography than any characteristic of the patient. Although our study had limited power to detect differences in mortality, the availability of coronary angiography had no discernible association with in-hospital mortality rates (odds ratio for mortality among patients admitted to hospitals with on-site facilities vs. patients admitted to hospitals without such facilities, 0.88; 95 percent confidence interval, 0.71 to 1.09). CONCLUSIONS: In this community-wide study, the availability of on-site cardiac catheterization facilities was associated with a higher likelihood that a patient would undergo coronary angiography. However, admission to hospitals with these facilities did not appear to be associated with lower short-term mortality.

Aged↗
PubMed2001

Skew deviation as a complication of cardiac catheterization.

PURPOSE: To report three patients who developed diplopia and skew deviation after cardiac catheterization. DESIGN: Interventional case series. METHODS: Three patients complained of diplopia after cardiac catheterization for myocardial infarction (two male patients) or aortic dissection (one female patient). Examination demonstrated skew deviation in each patient. RESULTS: Diplopia and skew deviation were mild and resolved completely in 4 months (case 1), 16 months (case 2), and 1.5 months (case 3). Sensitive signs of minor ischemic damage to the brain stem that cause such disorders are not detectable by neuroimaging. CONCLUSION: Rarely, cardiac catheterization may be complicated by diplopia and skew deviation.

Aged↗
PubMed1990

Hemodynamic effects of ketamine in children undergoing cardiac catheterization.

Ketamine is used to supplement sedation during cardiac catheterization. We studied ketamine-induced circulatory changes in 28 acyanotic children (18 of whom had left-to-right shunts), aged 4-161 months (mean, 33 months). Oxygen consumption (VO2) was measured continuously. In the 18 patients with shunts, the pulmonary to systemic flow ratio fell slightly (2.3 +/- 1.1 to 1.8 +/- 0.4, p less than 0.05). In all patients, the ratio of pulmonary (PVR) to systemic vascular resistance (SVR) rose from 0.16 +/- 0.09 to 0.28 +/- 0.21, p less than 0.001. Ketamine increases VO2, heart rate, cardiac output, and pulmonary arterial pressure (PAP). The rise in PAP is more consistent than the rise in PVR; resistance changes were greatest in patients with elevated resting PVR (r = 0.54). Caution should be used in administering ketamine to selected subjects; moreover, ketamine can confuse interpretation of cardiac catheterization data, especially if VO2 is assumed and not measured.

Adolescent↗
PubMed1992

Role of superficial femoral artery puncture in the development of pseudoaneurysm and arteriovenous fistula complicating percutaneous transfemoral cardiac catheterization.

Of 13,203 transfemoral diagnostic and therapeutic cardiac catheterization procedures performed between January 1, 1980 and December 31, 1990, 73 (0.55%) were complicated by pseudoaneurysm (PA) formation, and 15 (0.11%) by arteriovenous fistulas (AVF). The rate of PA increased progressively from 0.44% (1980-1987), to 0.59% (1987-1989), to 0.92% (1990), with no corresponding change in the incidence of AVF. The rising incidence of PA complicating transfemoral cardiac catheterization was associated closely with the use of larger diameter catheters and aggressive antiocoagulation during coronary interventions, but findings during surgical repair suggested that puncture of the superficial femoral (SFA), rather than the common femoral artery (CFA), was an important avoidable cause of some PA and AVF. A technique for fluoroscopic localization of the puncture site to avoid inadvertent SFA puncture and the associated increased risk of complication is proposed.

Aneurysm↗
PubMed1976

Long-term results of brachial thrombectomy following cardiac catheterization.

The late results of brachial thrombectomy following cardiac catheterization were evaluated in 20 patients. All patients had a radial pulse present and no symptoms or signs of ischemia of the hand at the time of discharge from the hospital. Late evaluation of these 20 patients revealed 8 in whom the long-term results were classified as failure of the thrombectomy. Four of these had intermittent claudication of the involved arm and hand. None had any tissue loss and four had no symptoms referable to the failed thrombectomy. The one patient who refused surgery had claudication of the affected arm. The mean period of followup was 20.8 months. The rate of failed thrombectomies was twice as high in females than in males. Prolonged time of cardiac catheterization (over 4 hours), delay in diagnosis of more than 24 hours, and omitting the use of systemic heparinization at the time of diagnosis are three factors that appear to increase the likelihood of late failures.

Arm↗
PubMed1995

Positioning post-outpatient cardiac catheterization.

UNLABELLED: The optimal positioning post-outpatient cardiac catheterization is a largely unexplored area of research. Traditionally, patients have been placed supine, with the head of the bed (HOB) flat. This study sought to explore the influence of three different post-procedure positions on the incidence of complications and patient perceptions of satisfaction. Sixty-nine patients were randomized into three groups immediately after hemostasis of the arterial puncture site was achieved. Group 1 patients were placed supine with the HOB flat. Group 2 patients were placed on their sides, with the affected extremity straight. Group 3 patients were placed on their backs, with the HOB at 15-30 degrees. Endpoints included the presence of any complication (bleeding, hematoma formation or expansion, back pain and urinary retention) and patient comfort and satisfaction with the randomized position. Patients were asked prior to discharge to select the position they would have preferred post-procedure. Selection of an alternative position was felt to indicate dissatisfaction with the randomized position. Ten patients in Group 1, and nine patients in Group 2 and Group 3 experienced a complication (X2 = 3.682, df = 1, p = 0.05). Eighty-five percent of Group 1 patients selected an alternative position vs. 24% of those patients in Group 2 and Group 3 (X2 = 27.6, df = 1, p < .001). CONCLUSION: varying patient position post-outpatient cardiac catheterization is at least as safe as the traditional supine position and is more comfortable for patients.

Adult↗
PubMed1989

Incidence and results of arterial complications among 16,350 patients undergoing cardiac catheterization.

A total of 16,350 patients underwent cardiac catheterization from January 1981 to December 1987. The brachial artery was used in 10,500 patients (group I), and the femoral artery was used in 5850 patients (group II). Surgical intervention for complications was necessary in 60 (0.57%) of the group I patients and in 14 (0.23%) of the group II patients. Hand ischemia in group I and bleeding in group II were the most frequent indications for operation. Procedures performed were segmental resection, vein interposition, and long bypass in group I, and simple suture and angioplasty were performed in group II. Fifty-six patients of the total of 74 underwent early repair (within 48 hours), and 18 patients underwent delayed intervention. Only one (1.7%) of the 56 patients who had early repair had a complication. Five of the 18 patients (28%) with delayed intervention suffered significant complications. Cardiac catheterization by the brachial or femoral route has a low incidence of complications. Delayed intervention is associated with high morbidity despite adequate restoration of circulation. Although there were fewer complications in the femoral group, they were far more serious with respect to life- or limb-threatening events.

Adult↗
PubMed1993

Femoral arteriovenous fistula following cardiac catheterization: an anatomic explanation.

The exact etiology of femoral iatrogenic arteriovenous fistula (AVF) following cardiac catheterization is not known. The most common explanation is simultaneous placement of arterial and venous catheters for left and right heart catheterization. Using a strict protocol for groin examination before and after cardiac catheterization, seven patients were found to have a groin thrill and/or bruit as a result of AVF after catheterization in the period from July 1986 to December 1990; one patient had two fistulas, making a total of eight. During the same period, a total of 2609 cardiac catheterizations were performed using the Seldinger technique; the incidence of AVF after the procedure was thus 0.22%. Arteriography was used to confirm the presence of the fistulas and identify their exact location. All eight lesions originated below the bifurcation of the common femoral artery (CFA). Three originated at the superficial femoral artery (SFA) and five at the profunda femoris artery (PFA). In the patient with two fistulas, one originated at the SFA and one at the PFA. The veins involved were the superficial femoral (SFV) in two AVFs and the profunda femoris (PFV) or its lateral circumflex branch in six. The fact that all eight fistulas originated below the bifurcation of the CFA points to a possible anatomic explanation for the formation of iatrogenic AVF. The CFA and common femoral vein (CFV) are located side by side, which makes it difficult to puncture both with one stick. Below the bifurcation, the PFV crosses laterally behind the proximal SFA and then lies in a posterior location to the PFA.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2006

Abnormal glucose metabolism and features of the metabolic syndrome are common in patients presenting for elective cardiac catheterization.

BACKGROUND: Abnormalities of glucose metabolism and the metabolic syndrome, including excess bodyweight, are potentially modifiable risk factors for cardiac morbidity and mortality. This study aimed to determine the prevalence of these in a group of patients presenting for elective cardiac catheterization or percutaneous intervention. METHODS: Data were prospectively collected on 297 consecutive patients presenting for elective cardiac catheterization or percutaneous intervention at a single tertiary referral centre. Demographic data, risk factors, medications and coronary angiogram results were recorded. Fasting lipids, fasting glucose, HbA1c levels were measured and if necessary an oral glucose tolerance test was carried out. Logistic regression and contingency table analysis examined associations of these with ethnicity. RESULTS: Impaired glucose metabolism (diabetes, impaired glucose tolerance or impaired fasting glucose) was present in 46.1% with our screening programme detecting previously unknown impaired glucose metabolism in 22.9%. Impaired glucose metabolism was strongly associated with non-European ethnicity (P < 0.0001). The metabolic syndrome was present in 49.2%. When defined by ethnic specific cut-offs, overweight or obesity was present in >80% of patients in all ethnic groups. CONCLUSION: There is a very high prevalence of impaired glucose metabolism and the metabolic syndrome in patients presenting for cardiac catheterization. Impaired glucose metabolism is particularly prevalent in the Polynesian and the Indian and the Sri Lankan ethnic groups. Screening of patients undergoing elective cardiac catheterization identifies a significant number of patients with undiagnosed impaired glucose metabolism and should be carried out routinely.

Aged↗
PubMed1993

Clinically guided closure of femoral arterial pseudoaneurysms complicating cardiac catheterization and coronary angioplasty.

Femoral artery pseudoaneurysm formation is a significant problem in patients undergoing cardiac catheterization and interventional cardiac procedures. It is especially more common with the use of anticoagulant and antiplatelet therapy and the use of intracoronary stents. We describe our initial experience with clinically guided bedside compression of femoral pseudoaneurysms in such patients. Eleven patients, 10 undergoing coronary angioplasty (including 3 with intracoronary stents) and 1 undergoing diagnostic cardiac catheterization, developed a femoral pseudoaneurysm. All patients had a femoral bruit and 9 had an expansile groin hematoma. The diagnosis was confirmed in each case by Doppler ultrasound. Seven patients were receiving heparin while 4 were on oral anticoagulants at the time of detection of the pseudoaneurysm. These patients underwent clinically guided graded external compression to close the pseudoaneurysm neck while maintaining femoral arterial flow. External compression for 104.1 +/- 63 min resulted in successful clinical resolution of pseudoaneurysm in all patients without complications. The results were confirmed by Doppler ultrasound at least 12 hr later. Bedside compression of femoral pseudoaneurysms guided by clinical clues is simple and appears to be an effective and safe technique to manage this iatrogenic problem.

Aged↗