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PubMedDate not supplied

Reducing radiocontrast use in the cardiac catheterization laboratory--a behavioral modification approach.

OBJECTIVES: This study assessed the impact of behavioral modification techniques on reducing the volume of contrast dye used during cardiac catheterization and percutaneous coronary intervention (PCI). BACKGROUND: Excessive administration of radiocontrast agents in the catheterization laboratory is associated with numerous adverse effects including radiocontrast nephropathy. This may be precipitated by using large volumes of contrast dye, particularly in diabetic patients and those with pre-existing renal dysfunction. METHODS: Data were prospectively collected on 20,322 consecutive patients undergoing cardiac catheterization and PCI between January 1997 and December 2001. A focused behavioral modification program was initiated in late 1998. The physician was informed verbally during the course of the procedure and by letter after the procedure regarding the volume of contrast dye used for cases in which the radiocontrast volume exceeded 300 mL. Data were analyzed using the Fischer's exact test. RESULTS: In the prefeedback years (1997 and 1998), high contrast use occurred in 7.7% (n = 602) of the total cases (n = 7799). In the postfeedback years (1999, 2000, and 2001), this declined to 3.6% (n = 445) of the total cases (n = 12,523), representing a 53% reduction (P < .001). The effect was most pronounced in PCI, with the percentage of high contrast cases decreasing from 24% (n = 563) of the total PCI cases (n = 2348) to 10.6% (n = 359) of the total PCI cases (n = 3386), representing a 56% reduction (P < .001). CONCLUSIONS: Our study demonstrates the effectiveness of behavioral modification and the contribution it can make in reducing the volume of contrast dye used in the cardiac catheterization laboratory, particularly in PCI. Adoption of such strategies may enhance patient safety and reduce contribution it can make in reducing the volume of contrast dye used in the cardiac catheterization laboratory, particularly in PCI. Adoption of such strategies may enhance patient safety and reduce costs.

Angioplasty, Balloon, Coronary↗
PubMed1997

The debate over cardiac catheterization.

At first glance, there would seem to be little controversy over cardiac catheterization, a diagnostic procedure used to evaluate problems with heart function and blood supply. In a typical cardiac catheterization, a long thin tube is inserted through blood vessels into the heart to evaluate blood pressure, inject dye, and take x-rays.

Cardiac Catheterization↗
PubMed1989

Peripheral vascular complications from percutaneous transluminal coronary angioplasty: a comparison with transfemoral cardiac catheterization.

The peripheral vascular complications associated with percutaneous transfemoral coronary angioplasty were compared with those that occurred during conventional transfemoral cardiac catheterization. Among 644 patients undergoing percutaneous transluminal coronary angioplasty (PTCA), 6 patients (0.9%) suffered peripheral vascular complications, whereas 35 of 2904 patients having cardiac catheterizations (1.2%) had a peripheral vascular complication. The types of complications associated with both procedures were similar and included groin hematomas, false aneurysms, arterial dissection, arterial perforation, and neurological deficits. The frequency of surgical repair of these complications also was similar in the two groups (50% required repair for a PTCA complication, 34% were repaired after a catheterization complication). The PTCA-associated complications included one myocardial infarction and one death, whereas neither of these occurred in association with a catheterization-induced vascular complication. The surgical management of five of the six PTCA complications was difficult, largely because of the size of the sheath-related puncture site and the presence of active bleeding from the associated systemic anticoagulation. PTCA carries the same risk of development of a peripheral vascular complication as found in transfemoral cardiac catheterization. Care must be taken to prevent sheath-related injury to the aorta-iliac-femoral system and hemorrhagic complications at the puncture site are of particular concern and require urgent surgical attention.

Aged↗
PubMed1993

Surgical treatment of femoral pseudoaneurysm following cardiac catheterization.

Over a period of 8 years, 31 femoral pseudoaneurysms following cardiac catheterization were surgically repaired in 15 men and 15 women ranging in age from 38 to 89 (mean 68.1) years. The catheterizations were performed for evaluation of coronary artery disease in 23 patients (77%), valvular heart disease in three (10%), both coronary artery disease and valvular disease in two (7%) and for other reasons in two (7%). Percutaneous transluminal coronary angioplasty was performed in eight patients (27%) and aortic valvuloplasty in one (3%). Surgical repair was performed from 1 to 47 (mean 10.2) days after catheterization under local anesthesia in 16 patients (52%), regional anesthesia in ten (32%) and general anesthesia in five (16%). All lesions were repaired by primary suture. The operating time ranged from 25 to 90 (mean 50.5) min and intraoperative blood loss from 50 to 900 (mean 259.2) ml. There were no operative deaths and one postoperative myocardial infarction. No patients have developed recurrent pseudoaneurysm, with follow-up ranging from 1 to 53 (mean 11.4) months. These results demonstrate that the surgical repair of femoral pseudoaneurysm following cardiac catheterization is safe, effective and durable.

Adult↗
PubMed1991

The effect of cardiac catheterization on fasting lipids.

Fasting lipid profiles were measured in 20 selected patients the day of and after cardiac catheterization in EDTA tubes. Samples were randomly labelled A or B, centrifuged, and stored at 3 degrees Centigrade. Lipid profiles were analyzed by a laboratory, which was participating in the Center for Disease Control Lipid Standardization Program, by using standard methods. The coefficients of variation for repeated measurements were: cholesterol = 1.9%, triglycerides = 3.6%, HDL cholesterol = 4.3%, and VLDL and LDL cholesterol = 2.6%. Data were evaluated by a two-tailed paired t-test and correlation coefficient. The total cholesterol was significantly lower (P less than .001) the day after cardiac catheterization as was the LDL cholesterol (P less than .002). Both VLDL and HDL cholesterol and triglycerides were lower, but these were not statistically significant. The mean dose of heparin was 3500 +/- 1469 units, and the mean dose of contrast was 181 +/- 30 cc. The total dose of heparin or contrast did not correlate with any change in lipid profiles. These results have implications on the number and timing of venous blood sampling for lipid measurements in regard to diagnosis and treatment of hyperlipidemia. Lipid profiles should not be drawn after cardiac catheterization but rather before and/or in the free-living state.

Adult↗
PubMedDate not supplied

Use of 5 French catheters for cardiac catheterization and coronary angiography: a critical review.

With the number of outpatient cardiac catheterizations increasing, much attention has recently been focused on the use of 5 French catheters for cardiac catheterization and selective coronary angiography. However, there are few reports in the literature regarding the technical aspects of their use or the quality of cineangiograms obtained. We reviewed our experience with these catheters in our first 100 consecutive cases. All cineangiograms were diagnostic, though 9% were deemed only of fair quality (incomplete luminal filling in some frames) by two experienced observers. Technical problems encountered with the use of these catheters included instability of the right Judkin's catheter in the right coronary ostium owing to high torquability, streaming of contrast during left coronary injections, and difficulty entering the left ventricle with a pig-tail catheter.

Cardiac Catheterization↗
PubMed1999

Research-based practice: reducing bedrest following cardiac catheterization.

Patient discomfort with prolonged bedrest following femoral arterial puncture for cardiac catheterization is a significant nursing problem. Safely reducing the time required for supine bedrest could improve patient comfort and reduce nursing care needs. Reducing bedrest also has the potential to improve organizational resource utilization. A review of the literature was conducted and a decision was made to implement 2 hours of bedrest, a significant decrease from the previous practice of 6 hours. Vascular complications were closely monitored in the first 50 patients, as a means of implementing the research-based change in practice. No significant vascular complications occurred and the practice change has expanded to all inpatient and outpatient areas caring for patients undergoing cardiac catheterization. This experience with utilizing research to change practice has created a positive environment for future research-based initiatives.

Back Pain↗
PubMed1980

Management of brachial artery occlusion after cardiac catheterization.

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

Arterial Occlusive Diseases↗
PubMed2002

Hyponatremia as a complication of cardiac catheterization: a prospective study.

BACKGROUND: A decrease in plasma sodium (P(Na)) concentration is common after surgery and attributed to the secretion of antidiuretic hormone in response to such nonosmotic stimuli as pain or nausea. In this setting, acute hyponatremia may lead to seizures, coma, and permanent neurological damage. Sporadic case reports have described severe neurological symptoms caused by hyponatremia occurring within hours after cardiac catheterization. We evaluated the prevalence, contributing clinical circumstances, and course of hyponatremia in patients undergoing cardiac catheterization. METHODS: We prospectively studied 309 consecutive patients scheduled for an elective cardiac catheterization. Plasma and urine electrolytes and urine osmolarity were measured at baseline and again 1 to 4 hours and 24 hours after the procedure. RESULTS: P(Na) level was 139.4 +/- 2.3 mEq/L at baseline. At 1 to 4 hours, P(Na) level decreased to 134.2 +/- 3.6 mEq/L (P < 0.0001). Mild (> or =5 to 10 mEq/L), moderate (11 to 14 mEq/L), and severe (> or =15 mEq/L) reductions in P(Na) levels occurred in 50%, 5%, and 0.3% of patients, respectively. At the 24-hour point, P(Na) level increased to 137.3 +/- 2.4 mEq/L, but was significantly lower compared with baseline (P < 0.0001). In hyponatremic patients at the 1- to 4- and 24-hour points, mean urine osmolarity values were 428 +/- 139 and 420 +/- 204 mOsm/kg, respectively; almost every urine sample was inappropriately concentrated. Multivariate logistic regression identified the amount of electrolyte-free water administered to be a predictor for the development of hyponatremia (3.7-fold incremental risk for every 1 L administered to a 70-kg patient). CONCLUSION: An acute reduction in P(Na) level commonly occurs shortly after cardiac catheterization. The cause of hyponatremia appears to be related to the administration of hypotonic fluids, together with impaired urinary dilutional capacity. Although symptomatic hyponatremia is rare, the diagnosis should be entertained when neurological symptoms develop in this setting.

Cardiac Catheterization↗
PubMed2001

Complications of cardiac catheterization in the current era: a single-center experience.

Consecutive cardiac catheterization procedures done over a 2-yr period (April 1996 to March 1998) were prospectively analyzed to determine and characterize procedure-related complications (in-hospital and 1-mo follow-up), as they occur at present. During the study period, 11,821 procedures (7,953 diagnostic and 3,868 therapeutic) were performed. The majority of procedures (> 60%) were done in high-risk patients. Stents were implanted in 33% of patients, and adjunctive abciximab was used in 6.6% of therapeutic procedures. The overall complication rate was 8% (3.6% of diagnostic procedures and 15.1% of therapeutic procedures). The procedure-related mortality rates were 0.2%, 0.1%, and 0.5% for total, diagnostic, and therapeutic procedures, respectively. Cardiac complications were seen in 3.9% (1.5% of diagnostic and 9% of therapeutic procedures). Emergency cardiac surgery was required in 0.05% of the diagnostic procedure group and 0.3% of the therapeutic procedure group (total, 0.1%). Despite marked changes in patient population and practice, the complication rates of cardiac catheterization remain very low.

Abciximab↗
PubMed1994

A randomized study of sheaths versus guidewires for arterial access during elective cardiac catheterization.

PURPOSE: The aim of this study was to compare the ease and safety of intravascular sheaths versus guidewires for maintaining arterial access during cardiac catheterization. METHODS: Two hundred patients with normal coagulation status undergoing routine diagnostic cardiac catheterization were randomized to intravascular sheath access versus guidewire access groups. Procedure times and difficulties were recorded during the procedure. Patients were asked to evaluate groin discomfort immediately after the procedure and two weeks later. Complications including groin hematoma, vascular damage, and stroke were assessed at the end of the procedure and the following morning. RESULTS: There were no differences between the sheath and guidewire groups in patient discomfort, procedural time or difficulty, or total complications. Hematomas occurred in 18% of patients (sheath 16% vs. guidewire 20%, p = NS) and were more often large in the guidewire group (5% vs. 0%, p = .05). None required vascular repair. Oozing around the catheter was more frequent in the guidewire group (6% vs. 0%, p = .03) but did not lead to any significant complications. CONCLUSIONS: We conclude that using guidewires for arterial access during cardiac catheterization leads to more large hematomas and more access site oozing during the procedure. However, there were no differences in patient comfort, overall procedural difficulty, or total complications between sheath and guidewire techniques.

Aged↗
PubMed1993

An historical cohort study of cardiac catheterization during childhood and the risk of cancer.

This study aimed to determine whether cancer risk was elevated among patients exposed to radiation from diagnostic cardiac catheterization during childhood. The study cohort included 3915 children who underwent at least one cardiac catheterization at a major children's hospital in Toronto, Canada, between 1950 and 1965, were < or = 18 years at the time of the procedure, and were residents of Ontario. Follow-up of the cohort was done by linkage to the Ontario Cancer Registry up to 1986. A total of seven cancer deaths were observed (O), compared with 5.7 expected (E) based on provincial cancer rates (mortality ratio [O/E] = 1.2; 90% confidence interval [CI] : 0.6-2.3). In the analysis of cancer incidence, 13 cancers were detected, compared with 17.3 expected (O/E = 0.75; 90% CI : 0.4-1.2). These mortality and incidence ratios were not statistically significantly elevated. Detailed analyses were conducted according to age at exposure, age at diagnosis, sex, number of procedures, year of first catheterization, and latent period. Detected deviations in risk were confined to an early period of exposure, indicating that later practices of cardiac catheterization were not associated with increased risk. In general, there was no statistically significant excess risk of cancer among the cohort.

Adolescent↗
PubMed1999

Low-risk cardiac catheterization in a community hospital.

Monmouth Medical Center opened its low-risk cardiac catheterization laboratory in 1997. One of the goals in seeking to provide approval of this service was to facilitate and provide equitable access to catheterization for patients in the catchment area. This study reports the first year's experience in providing low-risk cardiac catheterization.

Aged↗
PubMed1994

Retroperitoneal hematoma after cardiac catheterization: prevalence, risk factors, and optimal management.

PURPOSE: Retroperitoneal hematoma is an unusual, but potentially serious, complication after cardiac catheterization. The predisposing factors, typical presentation, and clinical course of this iatrogenic complication are identified, and the role of surgery in its treatment is defined. METHODS: A retrospective review of 9585 femoral artery catheterizations over a 5-year period allowed identification and evaluation of all patients with retroperitoneal hemorrhage. RESULTS: Retroperitoneal hematoma developed in 45 patients (overall prevalence 0.5%), with the highest frequency after coronary artery stenting (3%). In the group of patients who underwent coronary artery stenting, statistically significant predictors of this complication included protocol for sheath removal, female sex, nadir platelet count, and excessive anticoagulation. Signs and symptoms included suprainguinal tenderness and fullness in 100%, severe back and lower quadrant pain in 64%, and femoral neuropathy in 36%. Most patients were treated successfully with transfusion alone. Seven patients (16%) required operation; in four, hypotension unresponsive to volume resuscitation developed early after catheterization; and, in three, a progressive fall in hematocrit level led to surgery 24 to 72 hours after catheterization. CONCLUSIONS: Retroperitoneal hematoma after cardiac catheterization can usually be treated by transfusion alone. A small subset of patients who have development of hypotension unresponsive to volume resuscitation require urgent operation.

Aged↗
PubMed1991

Risk stratification in survivors of acute myocardial infarction: routine cardiac catheterization and angiography is a reasonable approach in most patients.

Noninvasive risk assessment in survivors of AMI can effectively subdivide patients into groups with differing risk profiles after hospital discharge, but some patients at risk for late death or recurrent AMI may be incorrectly identified; data from cardiac catheterization and angiography provide complementary and generally more powerful prognostic information. Many patients may derive particular benefit from early cardiac catheterization and angiography, including: (1) patients with AMI complicated by recurrent myocardial ischemia, congestive heart failure, and/or complex ventricular arrhythmias; (2) patients with abnormal or inconclusive results of noninvasive testing or those patients unable to perform an exercise test; (3) patients with abnormal left ventricular global systolic function and those with increased left ventricular end-systolic volume; (4) "young" patients (younger than 50 years of age?); (5) older patients (older than 65 to 70 years of age?); (6) patients with non-Q wave AMI; and (7) patients who are receiving thrombolytic therapy. Performance of early cardiac catheterization and angiography in virtually all survivors of AMI, with selective use of appropriate noninvasive tests, may provide a more efficacious means of risk assessment after AMI; if all tests are performed judiciously, the cost of such an approach need not be excessive. A combination of invasive and selected noninvasive tests probably provides optimal information. The risks to the routine performance of diagnostic cardiac catheterization and angiography in all survivors of AMI are: (1) adequate care and attention may not be paid to proper performance of the procedure(s) and to detailed and proper analyses of the data; (2) the need for additional noninvasive testing in selected patients may be ignored; and most importantly, (3) premature or unnecessary revascularization procedures may be performed subsequently. For optimal patient care, the clinician must obtain all necessary data, avoid unnecessary and repetitive tests, know the accuracy of individual tests at his or her own facility, interpret all data in proper context, and then counsel patients objectively about available management strategies. With this approach, all patients who might appropriately benefit from coronary artery revascularization will be correctly identified, and patients who are truly at very low risk (minimal residual coronary artery disease and preserved left ventricular function particularly if associated with a patent infarct-related artery) may be similarly identified and managed appropriately with elimination of unnecessary additional testing and pharmacologic therapy. Finally, whatever approach to risk stratification one chooses for an individual patient, the importance of and the need to correct and/or ameliorate risk factors for coronary artery disease must be recognized and undertaken.

Age Factors↗