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PubMed1976

Care of patients after cardiac catheterization.

In an effort to provide more definitive diagnosis for Air Force flyers referred to the USAF School of Aerospace Medicine, cardiac catherization has been performed, as indicated, on over 425 flyers since 1971. Since they are an apparently healthy and asymptomatic population, their recovery after cardiac catheterization is usually uneventful. However, the nurse must be able to recognize and interpret significant potential and/or existing post-catheterization complications. Nursing care of the patient after this procedure is essential to the successful completion of the test. Since any invasive procedure can lead to complications, quick and accurate nursing assessment and action are essential. The possible complications of cardiac catheterization which the nurse may encounter have been divided into possible causes, and a suggested plan of action. Reference tables are provided for each of the two main classifications, in an effort to provide quick guidance for the nurse responsible for care of the patients after catheterization.

Aerospace Medicine↗
PubMed1983

The preoperative evaluation in patients with endocarditis. Is cardiac catheterization necessary?

We retrospectively compared clinical assessment and cardiac catheterization to subsequent surgical findings with regard to specific valvular involvement, hemodynamic status, and presence of myocardial abscess in patients recommended for cardiac surgery for endocarditis. Of 105 consecutive patients with endocarditis, 19 met one or more of the following criteria suggesting the need for early surgery: congestive heart failure; systemic emboli; persistent infections or new conduction abnormalities. Of these 19 patients, seven had prosthetic cardiac valves. Clinical assessment was highly sensitive (95 percent) and specific (89 percent) for specific valvular involvement and was also highly sensitive and specific in evaluating myocardial abscess and congestive heart failure; however, clinical assessment could not identify the source of infection in one patient with multiple prosthetic valves, did not define the specific valve in one patient with right-sided endocarditis, and overestimated the severity of mitral regurgitation in one patient who had normal pressures and flows at catheterization. Catheterization incorrectly predicted multivalvular involvement in four patients. At catheterization, only one patient experienced evidence of clinical deterioration, and this was probably not related to the procedure. We conclude that although clinical assessment is correct in most patients, it may on occasion lead to an erroneous conclusion. Catheterization and angiograms are of value in the preoperative evaluation of patients with endocarditis, particularly in cases where the clinical assessment is ambiguous or uncertain. The procedures can be performed at low risk, and the information obtained may substantially influence management in some cases.

Adolescent↗
PubMed2000

Cardiac catheterization reduces resource utilization in patients with chronic chest pain.

The evaluation of patients with recurrent chest pain accounts for a significant proportion of the $274 billion annual cost of cardiovascular services in the United States. Our investigation examines the impact of coronary angiography on subsequent use of medical resources for evaluation of chest pain symptoms. The study seeks to determine whether a finding of noncritical coronary artery disease on cardiac catheterization leads to a reduced use of resources for subsequent evaluation and treatment of chest pain syndromes. Our study included 22 consecutive patients who had sought evaluation for chest pain symptoms, and who had persistence of symptoms after functional testing. Cardiac catheterization demonstrated angiographically mild coronary artery disease (stenosis less than 50%) in these patients. The patient cohort accounted for 22 emergency room evaluations and 41 ambulatory clinic evaluations in the 2.5 years before cardiac catheterization. In the 2.5-year period after catheterization, these patients had only 3 emergency room visits and 1 ambulatory clinic visit for chest pain evaluation (P < 0.001). There was a significant reduction in the number of prescriptions written for topical and oral nitrates (32% precatheterization vs. 5% postcatheterization, P < 0.04), but not of beta-blockers (26% vs. 21%, P = 0.53) or calcium blockers (32% vs. 32%, P = 1.0). Furthermore, most of the 21 surviving patients were found subsequently to have a noncardiac basis for their pain: pericarditis was felt to be the cause of chest pain in 4 patients, pulmonary disease in 7 patients, and gastrointestinal conditions in 8 patients. Diagnostic coronary arteriography may identify a subset of patients in whom a finding of noncritical coronary artery disease leads to a reduction in physician visits for evaluation of chest pain syndromes and reduced use of nitrates. In addition, when coronary artery disease is known to be mild, a noncardiac etiology for the chest pain can be sought. These results may decrease the use of expensive medical resources and encourage full occupational and lifestyle rehabilitation.

Angina Pectoris↗
PubMed1984

Complete heart block during cardiac catheterization in a normal individual.

A 44-year-old white male who developed third-degree heart block during cardiac catheterization is presented. Right heart catheterization precipitated bifascicular block, right bundle branch block with left posterior hemiblock, and resulted in third-degree heart block during the left heart procedure. It is recommended that multiple electrocardiographic lead monitoring be considered during cardiac catheterization in order to recognize more easily high-risk conduction disturbances, ie a bifascicular block pattern with frontal plane axis shifts.

Adult↗
PubMed2003

Early and late reactions following the use of iopamidol 340, iomeprol 350 and iodixanol 320 in cardiac catheterization.

GOAL: To investigate the incidence of early (< 24 hours) and late (> 24 hours to 7 days) reactions to 3 contrast agents commonly used in cardiac catheterization. METHODS AND RESULTS: A total of 2,108 patients undergoing cardiac catheterization in a Regional Cardiothoracic Unit were randomly assigned to receive 1 of 3 commonly used contrast agents in a prospective, double-blind study. The contrast agents were iopamidol 340 (Niopam ), a nonionic monomer; iomeprol 350 (Iomeron ), a nonionic dimer; and iodixanol 320 (Visipaque ), a nonionic dimer. The main outcome measures were the incidence of early (< 24 hours) reactions following catheterization and the incidence of late (24 hours to 7 days) reactions. Early reactions, excluding patients with heat on left ventriculography as the sole symptom, were relatively common (7.4%), but there was no significant difference between the 3 agents (p = 0.35). Late skin reactions, excluding reactions solely at the site of the arterial puncture and continuations of early urticarial reactions, were also relatively common (5.4%), but the incidence differed between the 3 agents. Such reactions occurred in 2.7% of those receiving iopamidol 340 (Niopam ), 3.5% of those receiving iomeprol 350 (Iomeron ) and 10.4% of those receiving iodixanol 320 (Visipaque ) (p < 0.01). CONCLUSION: The incidence of early adverse reactions is similar with these 3 contrast agents. However, late skin reactions are significantly more common with iodixanol 320 (Visipaque ) than with the other 2 agents. Although such reactions were rarely troublesome, patients should be advised accordingly.

Adolescent↗
PubMed1982

Permanent pacemaker implantation in the cardiac catheterization laboratory: the subclavian vein approach.

During a 36-month period, 171 permanent pacemaker procedures were performed in the cardiac catheterization laboratory by invasive cardiologists. This included 111 initial pacemaker system implants, via the percutaneous subclavian vein approach, 45 pulse generator changes, and 15 miscellaneous procedures. In no case did subclavian vein puncture result in pneumothorax, hemothorax, or brachial plexus injury. In patients undergoing initial lead placement, the dislodgment rate was 0.8% over a 16-month follow-up period. The reoperation rate for causes other than premature battery depletion was 5.4% during the first 12 months. The implantation of permanent pacemakers can be safely and effectively accomplished by experienced invasive cardiologists in the cardiac catheterization laboratory. In our series not only was continuity of patient care improved, but also medical costs were reduced.

Adult↗
PubMed2002

Which patients with unstable angina or non-Q-wave myocardial infarction should have immediate cardiac catheterization? A clinical decision rule for predicting who will fail medical therapy.

Unstable angina and non-Q-wave myocardial infarction (MI) are common and costly clinical events, but there is considerable uncertainty about optimal clinical management of these syndromes. We developed a prediction rule to help clinicians determine which patients with unstable angina or non-Q-wave MI are likely to "fail" medical therapy and ultimately require cardiac catheterization within 6 weeks of presentation. Subjects were 733 patients presenting with unstable angina or non-Q-wave MI enrolled in the TIMI IIIB trial and randomized to initial medical management. We developed a prediction rule based on logistic regression analysis of baseline data from history, physical examination, electrocardiogram, and blood studies. The outcome of interest was "failure" of medical therapy, defined as need for coronary catheterization within 42 days. Significant predictors of "failing" medical therapy included ST segment depression >or= .1 mV (odds ratio, OR, = 2.7, 95% confidence interval, CI, 1.8-4.1), accelerated angina in the prior 2 months (OR = 1.8, 95% CI 1.2-2.6), nitrate use in the prior week (OR = 1.6, 95% CI 1.1-2.2), exertional angina in the prior 2 months (OR = 1.6, 95% CI 1.1-2.2), and cardiac troponin I (cTnI) >or= 0.4 ng/mL (OR = 1.4, 95% CI 1.1-1.9). We used these variables to build a risk score by assigning point values based on these ORs. The risk score had a moderate ability to predict which patients would subsequently fail medical therapy and undergo cardiac catheterization (c = 0.682). Out of a total risk score of 13, failure of medical therapy occurred in 86% of patients who had a risk score >or= 8 (n = 111), 78% of patients who had a risk score >or= 6 (n = 240), and 72% of patients who had a risk score >or= 4 (n = 438). At scores of < 2 (n = 88), 40% of patients failed medical therapy. Although the management of unstable angina is in constant evolution, clinicians will always be faced with determining which patients should be managed most invasively. The simple prediction rule we present can be applied to patients with unstable angina or non-Q-wave MI at the time of presentation to predict which patients have a high probability of failing medical therapy. Such a rule may be useful for identifying patients who should be considered for early cardiac catheterization.

Adult↗
PubMed1998

Research utilization and improvement in outcomes after diagnostic cardiac catheterization.

This research utilization project helped summarize the research basis of current practice related to duration of bed rest after cardiac catheterization via the femoral artery. Several physicians have changed their practice as a result of this project, and the safety of patients is being maintained. Interestingly, De Jong and Morton recently published a research analysis of interventions used to control vascular complications after cardiac catheterization. These authors concluded from the review of the literature on duration of bed rest that evidence was sufficient to support a change in practice. Because we thought that the published evidence was insufficient to be used as the sole basis for a change in practice, we continued to follow the Iowa model. Specifically, we integrated scientific principles and expert recommendations with the published research base; recommended a change in practice; and monitored patients' outcomes, which ultimately did confirm the recommendations of De Jong and Morton. We are convinced that the combination of data from our own patients and the review of the literature was helpful to assure our medical and nursing staff that this change in practice was safe. This project illustrates the benefit of using the Iowa Model for Research Based Practice to Promote Quality Care as a guide to improve patients' outcomes.

Algorithms↗
PubMedDate not supplied

Effective anxiety treatment prior to diagnostic cardiac catheterization.

Music therapy, massage, guided imagery, therapeutic touch, and stress management instruction have been used successfully to decrease patient anxiety prior to diagnostic cardiac catheterization, providing better patient outcomes. The anxiety experienced among patients may have various causes, including not feeling cared about as an individual, too much waiting time before the procedure begins, and physical discomfort. This review determines nursing interventions that may effectively reduce anxiety prior to diagnostic cardiac catheterization.

Adaptation, Psychological↗
PubMed2003

The incidence and risk factors of cholesterol embolization syndrome, a complication of cardiac catheterization: a prospective study.

BACKGROUND: Cholesterol embolization syndrome is a systemic disease caused by distal showering of cholesterol crystals after angiography, major vessel surgery, or thrombolysis. METHODS: We prospectively evaluated a total of 1,786 consecutive patients 40 years of age and older, who underwent left-heart catheterization at 11 participating hospitals. The diagnosis of CES was made when patients had peripheral cutaneous involvement (livedo reticularis, blue toe syndrome, and digital gangrene) or renal dysfunction. RESULTS: Twenty-five patients (1.4%) were diagnosed as having CES. Twelve patients (48%) had cutaneous signs, and 16 patients (64%) had renal insufficiency. Eosinophil counts were significantly higher in CES patients than in non-CES patients before and after cardiac catheterization. The in-hospital mortality rate was 16.0% (4 patients), which was significantly higher than that without CES (0.5%, p < 0.01). All four patients with CES who died after cardiac catheterization had progressive renal dysfunction. The incidence of CES increased in patients with atherosclerotic disease, hypertension, a history of smoking, and the elevation of baseline plasma C-reactive protein (CRP) by univariate analysis. The femoral approach did not increase the incidence, suggesting a possibility that the ascending aorta may be a potential embolic source. As an independent predictor of CES, multivariate regression analysis identified only the elevation of pre-procedural CRP levels (odds ratio 4.6, P = 0.01). CONCLUSIONS: Cholesterol embolization syndrome is a relatively rare but serious complication after cardiac catheterization. Elevated plasma levels of pre-procedural CRP are associated with subsequent CES in patients who undergo vascular procedures.

Acute Kidney Injury↗
PubMed1981

Valve replacement without preoperative cardiac catheterization.

During the year 1978, the decision to perform cardiac catheterization in patients with valvular heart disease was delayed until clinical and noninvasive assessment have been completed. As a result, 184 patient underwent operation without invasive studies, and 59 had elective catheterization. Another 62 patients were referred during the same period for valve replacement after routine catheterization had been performed elsewhere. Age, sex distribution, symptoms, and cause of valve disease were similar in all three groups, although we managed emergencies and second operations more frequently without catheterization. In all patients, the preoperative diagnosis was confirmed, and no unexpected pathologic process was encountered. Operative mortality was the same in all three groups, and after two years of follow-up there was no difference in survival or symptoms. No uncorrected valve lesions became apparent in uncatheterized patients. We conclude that routine catheterization is unnecessary before valve replacement but can be reserved for specific indications in some patients.

Adolescent↗
PubMed1988

The anaesthetist and paediatric cardiac catheterization.

Despite recent developments in echocardiography and MR imaging, cardiac catheterization continues to be an important preoperative investigation in children with heart disease. Anaesthetic management varies considerably, but the presence of a skilled, well-informed anaesthetist should be invaluable in the early recognition and treatment of dangerous complications which may occur during the procedure.

Anesthesia↗
PubMed1986

Stress management training for parents and their children undergoing cardiac catheterization.

A program to prepare school age patients for cardiac catheterization is described and evaluated. Children and their parents were provided with a combination of interventions including information, supportive counseling, and stress management training. A team approach was used to reduce anxiety and upset and to increase cooperation of pediatric patients in the hospital and following discharge.

Adolescent↗
PubMed2004

Deep vein thrombosis in the arm following transradial cardiac catheterization: an unusual complication related to hemostatic technique.

Transradial cardiac catheterization is an increasingly popular technique mainly because of the low vascular complication rate. We report a case of arm deep vein thrombosis that may be related to a common puncture site hemostasis technique. This complication supports the use of specific unilateral compression hemostatic systems following transradial procedures.

Aged↗
PubMed1978

Physician and patient exposure during cardiac catheterization.

A survey of the literature was conducted to establish the anticipated ranges of exposure to both physicians and patients during cardiac catheterization. A brief explanation of a technic for using time-lapse photography and a computer model for exposure calculation is presented. The thermoluminescent dosimeter (TLD) results used as controls for exposure values calculated by the developed technique are presented in detail. Physician eye exposures of approximately 20 mR per cardiac catheterization procedure were measured, which would suggest a limit of five procedures per week for physicians. The average patient skin entrance exposure of 28 R is high, as is the 12 mR gonadal exposure; however, they are accepted because of the possible benefits of the procedure.

Cardiac Catheterization↗
PubMed1996

Regional wall motion changes with dobutamine as a pharmacological stress test during cardiac catheterization in patients with significant coronary artery disease.

BACKGROUND: Preliminary study to test the feasibility of pharmacological stress testing during cardiac catheterization, thus combining anatomical and functional information. PATIENTS AND METHODS: 21 consecutive patients with known or suspected coronary artery disease, referred for diagnostic catheterization. Biplane ventriculography was performed before and during dobutamine infusion. The patients were subdivided into 3 groups: Group I (n = 11, 52%) with at least one territory supplied by a significantly stenosed coronary artery and showing normal resting regional wall motion. Group II (n = 6, 29%) patients in whom the affected vessel(s) supplied exclusively a territory with regional wall motion abnormalities at rest. Group III (n = 4, 19%) had no significant coronary artery disease and served as control. RESULTS: In group I, 9/11 (82%) patients and in group II, 3/6 (50%) patients showed either ischemia or viability reactions or both after dobutamine stress. Overall, substantial functional information was gathered in 12/17 patients (71%). Control patients showed no worsening of regional wall motion under dobutamine. Neither global left ventricular ejection fraction nor left ventricular end diastolic pressure were as accurate in detecting ischemia as regional wall motion analysis. In patients who had only ischemia and no viability reaction as judged by regional wall motion analysis, ejection fraction fell significantly in 4/6 (67%) patients; end diastolic pressure on the other hand rose significantly in 3/6 (50%). CONCLUSIONS: Dobutamine stress testing performed during cardiac catheterization is convenient, feasible and safe and yields clinically useful information in a high percentage (71%) of patients with significant coronary artery disease. Further experience is needed to evaluate the sensitivity, specificity and predictive value of this new approach.

Cardiac Catheterization↗