Cardiac catheterization; general nursing care.
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Cardiac Catheterization↗
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Preventing complications during cardiac catheterization.
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Adult↗
Factors affecting the radiation dose to the lens of the eye during cardiac catheterization procedures.
Concern has been expressed about the relatively high radiation doses to the lens of the eye received by the operator during cardiac catheterization studies. A study was undertaken to assess the occupational doses received by cardiologists and to examine the factors that affect the individual's eye dose. Eighteen cardiologists working in five catheterization laboratories at three centres were included in the study. Their eye doses, workload and individual study details were monitored at each centre. Operating dose rates and scattered radiation were also measured for each unit to compare equipment performance. The study demonstrated that the relationships between the cardiologist's eye dose and factors such as the dose efficiency of the X-ray equipment, scattered dose rates, examination protocols and workload are complex and vary from centre to centre. Because of these variations general workload limits may be inaccurate and should only be used for general guidance when no direct measurements are available. Such limits should be verified by local measurements as soon as is practical.
Cardiac Catheterization↗
Specialized service offerings and patients' choice of hospital: the case of cardiac catheterization.
Patients' choice of hospital is modeled as a function of their expectation of needing a specialized service (option demand). The estimation tests whether cardiac patients' choice of hospital responds to changes over time in the availability of a specialized cardiac service. Results suggest that availability of cardiac catheterization has a strong, significant effect on the choice of hospital, even after controlling for other quality characteristics. However, the effect appears confined to those patients whose diagnosis indicates some probability of needing the service. Patients with no 'option demand' do not appear to use specialized services as a signal of quality.
Aged↗
Utility of Doppler color flow imaging for identification of femoral arterial complications of cardiac catheterization.
Doppler color flow and two-dimensional ultrasonographic images of the femoral region were obtained in 25 patients referred for suspected vascular complications of cardiac catheterization. Five patients had normal findings, while 23 abnormalities were noted in 20 patients, including seven femoral arteriovenous fistulae, 12 femoral pseudoaneurysms, and two patients with both femoral arteriovenous fistulas and pseudoaneurysms. Operation confirmed the abnormalities diagnosed by color flow examination in 15 of 20 patients. Three patients refused operation and one was not felt to be a surgical candidate due to high anesthetic risk. One patient died preoperatively and postmortem examination confirmed the color flow diagnosis. Etiologies of the arterial complications included percutaneous aortic valvuloplasty (6), coronary angioplasty (4), and arterial or both arterial and venous catheterization (10). Doppler color flow imaging is a reliable technique for identification of vascular complications following catheterization procedures.
Aged↗
Cardiac catheterization laboratory imaging quality assurance program.
With the recent approval of the National Electrical Manufacturers Association (NEMA) standard for "Characteristics of and Test Procedures for a Phantom to Benchmark Cardiac Fluoroscopic and Photographic Performance," comprehensive cardiac image assurance control programs are now possible. This standard was developed by a joint NEMA/Society for Cardiac Angiography and Interventions (SCA&I) working group of imaging manufacturers and cardiology society professionals over the past 4 years. This article details a cardiac catheterization laboratory image quality assurance and control program that includes the new standard along with current regulatory requirements for cardiac imaging. Because of the recent proliferation of digital imaging equipment, quality assurance for cardiac imaging fluoroscopy and digital imaging are critical. Included are the previous works recommended by the American College of Cardiology (ACC) and American Heart Association (AHA), Society for Cardiac Angiographers and Interventions (SCA&I), and authors of previous image quality subjects.
Cardiac Catheterization↗
The effectiveness of teaching a relaxation technique to patients undergoing elective cardiac catheterization.
The effects of a relaxation technique (RT) on anxiety, vital signs, procedure length, and amount of diazepam given were examined in patients undergoing cardiac catheterization (CC). Forty patients were randomly assigned to an experimental (RT) or a control (no RT) group. No significant differences were found between groups in pre-CC or post-CC State-Trait Anxiety Inventory (STAI) scores, vital signs, or procedure length. The experimental group received significantly less diazepam, and their STAI scores declined significantly.
Adult↗
Radiation exposure of pediatric patients and physicians during cardiac catheterization and balloon pulmonary valvuloplasty.
Thermoluminescent dosimeters were applied to various areas of 61 pediatric patients and physicians to measure radiation doses during routine cardiac catheterization and during 4 cases of balloon pulmonary valvuloplasty. Radiation doses were measured during chest roentgenography, fluoroscopy and cineangiography. Average skin dose to the chest was 121 microGy during chest x-ray, 5,182 microGy during catheterization and 641 mGy during valvuloplasty. For the eyes, thyroid and gonads of the patients, the exposure during routine catheterization was equal to 0.4, 6 and 0.2 chest x-rays, respectively. Radiation dose of the operator was 3 microGy for the eyes and 6 miCroGy in the thyroid. About 56% of the operator's dose could be reduced by thyroid shields, and 80% by lead aprons. The assistant received only 1 microGy outside the thyroid shield. Therefore, we have concluded that the patients' dose during routine catheterization is largely based on our experimental results, but the dose is acceptable based on the risk factor analysis. The skin dose to the right lateral chest of the patient during valvuloplasty is extremely high, perhaps as high as the equivalent of 1,000 chest x-rays. Besides the clinical benefits of valvuloplasty, the long-term radiation-related hazards to the patient should be carefully monitored.
Adolescent↗
[Echocardiographic indices of the pumping and contractile functions of the left ventricle and the hemodynamic data obtained from left and/or right cardiac catheterization].
A juxtaposition of the EchoC-indices for the pump and contraction function of left ventricle and the hemodynamic data obtained with right and left cardiac catheterization was carried out in 95 patients with different myocardial and valvular heart diseases. The following EchoC-indices were determined for the assessment of the left-ventricle function -- telediastolic dimension and volume of left ventricle, stroke and minute heart volume, fraction of shortening (FS), average contraction speed of circumferential fibres (CCF), fraction of expulsion (FE), left auricle dimension. A considerable correlation was found among the EchoC-indices for pump and contraction function of left ventricle and the final diastolic left ventricle pressure and the average left auricle pressure. In heart patients with a normal final diastolic pressure in left ventricle and average left auricle pressure, pulmonary capillaries (PC) resp., the average values of all functional EchoC-indices are normal. With an elevated final diastolic pressure in left ventricle, diminished values of dP/dt max and elevated mean pressure in left auricle, the pulmonary capillaries resp., the values of all EchoC-indices for the pump and contraction left ventricle function are pathological -- enlarged telediastolic dimension and left ventricle volume, enlarged dimension of left ventricle, reduced values of FS, CCF, FE, SV and MV. EchoC-functional indices properly differentiate the pathological from the normal hemodynamics of left ventricle. determined by catheterization in 86 per cent of the cases. The false positive and false negative results are obtained in 14 per cent of the cases.
Cardiac Catheterization↗
Overcoming vascular anatomic challenges to cardiac catheterization by the radial artery approach: specific techniques to improve success.
Anatomical variations in the peripheral vasculature can result in decreased procedural success rates for cardiac catheterization performed through the radial artery approach. We describe four categories of vascular challenges encountered in our catheterization laboratory: severe spasm, severe tortuosity, vascular stenosis, and congenital anatomical variations (e.g., accessory radial artery, radioulnar loop). For each situation, we provide a case report illustrating techniques that allowed for successful completion of the case.
Aged↗
Reduced radiation during cardiac catheterization of infants using acquisition zoom technology.
The new digital technology of obtaining images in an AZ mode effectively reduces the radiation dose to infants undergoing cardiac catheterization. Future software advances in this technique should enhance the image quality and potentially broaden its application to older patients.
Age Factors↗
Pulmonary edema during cardiac catheterization successfully treated with bolus administration of nicardipine.
This report describes a 62-year-old patient with ischemic dilated cardiomyopathy who presented pulmonary edema during cardiac catheterization. Bolus administration of nicardipine (5 mg in 5 min) into the pulmonary artery determined prompt recovery from the crisis and optimal hemodynamic conditions for completion of the catheterization. The action of the drug was mediated by the rapid reduction of the left ventricular preload and afterload. We believe that bolus administration of nicardipine is useful in treating episodes of acute left ventricular insufficiency.
Cardiac Catheterization↗
Nuclear scans: a clinical decision making tool that reduces the need for cardiac catheterization.
We have assessed the impact of cardiovascular nuclear medicine studies (CVNMS) on physicians' decisions to send patients with suspected ischemic heart disease (N = 439) on to cardiac catheterization at three Bronx hospitals. A change in management plans with respect to catheterization was observed in 31% of cases. Catheterization rates were reduced by 25% among patients referred for resting studies and by 49% for exercise studies (thallium perfusion or exercise wall motion studies). Results of CVNMS had little impact on catheterization decisions for resting study patients (N = 192). Among exercise study patients (N = 247), those with normal results had a relative reduction in catheterization post-CVNMS of 82% vs 27% for patients with abnormal results (p less than 0.001). However, impact of exercise CVNMS test results on post-CVNMS catheterization rates obtained for men only; women with abnormal exercise study results were much less likely to undergo subsequent catheterization (7.7%) than men with abnormal results (41.9%), p less than 0.005, independent of age. The apparent discrepancy in referral for catheterization based on sex needs to be investigated further.
Adolescent↗
Transcutaneous PO2 monitoring (tcPO2) in the newborn during apneic spells, convulsions, cardiac catheterizations, and exchange transfusions.
Continuous transcutaneous PO2 recording improves the monitoring of critically ill infants and newborns submitted to invasive procedures such as exchange transfusions or cardiac catheterization. The measurement of tcPO2 in babies with apneic spells or seizures gives a better understanding of these respiratory disorders. It is reasonable to recommend the continuous monitoring of PO2 with a transcutaneous electrode in neonatal intensive care units.
Apnea↗
An accurate method for the continuous measurement of oxygen consumption in infants during cardiac catheterization.
This paper describes the assessment of a method for measuring the oxygen consumption of infants and young children that is suitable for use in the cardiac catheterization laboratory. It is based upon the open-circuit technique and permits the continuous display of the oxygen consumption during the investigative procedures. The accuracy of the apparatus was assessed over the range 40-200 ml/min, both in vitro and in vivo. It was found that the apparatus was free from systematic error and that it had a random error of approximately 2% of the measured value.
Cardiac Catheterization↗
Measuring skin dose with radiochromic dosimetry film in the cardiac catheterization laboratory.
A new radiochromic dosimetry film was tested to determine its potential for patient skin dose monitoring in a fluoroscopically intensive environment such as the cardiac catheterization laboratory. The dose, time, energy, dose fractionation, dose rate, and sheet to sheet uniformity response were tested. All tests support the conclusion that this is a simple, noninvasive, retrospective method to identify skin regions at risk from high x-ray doses. The consistency and accuracy of dose measurements allow for an estimation of the localized skin dose to those patients who are susceptible to radiation induced skin injury.
Cardiac Catheterization↗
[Transient cortical blindness after cardiac catheterization in a post-surgical coronary patient].
Transient cortical blindness is a known complication after cerebral and vertebral angiography although is a rare complication following cardiac catheterization. In this report, we describe a seventy-six-year-old male patient who had cortical blindness after coronary bypass graft angiography. The development of cortical blindness, in this setting, appears to be an osmotic disruption of the blood-brain barrier which is selective for the occipital cortex. Other hypotheses, such as an immunological reaction to the contrast agent or a direct injection of dye into the vertebral artery system, were considered. The clinical outcome is usually favourable, with vision completely restored within 24-48 hours, as was the case of the patient described in the present report.
Aged↗
Two versus six hours of bed rest following left-sided cardiac catheterization and a meta-analysis of early ambulation trials.
The present study and associated meta-analysis shows that 6 hours of bed rest after outpatient cardiac catheterization offers no advantage over 2 hours of bed rest with respect to groin bleeding complications. The occasional bleeding observed occurred shortly after ambulation rather than after discharge.
Aged↗