Strategies for Decreasing Vascular Complications in Diagnostic Cardiac Catheterization Patients

Cale, Laureen; Constantino, Rose E.

doi:10.1097/dcc.0b013e31823a52f5

Cited by 5 publications

(4 citation statements)

References 12 publications

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“…Although pacing with leads has been successfully used clinically for almost 60 years, these catheters are associated with costs (single-use devices, need of a sterile environment) and inherent risks1234 from the nature of interventional procedure. Also long-term complications with leads are not negligible, therefore ways to stimulate the heart without leads are intensively looked for.…”

mentioning

confidence: 99%

Non-invasive cardiac pacing with image-guided focused ultrasound

Marquet

Bour

Vaillant

et al. 2016

Sci Rep

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Currently, no non-invasive cardiac pacing device acceptable for prolonged use in conscious patients exists. High Intensity Focused Ultrasound (HIFU) can be used to perform remote pacing using reversibility of electromechanical coupling of cardiomyocytes. Here we described an extracorporeal cardiac stimulation device and study its efficacy and safety. We conducted experiments ex vivo and in vivo in a large animal model (pig) to evaluate clinical potential of such a technique. The stimulation threshold was determined in 10 different ex vivo hearts and different clinically relevant electrical effects such as consecutive stimulations of different heart chambers with a single ultrasonic probe, continuous pacing or the inducibility of ventricular tachycardia were shown. Using ultrasonic contrast agent, consistent cardiac stimulation was achievable in vivo for up to 1 hour sessions in 4 different animals. No damage was observed in inversion-recovery MR sequences performed in vivo in the 4 animals. Histological analysis revealed no differences between stimulated and control regions, for all ex vivo and in vivo cases.

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mentioning

confidence: 99%

Non-invasive cardiac pacing with image-guided focused ultrasound

Marquet

Bour

Vaillant

et al. 2016

Sci Rep

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“…Cale and Constantino performed a literature search to examine the risk factors for, and strategies to prevent, complications in the CCL, but the authors noted ‘a lack of quality research on this subject’. 15 Furthermore, the writing committee of a recent ‘Best Practice in the Cardiac Catheterisation Laboratory’ document published by the American Society for Cardiovascular Angiography and Interventions acknowledged ‘a dearth of high-quality published studies’ and recommended further research into quality improvement in the CCL. 16 A previous study by Gordon et al looked at the impact of a checklist in patients who were undergoing procedures for structural heart disease, but this was partly retrospective, involved far fewer patients and did not use the WHO checklist design.…”

Section: Lessons and Limitationsmentioning

confidence: 99%

Use of a safe procedure checklist in the cardiac catheterisation laboratory

et al. 2018

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BackgroundThe use of the WHO safe surgery checklist has been shown to reduce morbidity and mortality from surgical procedures. However, whether a WHO-style safe procedure checklist can improve safety in the cardiac catheterisation laboratory (CCL) has not previously been investigated.ObjectivesThe authors sought to design and implement a safe procedure checklist suitable for all CCL procedures, and to assess its impact over the course of 1 year.MethodsIn the first 3 months, weekly PDSA cycles (Plan-Do-Study-Act) were used to optimise the design of the checklist through testing and staff feedback, and team briefing sessions were introduced before each procedure list. The impact of the checklist and team briefs was assessed by analysing in-house procedural data subsequently submitted to national audit databases. Staff and patient questionnaires were performed throughout the year.ResultsIntroduction of the checklist was associated with a significant reduction of 3 min in average turnaround time (95% CI 25 s to 6 min, p=0.027). Similarly, an initial reduction in patient radiation exposure was recorded (dose area product reduction of 641.5 cGy/cm2; 95% CI 255.9 to 1027.1, p=0.002). The rate of reported complications from all procedures fell significantly from 2.0% in 2012/2013 (95% CI 1.6% to 2.4%) to 0.8% in 2013/2014 (95% CI 0.6% to 1.1%, p≤0.001). Staff climate questionnaires showed that technicians and radiographers gave more positive responses at the end of the study period compared with the beginning (p=0.001).ConclusionsThe use of a team brief and WHO-derived safe procedure checklist in the CCL was associated with decreased radiation exposure, fewer procedural complications, faster turnarounds and improved staff experience.

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“…The rate of complications for diagnostic catheterization is no more than 1%, and the complication rate associated with PCI is 3% Complications that can disturb a patient's post procedure recovery, cause pain, and an increase in length of stay include vascular complications such as hematoma, pseudoaneurysm, arteriovenous fistula, peripheral artery occlusion, dissections, and retroperitoneal bleeding (Cale & Constantino, 2012). Vascular complications alone have been reported from 0.1 % to up to 61%, depending on the definition of complications and covariates (Dumont, Keeling, Bourguignon, Sarembock, & Turner, 2006).…”

Section: Vascular Complications Of Interventional Treatmentmentioning

confidence: 99%

Intra-Femoral Sheath Time: Does it Increase a Patient's Risk for Developing a Hematoma?

Planchon

2013

Preprint

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Despite advancements in technology and medication therapy, coronary artery disease continues to remain the number one cause of death. Treatment for coronary artery disease requires life style modifications, medication therapy, percutaneous coronary interventions, and sometimes coronary artery bypass surgery. Though percutaneous coronary interventions are considered safe and are commonly occurring procedures, there are still risks for complications. One of the most frequently occurring complications is hematoma of the femoral artery site. The purpose of this study was to determine if there was an increased incidence of hematomas in individuals undergoing percutaneous coronary intervention with associated sheath times of less than five hours (Group A) as compared to sheath time of greater than five hours (Group B). The study used a retrospective, two group design and was conducted at a tertiary care center that performs over 1500 PCI's annually. Inclusion criteria included adults over the age of 18 who were hemodynamically stable, had no known bleeding disorders, and were punctured once at the femoral artery to perform the percutaneous intervention. Two hundred fifty medical records were reviewed utilizing a data collection tool designed by the researcher. Total sample size was 55, 21 in Group A and 34 in Group B. Six hematomas were documented as occurring, but were not reportable based on the ACC definition. Hematomas were documented in the medical record using the terms "small", "medium," and "large" versus an objective measurement. No hematomas were identified using the ACC definition, which was the measurement standard for this research hospital. Sheath times in Group A averaged 4.02 hours, and group B 7.42 hours.There was a higher incidence of descriptive hematoma that did not meet the criteria of this study in Group B. Results call for recommendations of on-going documentation of post procedure hematomas using a standardized, reliable, and valid measuring tool. APRN's can be instrumental in implementing change in patient care , hospital policy and on the national level by assuring that hematomas are accurately and consistently documented. Further research is indicated related to sheath times and potential associated negative outcomes.

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Strategies for Decreasing Vascular Complications in Diagnostic Cardiac Catheterization Patients

Cited by 5 publications

References 12 publications

Non-invasive cardiac pacing with image-guided focused ultrasound

Non-invasive cardiac pacing with image-guided focused ultrasound

Use of a safe procedure checklist in the cardiac catheterisation laboratory

Intra-Femoral Sheath Time: Does it Increase a Patient's Risk for Developing a Hematoma?

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