ACC/AHA guidelines for cardiac catheterization and cardiac catheterization laboratories. American College of Cardiology/American Heart Association Ad Hoc Task Force on Cardiac Catheterization (original) (raw)

Outpatient cardiac catheterization: a report of 3,000 cases

Clinical cardiology, 1991

A total of 3000 patients have had cardiac catheterization in the Andreas Gruentzig Cardiovascular Laboratory of the Emory Clinic. The purpose of this presentation is 10 describe the patient population selected for this procedure and our experience with this group. The concept of catheterization as an outpatient is attractive from the standpoint of cost savings and time conservation. Safety has been questioned. We have found that this technique can be performed safely in carefully selected outpatients. Careful selection attempted to eliminate those with unstable symptoms, recent myocardial infarction, severe diabetes, and reniil failure. Small catheters were used to minimize the potential for bleeding. Excellent opacification of vessels was obtained with these catheters. Despite careful screening we found 2.2% had significant left main obstruction, 10.8% had triple-vessel disease, 16.0% had double-vessel disease, and 23.5% had single-vessel disease, and a similar percentage had normal coronary arteriograms. Our patients experienced ventricular fibrillation on five occasions, there were two small cerebral emboli with reversible neurologic defects, two episodes of pulmonary edema, and two episodes of severe allergic reactions. Only three palients had significant groin bleeding at home that required compression of the site. We subsequently did angioplasty on 323 patients, performed cardiac surgery (mostly coronary bypass) on 187 patients, and admitted 18.2% tvf the entire group. We conclude that this procedure can be done safely in this carefully designed setting and it saves time and offers cost savings. Patient selection is very important to minimize potential emergency situations and complications. The laboratory must be carefully set up

The changing role of the cardiac catheterization laboratory

Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 1988

The Changing Role of the Cardiac Catheterization Laboratory C atheterization of the arterial and venous systems was first applied by the French physiologist Claude Bernard, who, beginning in 1844, undertook an extended series of animal experiments with the goal of developing and refining this technique.1'2 Many of Bernard's investigative concepts were later. adopted by Adolph Fick who proposed the use of cardiac catheterization as a means of measuring the total cardiac output.3 At first, catheterization was used mainly for studying the heart's angiographic anatomy and physiologic function, and for determining the effect of various cardiac control mechanisms. In the early 1900s, rubber catheters were inserted into the venous and arterial systems, principally in order to direct medications to specific sites and thus provide increased concentrations at those sites. During the 1920s, Werner Forssmann, a German urological surgeon, became interested in adcninistering drugs directly into the central circulation. Fearing the potential dangers of direct injection, Forssmann investigated the possibility of advancing a catheter into the right atrium, where drugs might be administered more safely By experimenting with this technique in cadavers, he demonstrated that a catheter could easily be so passed. In 1929, he inserted a small urologic catheter into his own antecubital vein and advanced its tip into his right atrium, after which he walked to the X-ray department and recorded the device's location.4 Unfortunately, Forssmann's attempts met with ridicule and were eventually abandoned.

Quality initiatives in the cardiac catheterization and interventional laboratories

Chinese medical journal, 2014

Change in the healthcare landscape: life on the fast lane The working env i r o n m e n t i n A m e r i c a n ca r d i a c catheterization laboratories (CCL) has changed significantly over the last two decades (http://www.scai. org/QIT/Default.aspx). It has moved from performing mostly cardiac diagnostic catheterization to more complex and diverse interventional procedures. About 60% of the percutaneous coronary interventions (PCI) are done ad hoc. With more robust operator training in combination with excellent refinement and miniaturization of equipment, the risk of procedure-related complications including emergent coronary artery bypass grafting (CABG) has decreased significantly. As a consequence, almost one third of the CCL in the United States (US) are performing PCIs without on-site cardiac surgery. A significant number of procedures are non-coronary including peripheral, carotid, renal, aortic, venous angioplasty, and stenting. Therefore, the responsibilities of the interventional cardiology community and expectations from American society and patients have increased tremendously, thus demanding near perfect performance and adherence to the highest quality and standards.

Outpatient cardiac catheterisation

International Journal of Cardiology, 1996

Cardiac catheterisation is increasingly performed in an outpatient setting. The majority of series of outpatient cardiac catheterisation are in laboratories with immediate access to cardiovascular surgery. However, some units may be sited more distantly, although still generally close to a hospital. Compared to an inpatient procedure, outpatient cardiac catheterisation increases bed availability and there are considerable financial rewards with suggested savings of l l-54% of inpatient costs. Most patients are satisfied with an outpatient procedure and, although a quarter may have unanswered questions afterwards, this level may not differ from that found with inpatients. No study has been large enough to detect differences in the major complication rate which occur infrequently in whichever setting, and there is considerable variation between studies in the incidence of minor complications after outpatient procedures. In the only study which randomised all eligible patients to an inpatient (189 patients) or outpatient (192 patients) procedure, seven outpatients (3.6%) suffered bleeding or developed haematomas at the site of percutaneous femoral artery puncture towards the end of the mobilisation period and one patient was syncopal. These events were thought to be a direct result of the procedure being carried out in the outpatient setting. The proportion of patients considered eligible for outpatient cardiac catheterisation varies widely between different series from 20% to more than 80%. Whereas some of this variation may result from the implementation of different exclusion criteria for patients with potentially severe disease, the differences are so large that it is likely that different populations were studied. Unplanned admission rates varied from less than 1% to nearly 19%. With the currently available data no absolute guidelines can be derived to exclude all patients at risk of complications, but the American College of Cardiology/ American Heart Association (ACC/AHA) task force recently published guidelines which identified low risk patients suitable for outpatient procedures. These guidelines have been used to select patients for investigation in two mobile units in the USA, and only 0.9% required urgent transfer for clinical instability, and 0.6% developed major complications. However, most patients did not need referral to a tertiary centre for additional procedures and there may be less scope for selecting patients within the ACC/AHA guidelines in the UK compared with the USA.