Cardiac Catheterization: What Residents Should Know¶
Learning Objectives¶
By the end of this rotation, you should be able to:
- Understand basic indications for cardiac catheterization
- Know what to monitor post-procedure
- Recognize common complications and when to call for help
- Communicate with families about what to expect
What Is Cardiac Catheterization?¶
A procedure where catheters are inserted through blood vessels (usually femoral vein/artery or jugular vein) to: - Measure pressures and oxygen saturations in heart chambers and vessels - Perform interventions (close holes, open valves, place stents) - Obtain images of cardiac anatomy
Common Indications in Children¶
Diagnostic¶
| Indication | Purpose |
|---|---|
| Pre-operative assessment | Hemodynamic data for surgical planning |
| Pulmonary hypertension workup | PVR measurement, vasoreactivity testing |
| Post-surgical assessment | Evaluate repair, measure gradients |
Interventional¶
| Procedure | What It Treats |
|---|---|
| Balloon atrial septostomy (BAS) | D-TGA, restrictive ASD |
| Balloon valvuloplasty | Pulmonary/aortic stenosis |
| Device closure | ASD, PDA, some VSDs |
| Stent placement | Branch PA stenosis, coarctation |
| Coil embolization | Collaterals, small vessels |
Pre-Procedure: What Families Should Know¶
- Fasting required (typically NPO after midnight)
- Usually same-day or overnight stay
- General anesthesia or sedation for children
- Access sites: Usually groin, sometimes neck
- Duration: 1-4 hours depending on complexity
Post-Procedure Care¶
Standard Monitoring¶
| Parameter | Frequency |
|---|---|
| Vital signs | q15min x1hr, then q30min x2hr, then q1hr |
| Access site | Check each vital sign |
| Distal pulses | Check each vital sign |
| Color/temperature of limb | With pulse checks |
Post-Procedure Orders¶
- Bed rest with affected leg straight (typically 4-6 hours)
- Resume diet when awake
- Monitor access site for bleeding/hematoma
- Pain management PRN
Complications - When to Call for Help¶
Access Site¶
| Finding | Concern | Action |
|---|---|---|
| Expanding hematoma | Active bleeding | Apply pressure, call cath team |
| Diminished/absent distal pulses | Arterial occlusion | Urgent - call cath team |
| Cool, pale limb | Arterial compromise | Urgent - call cath team |
| Numbness/weakness | Nerve compression | Call cath team |
Systemic¶
| Finding | Concern | Action |
|---|---|---|
| Fever | Infection | Evaluate, may need cultures |
| Chest pain | Pericarditis, perforation | Echo, call cath team |
| Respiratory distress | Various | Evaluate, call cath team |
| Arrhythmia | Procedure-related | ECG, call cath team |
Key Teaching Points for Residents¶
- Check pulses frequently post-cath - arterial compromise is time-sensitive
- Expanding hematoma = call for help and apply pressure
- Keep leg straight for the prescribed time - prevents bleeding
- Most procedures are low-risk but complications can be serious
- Low threshold to call cath team if concerned
Key Guidelines¶
2019 ACC/AHA/STS Guidelines on the Management of Patients With Cardiac Catheterization General principles from adult guidelines apply; pediatric practice is procedure-specific
Board Pearls¶
Pearl: Check distal pulses frequently post-cath - arterial compromise is time-sensitive
A cold, pale, pulseless leg after femoral artery access requires immediate intervention.
Pearl: Expanding hematoma at access site = apply pressure and call the cath team
This is active bleeding. Direct pressure and urgent notification are required.
Pearl: Common pediatric interventions: BAS, balloon valvuloplasty, device closure, stent placement
Know the basic indications - D-TGA needs BAS, pulmonary stenosis gets balloon valvuloplasty.