Cardiac catheterization is a safe and effective procedure used to obtain detailed information about a patient's heart as well as repair the heart without surgery. This procedure uses catheters, which are thin, flexible tubes, inserted through tiny incisions in the groin or neck and threaded through blood vessels to the heart. The catheter can take blood samples, record moving X-rays called fluoroscopy, and carry small instruments and devices to repair the heart.
Your child will be admitted to the hospital the morning of the test and will likely go home that evening. If catheterization is used to repair the heart, the procedure may take longer and your child may be hospitalized overnight.
The morning of the catheterization, you and your child will check in at the surgical waiting area on the second floor of UCSF Benioff Children's Hospital at 1975 Fourth St. in San Francisco. Your child should not eat or drink anything during the morning of the procedure, unless directed otherwise by your doctor.
When it's time for the procedure, your child will be taken to the Pediatric Cardiac Catheterization Laboratory, also called the "cath lab," where the procedure will be performed. You may accompany your child into the procedure room and stay while he or she goes to sleep.
Your child will be placed on his or her back on an X-ray table. Nurses and technicians will prepare your child for the procedure. Preparations may take half an hour and include:
- Set up intravenous (IV) line
- Administer oral or IV sedation
- Apply a sensor on your child's finger to measure oxygen level
- Apply limb restraints for safety
- Set up monitoring equipment, such as electrocardiogam patches on your child's chest
- If necessary, shave skin where the catheter will be inserted
- Cleanse area where catheter will be inserted with an antiseptic solution
- Cover your child with sterile towels and sheets
During the procedure, you may wait in the hospital room or leave. You will be given a pager and contacted during your child's procedure with progress reports. You will be notified when the procedure is finished.
After your child has been sedated, the doctor will inject an area in your child's groin with a numbing medication at the site where the catheter is inserted. The injection feels like a bee sting and is probably the most uncomfortable part of the procedure.
After the numbing medication has taken effect, the doctor will make a small puncture in a blood vessel in the groin or neck and insert a flexible, thin tube, called a catheter. Some pressure may be felt at the site of insertion, but this sensation should pass quickly.
While watching the progress of the catheter on an X-ray monitor, the doctor will gently guide it toward your child's heart. The catheter can be used to carry small instruments or devices to a specific area of heart.
Once the catheter has reached your child's heart, a special dye is administered through the catheter. X-ray pictures, called angiograms, are taken of the heart and coronary arteries. During injection of the dye, your child may feel a hot flush through his or her body for about 10 to 20 seconds. This is a normal reaction and is not a cause for concern. There may be several injections of dye and the catheter may be moved during the procedure. This is necessary to get different views of the heart and coronary arteries.
Following coronary catheterization, your child's doctor will review the X-ray films taken during the procedure and determine if there is blockage or narrowing that requires further treatment. If a catheter-based repair is possible, it can be performed at that time. Catheter-based interventions include balloon valvoplasty, coil closure of blood vessels, patch device closure of holes and stent repair of blocked blood vessels.
Cardiac catheterization may take from two to four hours, depending on the procedure.
Risks and Complications
Catheterization is a safe and effective procedure. Complications, which are rare, include blood loss requiring a transfusion, allergic reaction to X-ray dye requiring medication, stroke, pain, bruising at the catheter site and possible blockage of the groin artery, which usually responds to medication. Complications are treated immediately.
Most children go home the same day as the procedure, while a small number stay overnight. This depends upon the medications given during the procedure, the type of repair performed and the need for further tests.Once the procedure is finished, your child will return to a hospital room to be closely monitored. A nurse will check your child's blood pressure, vital signs and the catheter insertion site to make sure there is no bleeding. Your child's doctor will check on your child and talk with you about the results of the procedure.
The X-ray dye may cause your child to urinate more than usual and your child may be asked to drink fluid to help flush out the dye.
Please inform your nurse if your child experiences any of the following:
- Chest pain or discomfort at the insertion site
- Numbness or a cold sensation near the catheter insertion site
- Warmth or wetness around the insertion site
Most children experience minor or no pain after catheterization. A large bandage will be placed where the catheter was inserted. That bandage will be replaced with a smaller one the next morning.
Your child should lie in the hospital bed for four to six hours. To prevent bleeding, your child should limit moving the arm or leg near the catheter site. Your child will be awake but sleepy and may nap for one to three hours after the procedure.
Once fully awake, your child may drink clear liquids, such as water, Seven-Up and apple juice. If these go down well, your child may have something to eat.
When your child returns home, the area where the catheter was inserted should be kept dry and clean. The bandage should be changed daily until the area heals, which usually takes three to five days. Your child can take a shower but not soak in a bathtub or hot tub and shouldn't swim in a pool. After showering, the incision site should be carefully dried and a new bandage applied.
When the bandage is removed, you may notice a small bruise, about the size of a quarter, at the insertion site. You also may feel a hard lump. The bruise may become larger and darker the first few days after the procedure. The bruise and the lump are the result of the blood vessel's normal healing process and will disappear in one to two weeks. If bleeding occurs, apply firm, constant pressure to the site for five minutes. Call our office immediately if any of the following symptoms occur:
- Body temperature of more than 101.5° Fahrenheit
- Chest pain
- Green or yellow discharge at the catheter site
- Increased bruising or swelling
- Numbness or a cold sensation near the catheter site
- Pain or discomfort at the catheter site
- Redness of the skin near the catheter site
Before leaving the hospital, your child's doctor will give you specific instructions regarding when your child can resume regular activities. Most children return to school and normal activities a couple of days after the procedure. Generally, your child should take it easy and engage in light activity for two days.