Heart Catheterization in Children

An Informative Guide for Parents of Heart Catheterization Patients

This guide will provide you with a basic understanding of the heart catheterization (cath) procedure at Comer Children's Hospital at the University of Chicago. Our staff will do everything we can to answer your questions and to make your child's experience as comfortable as possible. If you have additional questions after reading this material, please speak with our cardiac nurse or contact our office at (773) 702-6172.

Why perform a catheterization?

Heart cath helps cardiologists gain information needed to fully evaluate a condition and recommend treatment for your child. It is a test that shows how the heart chambers, valves, and vessels are formed, and how they are functioning. A cath also provides cardiologists with information about specific areas of the heart and lungs. For patients who need surgery, a cath provides surgeons detailed information not available through other testing, such as the precise location of abnormalities and the specific structure of your child's heart. A heart cath may also be used therapeutically, to treat a condition or to correct a problem.

What is a heart catheterization?

Caths are performed in a specially equipped cath lab by a cardiologist with the help of a trained team of nurses and technicians. It is similar to a surgical procedure, although there are usually no incisions or stitches. To prevent infection, the staff wears sterile gowns, hats, and masks and the patient is covered with a sterile drape. The patient is sedated and a local anaesthetic is used to numb the groin area. This injection is the only discomfort your child should experience during the procedure. The anesthetic is similar to Novocaine--used by your dentist. A thin, flexible tube, known as a catheter, is then inserted into a vein and sometimes an artery, usually in the groin.

Once the catheter is in the blood vessel, the cardiologist uses a fluoroscope (similar to an X-ray machine) to guide the catheter into the different areas of the heart. The movement of the catheter within the heart is not painful or uncomfortable. While the catheter is in the heart, several procedures are performed:

• Blood presssures in different heart chambers and blood vessels are recorded.
• Oxygen content of the blood in each heart chamber is evaluated.
• Dye is injected through the catheter.
• Angiograms (x-ray movies of the dye's movement) are filmed so that the details of the cardiac problem are recorded.

The cath lasts from one to three hours. Afterwards, the only outward sign of the procedure will be a pressure bandage applied to the cath insertion site. Before your child is discharged, the cardiologist will review the preliminary findings with you. Later, these data and findings are reviewed at the cardio-surgical conference, a weekly meeting of cardiologists and surgeons at Comer Children's Hospital at the University of Chicago. This gives your child's cardiologist "second and third" opinions for any decisions made in your child's care.

Your Child's Catheterization

The week of the procedure:

Illness: If your child has a fever, cold, flu, severe diaper rash, exposure to any contagious disease during the week prior to the cath, check with your child's cardiologist or cardiology nurse before coming to the hospital.

Medications: It is important to discuss with your cardiologist the timing of any medications your child is taking.

The day before the procedure:

Your child should eat a good meal, have a bedtime snack and get a good night's sleep.

Your child may not eat or drink anything, including water, after ________________.

The cardiology nurse will call to tell you what time you should arrive at the hospital.

The morning of the catheterization:

All patients:
Do not give your child any medications, prescription or over-the-counter, unless your cardiologist has previously given you approval.

Prior to the cath, your child will receive a physical evaluation. A chest X-ray, EKG, and echocardiogram may also be performed if they have not been already.

Outpatients:
Arrive at the hospital at ___________.

When you arrive at the hospital, proceed to ______________________________.

You and your child will be escorted to the cath waiting room. Your child will then be taken to the adjacent cath lab where the procedure will be performed.

Inpatients:
When you arrive at the hospital, proceed to ______________________________.

The nurse will take you to the cath lab where the procedure will be performed.

Before and During the Catheterization

Before the procedure, the cardiologist and nurse will discuss any remaining questions you may have, and ask you to sign a consent form. A consent form is standard in any surgical or invasive procedure.

Sedation or general anesthesia may be used in order to keep your child calm and properly positioned during the catheterization procedure. The type of sedative used will depend on the procedure being performed as well as other factors such as your child's age, ability to lie still, and associated medical problems. Therefore, your child may be given a sedative before the test, and again in the cath lab, if needed.

Following the Catheterization

Inpatients will return to their hospital rooms and outpatients in the outpatient recovery area. You may see your child immediately. Your child may be drowsy and/or sleep for a few hours.

During recovery, your child will be placed on a heart monitor until completely awake from the sedation. A nurse will frequently check vital signs (temperature, pulse, breathing, blood pressure), circulation, the heart monitor, and the pressure bandage placed over the cath insertion site. Inpatients will be closely monitored by their primary nurse.

Your child should rest until fully awake and the cardiologist gives approval to move around. A urinal and bed pan will be available for your child to use.

Once fully awake, your child may drink clear liquids and juices, provided by the nurse. If nausea or vomiting occurs, discontinue the liquids until the symptom subsides.

Before you leave that day, the cardiologist will discuss the preliminary results and recommended a treatment plan. This plan will be finalized after review by the cardiologists and surgeons at the cardio-surgical conference.

Outpatient Discharge

Most outpatients are discharged later in the afternoon or the evening of the procedure. Occasionally the cardiologist may decide to admit a child as an inpatient for further observation or treatment. Otherwise, your child may leave the hospital in your arms or in a wheelchair after the conditions listed below are satisfied.

Your child must be able to do the following:

• Take clear liquids without vomiting.
• Exhibit no bleeding or other complications at the cath insertion site.
• Urinate without difficulty.
• Receive physician approval to go home based on a physical examination.

Parents must do the following:

• Review discharge instructions with the nurse, especially resumption of cardiac medications.
• Discuss the cath results and follow-up treatment plans with the cardiologist.

Taking Your Child Home

Outpatients
It is important for your child to remain in bed or on the couch until the morning after the cath. Getting up briefly to go to the bathroom is permitted.

The morning after the cath, remove the pressure bandage from the groin area and apply a band-aid, if this has not already been done.

All patients
Keep the band-aid over the cath site for two days after the test. Each day remove the band-aid, check the site for infection or bleeding, then reapply a clean band-aid.

Give Tylenol for pain or fever, if needed.

Refrain from tub baths or swimming for three days after the test. Showers or sponge baths are permitted, but the site should be kept as dry as possible.

Permit only mild activity on the day after the test.

Strenuous exercise or participation in sports is prohibited for three days after the test.

Resume normal activity three days after the test.

When to Call the Doctor

It is unlikely that any problems will arise after the cath, but if you observe any of the following, call your cardiologist.

• Bleeding from the cath site is abnormal and can be stopped by firm pressure on the site. Apply pressure for 10-15 minutes and notify your cardiologist immediately. If bleeding does not stop, take your child to the nearest hospital emergency room for treatment, and notify your cardiologist immediately.
• A small amount of bruising and minimal discomfort at the cath site is normal and will go away in a few days. Swelling, redness, pus at the insertion site, severe discomfort or significant pain upon walking should be reported to your child's cardiologist.
• A slight fever is common after cath, but should not last longer than 24 hours. Any fever of more than 100 F in the week following the cath should be reported to your child's cardiologist.
• Continued nausea should be reported to your child's cardiologist.

Questions

For questions or problems, call (773) 702-6172.

Pediatric cardiologists are available 24 hours, seven days a week. After regular business hours, our answering service will contact the cardiologist on-call immediately.

A cardiology nurse is available from 8 a.m. to 4:30 p.m., Monday through Friday.