Cardiac Catheterization - Essay Example

Download file to see previous pages In 1947, Louis Dexter expanded the clinical use of right heart catheterization with studies in patients with congenital heart disease and identified the pulmonary capillary wedge pressure as a useful clinical measurement. By this point, the value of homodynamic measurements was being fully realized, and further developments came rapidly" (Roger, 2008). The technique and safety profile of the instruments used for bringing homodynamic stability though has been evolving over the time. Initial there used to be compression techniques to stop the vessels from bleeding which was and still is the main complication of angiography and angioplasty. Post op bleeding from the intervention site is the main reason of keeping patients in bed for a couple of hours which is very cumbersome for the patients. Cardiac catheterization can be done through different access points but the window to work in becomes an issue. Using upper extremity vessels will be a very good alternative to have a controlled bleeding because of the diameter of the vessel and their easy access but the window of access gets compromised and the choice of catheters for maximum access and manipulation becomes a problem so, the preferred access rout is still femoral arty and mainly the common femoral artery neither above non below it. "The main advantages to this method are its ease and substantial safety record. The main disadvantage is the need for an extended (2-6 h) period of bed rest after completion of the procedure. Several types of arterial closure devices now are available that provide rapid homeostasis and shorten the period of bed rest considerably. However, complication rates with these closure devices are similar to conventional manual compression". (Roger, 2008). "Reductions in sheath size, intensity and duration of anticoagulation with heparin, and procedure time were observed. Adverse outcomes of major femoral bleeding included prolonged hospital stay, and increased requirement for blood transfusion. Major femoral bleeding and blood transfusion are both associated with decreased long-term survival, driven by a significant increase in 30-day mortality" (Brendan, 2007). Manual or mechanical compression as the name itself explains it is to be done by the surgeon or any other volunteer in the surgical team to provide compression with the pressure through the pulp of three or four fingers in the downward direction without releasing it for a microsecond for at least for 10-15 minutes at the site of the intervention. (Shaffer, 2005).Vascular closure devices are a very nice and safe alternative to the mechanical compression methods in terms of vascular complication, surgeon's factors and patient's factors.
In percoutaneous intervention intra vascular complication which includes "ecchymosis (37%), hematoma (20%), and oozing (15%)" are major complications. These complications occur more frequently with mechanical and device assisted compression. The main reason for these complications is the way mechanical or device assisted compression is applied and unless it is applied exactly the same way it does not fulfill the purpose. Apart from these commonly happening but comparatively less dangerous issues there is a another major complication of leg ischemia which occurs due to prolonged deprivation of blood supply. Post-operatively some patients do ...Download file to see next pagesRead More