Early ambulation after 5 French diagnostic cardiac catheterization: Results of a multicenter trial

Abstract

Because earlier ambulation and discharge after cardiac catheterization may result in the increased utilization of outpatient facilities, a prospective five center clinical pilot trial assessing the safety and outcome of early ambulation after routine left heart catheterization was performed in 287 patients. Catheterization routines at each clinical center were unchanged throughout the study. After the diagnostic catheterization using 5 French (F), preformed, large lumen catheters and arterial puncture compression (mean 15 min, range 5 to 52), 260 patients were ambulated by a physician at a mean time of 2.6 h (range 1.8 to 3.1) after catheterization. Follow-up examination or a phone call 24 to 72 h later was performed to assess late results. The mean age of the patients was 58 years (range 25 to 91); 166 (58%) were men. Left ventricular ejection fraction was 54 +/- 15%. One hundred twenty-seven patients (44%) received intravenous heparin (1,500 to 5,000 U as an intravenous bolus) and 136 (47%) received aspirin. Major complications included transient ischemic attack (one patient) and ventricular tachycardia requiring cardioversion during ventriculography (two patients). A small hematoma (less than 5.0 cm) after ambulation occurred early (from compression to standing) in 14 patients (5%; 9 received heparin, 8 were taking aspirin) and later (after standing to 72 h) in 9 patients (3%; 2 receiving heparin, 2 taking aspirin). Five patients with a hematoma had studies with a 6F sheath. No patient required surgical intervention for early or late hematoma. Only three patients (1%) needed a 7F or 8F catheter because of suboptimal 5F coronary angiography.(ABSTRACT TRUNCATED AT 250 WORDS)

Editorial comment: The cath lab bottom line: Faster, cheaper, better, safer

“…Wood et al [1] point out that the rate of hematoma formation in their study was significantly lower than previously reported in similar studies [2][3][4]. They also point out that with the lower-thanexpected complication rate, the clinical relevance of such a study would be questionable.…”

Arteriografia coronária com cateter de muito baixo perfil. Eficácia e segurança do procedimento e da alta hospitalar aos 60 minutos

“…Contudo, mais recentemente, têm-se observado igualmente bons resultados com cateteres menores ainda 4 , percebendo-se uma tendên-cia ao emprego destes instrumentais de menor calibre para que, ainda com a manutenção da qualidade das imagens, reduzirem-se mais as complicações vasculares e agilizar-se a alta hospitalar [4][5][6][7] . São, no entanto, muito escassas as informações a respeito de cateteres de muito pequeno diâmetro (<5F).…”

“…Uma hora após, conseguiu-se, na maioria dos pacientes (85%), uma deambulação segura e sem complicações hemorrágicas, na via de acesso. Kern e col 4 , com o uso de cateteres 5F, necessitaram quase três vezes este tempo, Brown e col 5 , sete vezes e Carosio e col 7 , oito vezes. A minimização do tempo de imobilização é um fato de grande importância, não só na percepção do paciente quanto à traumaticidade e invasividade do exame, quanto na agilização da ocupação e alta do leito hospitalar, com importante impacto na sua reutilização, no mesmo dia e, evidentemente, nos custos de saúde.…”

“…Este fato reproduziu a experiência de Pande e col 8 , nos 100 pacientes em que também se utilizaram cateteres 4F. Entretanto, um pequeno aumento de calibre (5F) já representou surgimento de pequenos hematomas em 2% dos pacientes de Brown e col 5 e em 7% nos de Kern e col 4 , salientando a correlação entre os diâmetros do material empregado e os problemas no local de abordagem, muito embora, todos esses índices de pequenas complicações com o cateterismo ambulatorial comparam-se muito favoravelmente à técnica convencional com cateteres 8F, como destacamos em trabalho anterior de nossa Instituição…”

Reduction of femoral artery bleeding post catheterization using a collagen enhanced fibrin sealant

“…Not only does this requirement increase the time and discomfort involved for the patient, but it also tends to increase costs associated with the procedure by making its performance on an outpatient basis difficult. While there are currently efforts being made to increase the number of outpatient procedures using the conventional compression method [9,10], a new method of achieving safe and rapid hemostasis with reduced complications would allow earlier mobilization. More rapid mobilization might permit more outpatient procedures which have been found to cut costs [11][12][13] as well as ease patient anxiety and discomfort [14,15].…”