Cardiac Catheterization

With this text we want to provide a basic understanding of the cardiac catheterization (heart cath) procedure and answer some of the more common questions asked by parents.This booklet is a guide for you to follow before, during and after the cardiac catheterization.

The heart

All catheterization procedures performed at the Montreal Children's Hospital are done in a catheterization suite (Room C-323) designed for the diagnosis and treatment of children with congenital heart disease or cardiac rhythm disturbances. This special procedure room (also called a cath lab) is equipped with the latest technology. This room is equipped with high-quality imaging equipment and all of the necessary monitoring and emergency equipment.

A thin, flexible tube, called a catheter, is inserted into the large vein and/or artery in the groin area (femoral) using only a needle puncture and a thin wire. In certain circumstances, a vein in the neck might be used. Once the catheter is in the blood vessel, the cardiologist guides the catheter into different areas of the heart using fluoroscopic (X-rays) imaging. 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 pressure monitoring in chambers and blood vessels are recorded.
• Oxygen saturation of the blood in each chamber and vessel is tested.
• Dye is injected in select areas of the heart and the pictures are digitally recorded.

A heart catheterization carries a low degree of risk. This level of risk is influenced by the general health of your child, his/her age, as well as the complexity of the procedure to be performed.

You will have the opportunity to discuss the specific risks of your child’s case with the interventional cardiologist prior to the procedure.

Prior to the date of the heart cath, you and your child will be seen in a Pre-Cath Clinic. It is held on Monday mornings in the Cardiology Clinic area Room B-230. The purpose of this clinic is to:

• Meet with the heart cath nurse who will be with your child during the procedure. Your child will see a familiar face the next time he/she comes to the hospital.
• Assess: Weight, height, allergies, medications, general health, vital signs etc.
• Discuss the heart cath procedure and have your questions answered.
• Discuss pre-cath preparations including fasting instructions
• Discuss type of sedation required for your child.
• Have pre-cath tests done: Chest X-Ray, ECG, echocardiogram and blood tests. Please be prepared to spend at least 2-3 hours at the hospital because there are frequently wait times for some of these tests.
• Meet with the interventional cardiologist. He will discuss the procedure and its risks. Then he will obtain your written consent for the procedure.
• Be seen by the anesthesist, if necessary.

Your child should eat a good dinner and possibly have a bedtime snack as well. Your child should have a bath before bedtime. Follow any other pre-cath instructions that you received.

• No formula, milk or food for 6 hours prior to heart cath.
• No breast milk for 4 hours prior to heart cath.
• Clear fluids until 3 hours prior to heart cath: Water, apple juice, cranberry juice.
• Nothing by mouth after this time.

• Montreal Children Hospital card
• Medicare card
• A favourite small toy or blanket
• Diapers
• Empty bottle/ child’s cup
• Formula
• Comfortable, loose clothing
• For older children: CD player, handheld video game
• Toothbrush and toothpaste if appropriate

If your child was not seen in the Pre-Cath Clinic, then a physical assessment and tests will be done at this time. An anesthetic cream, which freezes the skin, will be applied to the groin area. 

The cardiologist will discuss the procedure and then obtain your written consent if this was not already done at the Pre-Cath Clinic.

 If appropriate, an anesthetist may speak to you as well.

Yes. Additional sedation medication will be given through the I.V. as needed. Nurses, in the room, monitor your child and make sure that he/she is comfortable. Patients receiving general anesthesia are closely monitored by the anesthesia team.

We suggest that parents remain in the hospital while their child is undergoing the procedure. Please wait in the Parent’s Waiting Room adjacent to the Recovery Room on the 10^th floor. Use the “D” wing elevators.

Your child will be moved to the Recovery Room (10D) immediately after the procedure. You will be allowed to stay with your child in the recovery room once the nurses have completed their initial assessment. During recovery, your child will be placed on heart and oxygen saturation monitors until he/she is completely awake from the sedation. Your child may be drowsy or completely asleep depending on the type of sedation or anesthesia given during the procedure. A nurse will frequently check vital signs (temperature, pulse, breathing, blood pressure), circulation, the heart monitor, and the pressure bandage.

These children will remain in the recovery room for approximately 1-2 hours and then be transferred to the ward (7C-1). Your child will be observed and monitored overnight. One parent may stay overnight at the bedside. Sleeper chairs or cots are provided.

It is possible that additional tests such as an echocardiogram or a chest x-ray will be done pre-discharge. The cardiologist will visit and discharge your child in the morning. Discharge instructions will be discussed with you.

Reminders at discharge:

• Do you understand all treatments or medications that you must give at home?
• Do you have a prescription for medications?
• Do you have the written discharge instructions?
• Do you have or know how to make a follow-up appointment
• Do you have your child’s Medicare and Hospital card?

Keep the puncture site dry and clean. If the dressing becomes soiled or wet, remove it and wash the skin gently with soap and water. Let the area dry and then apply another adhesive strip bandage. Continue to change it, whenever necessary, for 24 hours. It is normal for the area to appear slightly bruised. The area may be sensitive for a few days, but should not be painful or reddened.

In the case of bleeding at the puncture site, apply pressure on the site using two fingers for at least 10 minutes. If the significant bleeding persists despite this maneuver, call “911” for immediate transportation and evaluation at the emergency room. 

For the 48 hours following the catheterization, consult the cardiologist on-call if your child shows any of the following symptoms:

• Difficult to arouse.
• Loss of consciousness.
• Pallor and weakness.
• Persistent vomiting.
• Redness at the puncture site.
• Bleeding (see previous section).