Catheterization Units Research Articles

Hematological and Cytogenetic Effects of X-rays in Cardiac Unit Workers and Catheterization Patients.

Introduction X-rays are widely used in medicine for diagnosis and treatment. Such beneficial uses may cause potentially hazardous situations for patients andworkers in the cardiac catheterization laboratory. The present study aims to estimate the radiation dose scattered in different parts of the catheterization units and doses absorbed by workers in thisunit, and patients who underwent cardiac catheterization procedures to evaluate all changes in hematological parameters and damaged cells (the cells that contain a number of chromosomal aberrations) after exposure to radiation at Azadi Teaching Hospital in the Duhok City of Iraq. Methodology Thestudy was conducted in one year and involved 19 male workers chronically exposed to X-ray machines in the cardiac catheterization laboratory, and 45 patients, 20 males and 25 females, who have been exposed to lower doses of X-ray during the cardiac catheterization process. There were 32 healthy individuals, 19 males and 13 females, as a control. Scattered radiation was calculated using an area monitoring detector.Optically Stimulated Luminescence (OSL) dosimeter andFlat Panel Detector (FPD)were used to calculate absorbed doses by workers and patients, respectively. Twelve hematological parameters before and after radiation were examined between study groups; the cytogenetic effects, damagedcells, and chromosomal aberrations of the white blood cells of workers, patientsin the catheterization unit, and individuals of the control group were analyzed. Results The results showed that the scattered X-rays in the catheterization unit after one year of continuous detection did not change significantly compared to the data before the start of the trial. The results of all blood parameters looked to be significantly different (p<0.05) compared to the controls but within the normal range.There is no significant difference (p>0.05) in corpuscular hemoglobin, white blood cells, red distribution width, and neutrophilvalues for workers after one year of exposure as compared with the control. Also, there was no significant difference (p>0.05) in white blood cells, neutrophils, and monocyte values for patients after the operation. The current study showed the damaged cells in workerswere significantlydifferent compared to the control. At the same time, the differences were non-significant for all workers (p=0.0962) after one year of exposure.The differences in damaged cells in patients were highly significant after the operation (p=0.0003). The present study demonstrated that the inductions of dicentrics, acentric, chromosome break, and ring chromosomes in human lymphocytes were intimately related to the irradiation dose. Conclusions The presentstudy found that the scattered X-rays in the catheterization unit after the end of the experiment did not change significantly. The current study also revealed that the exposure to X-rays had no significant effects on the blood indicators of workers and patients in the catheterization unit, whereas the damaged cells in patients did not change significantly compared with the control group at the beginning of the experiment.In patients, these cells were increased after the operation but were present at a high level in the workers, as compared with controls.The damaged cells in workers remained constant from the beginning of the experiment till the end.Finally, patients had increased damaged cells after the end of the trial period compared to workers.

Change Management Accompanying Implementation of Decision Support for Prevention of Acute Kidney Injury in Cardiac Catheterization Units: Program Report.

Different models exist to guide successful implementation of electronic health tools into clinical practice. The Contrast Reducing Injury Sustained by Kidneys (Contrast RISK) initiative introduced an electronic decision support tool with physician audit and feedback into all of the cardiac catheterization facilities in Alberta, Canada, with the goal of preventing contrast-associated acute kidney injury (CA-AKI) following coronary angiography and intervention. This report describes the change management approaches used by the initiative and end-user's feedback on these processes. The Canada Health Infoway Change Management model was used to address 6 activities relevant to project implementation: governance and leadership, stakeholder engagement, communications, workflow analysis and integration, training and education, and monitoring and evaluation. Health care providers and invasive cardiologists from all sites completed preimplementation, usability, and postimplementation surveys to assess integration and change success. Prior to implementation, 67% of health providers were less than satisfied with processes to determine appropriate contrast dye volumes, 47% were less than satisfied with processes for administering adequate intravenous fluids, and 68% were less than satisfied with processes to ensure follow-up of high-risk patients. 48% of invasive cardiologists were less than satisfied with preprocedural identification of patients at risk of acute kidney injury (AKI). Following implementation, there were significant increases among health providers in the odds of satisfaction with processes for identifying those at high risk of AKI (odds ratio [OR] 3.01, 95% confidence interval [CI] 1.36-6.66, P = .007), quantifying the appropriate level of contrast dye for each patient (OR 6.98, 95% CI 3.06-15.91, P < .001), determining the optimal amount of IV fluid for each patient (OR 1.86, 95% CI 0.88-3.91, P = .102), and following up of kidney function of high risk patients (OR 5.49, 95%CI 2.45-12.30, P < .001). There were also significant increases among physicians in the odds of satisfaction with processes for identifying those at high risk of AKI (OR 19.53, 95% CI 3.21-118.76, P = .001), quantifying the appropriate level of contrast dye for each patient (OR 26.35, 95% CI 4.28-162.27, P < .001), and for following-up kidney function of high-risk patients (OR 7.72, 95% CI 1.62-36.84.30, P = .010). Eighty-nine percent of staff perceived the initiative as being successful in changing clinical practices to reduce the risk of CA-AKI. Physicians uniformly agreed that the system was well-integrated into existing workflows, while 42% of health providers also agreed. The Canada Health Infoway Change Management model was an effective framework for guiding implementation of an electronic decision support tool and audit and feedback intervention to improve processes for AKI prevention within cardiac catheterization units.

Patient Experience After Risk Stratification and Follow-up for Acute Kidney Injury After Cardiac Catheterization: Patient Survey

BackgroundAcute kidney injury (AKI) after cardiac catheterization procedures is associated with poor health outcomes. We sought to characterize the experiences of patients after receiving standardized information on their risk of AKI accompanied by instructions for follow-up care after cardiac catheterization. MethodsWe implemented an initiative across 3 cardiac catheterization units in Alberta, Canada to provide standardized assessment, followed by guidance for patients at risk of AKI. This was accompanied by communication to primary care providers to improve continuity of care when patients transition from the hospital to the community. A structured survey from a sample of 100 participants at increased risk of AKI determined their perceptions of information provided and experiences with follow-up steps after the initiative was implemented in each cardiac catheterization unit in Alberta. ResultsThe mean age of participants was 72.4 (SD 10.4) years, 37% were female, and the mean risk of AKI was 8.8%. Most (63%) participants were able to recall the information provided to them about their risk of kidney injury, 68% recalled the education provided on strategies to reduce risk, and 65% believed their primary care practitioner had received enough information to conduct appropriate follow-up care. Eighty-six percent of patients were satisfied with their transition to the community, and 53% were reassured by the information and follow-up care they received. ConclusionsThese findings suggest that communicating risk information to patients, in combination with education and collaboration for follow-up with primary care providers, is associated with positive patient experiences and satisfaction with care.

Learning Needs and Its Associated Factors among Elderly Patients Undergoing Coronary Angiography and Percutaneous Coronary Intervention

Coronary Angiography and Percutaneous Coronary Intervention consider corner stone for diagnosis and treatment of CAD today. The previous studies that evaluated cardiac patients learning needs didn’t shed light on the unique needs of patients undergoing coronary angiography and percutaneous coronary intervention. The current study aimed toassesslearning needs and its associated factors among elderly patients undergoing coronary angiography and percutaneous coronary intervention at Zagazig University Hospitals. Descriptive design was utilized to conduct this study. A purposive sample of 155 elderly patients undergoing Angiography and percutaneous coronary intervention at cardiac catheterization units in Zagazig University Hospitals a structured interview questionnaire consisted of three parts (demographic characteristics, health profile and habits of the studied elderly) anda modified Cardiac Patient Learning Needs Scale. The present study revealed that 61.3% of studied elderly patients had high learning needs, 29.7% had moderate learning needs. High level learning needs were found in males, married, those with low educational level, those didn’t receive instructions preoperatively and those didn’t have a history of previous coronary intervention. The studied elderly patients' learning needs were high in all domains. There were statistically significant relations between total learning needs and gender, marital status,educational status, receiving instructions previously, and previous cardiac catheterization. Continuously assessing the learning needs of patients undergoing coronary angiography and PCI. Develop a comprehensive health education program that is focused on these needs to enhance their knowledge and improve the outcome of their disease.

ANXIETY AND ITS ASSOCIATED FACTORS AMONG OLDER PATIENTS UNDERGOING CORONARY ANGIOGRAPHY AND PERCUTANEOUS CORONARY INTERVENTION

Coronary Angiography and Percutaneous Coronary Interventions (PCI) are diagnostic andtherapeutic procedures often for patients with CAD. Although these are minimally invasive andhave relatively low risk, most patients showed pre-procedural anxiety. The present study assessedthe anxiety level and factors associated with it among older Adults undergoing coronaryangiography and percutaneous coronary intervention. A total of 155 older patients undergoingCoronary Angiography and PCI at Cardiac Catheterization Units, Zagazig University Hospitalswere selected.The results showed that 58.1% of the studied older adults patients had moderate anxiety,while, 25.8% of them had severe anxiety and only 16.1% of them had mild anxiety level. Thehighest rates of anxiety were found in in female patients with age greater than or equivalent to70 years compared with other age groups, with low educational level, had chest pain attack andthose without previously cardiac intervention.

Relationship between Cardiac Catheterization Patients' Expectations and their Satisfaction with Health Service Quality in Selected Hospitals

AbstractBackground: Health service quality has become important for customers when deciding on services; which are intangible and depends on their perceptions and expectations.Aim of Study: Was to identify the relationship between cardiac catheterization patient's expectations and their satis-faction with health service quality in selected hospitals.Subjects and Methods: A descriptive, correlational design was conducted to achieve the aim of the study. The study was conducted in the Cardiac Catheterization Units at El-Manial University Hospital (ISO non-certified hospital) and the New El-Kasr Al-Ainy Teaching Hospital (ISO certified hospital), Egypt. A convenient sample of 147 patients from both units participated in the current study. A modified service quality (SERVQUAL) tool was adopted to collect the data.Results: There was a highly significant relation between levels of expectations and satisfaction of patients with health service quality.Conclusion: Most of the patients with high expectation had also high satisfaction while most of the patients with moderate expectation had moderate satisfaction. The most important factors contributing to expect quality was reliability and responsiveness while the most important factors contrib-uting to satisfaction with quality was empathy.Recommendations: Hospital managers and health care providers should identify patient's expectations before health services delivery to enhance their satisfaction and health service quality.

Effect of Self-Care Management on Nursing-Sensitive Patients’ Outcomes after Permanent Pacemaker Implantation

&#x0D; &#x0D; &#x0D; Context: Nursing is striving to build a knowledge base that supports professional practice and improves the quality of care. Aim: This study aimed to evaluate the effect of self-care management guidelines on nursing-sensitive patients' outcomes after permanent pacemaker implantation. Methods: A quasi-experimental design was utilized in this study. A purposive sample of 50 patients admitted to the cardiac catheterization unit at Ain Shams University Hospital after permanent pacemaker implantation during their follow up visit. They are divided into two matched group study and control groups. Their mean age ±SD was 45.37±5.76, and 48.75±4.27 successively. Patient socio-demographic characteristic and medical data sheet, self-care management level assessment scale, and nursing-sensitive outcomes measuring scale were utilized to achieve the study aim.&#x0D; Results: The study results revealed positive outcomes for patients of the study group compared to the controls and their pre-implementation level of self-care guidelines. Conclusion: The study concludes that implementation of self-care management guidelines reflected positively on enhancing all dimensions of nursing-sensitive patients' outcomes recommending that it should be applied in all cardiac catheterization units and should be updated periodically to enhance self-care management for those patients based on nursing-sensitive outcome classification.&#x0D; &#x0D; &#x0D;

Association between Time of Ambulation and Clinical Outcome of Patients after Cardiac Catheterization

Cardiac catheterization is the gold standard diagnostic test for coronary heart disease. The aim: the present study was conducted to assess the association between time of ambulation and clinical outcomes of patients after cardiac catheterization. Methodology: Setting: the study was conducted at the cardiac catheterization units at Ain Shams University Hospital and Ain Shams University Specialized Hospital. Design:The descriptive exploratory research design was utilized in this study. Subject: A purposive sample of 150 patients was used in the study. Tools: 1) Patients’ interview questionnaire to assess patients' demographic characteristics data and patients' medical history. 2) Patient post cardiac catheterization clinical outcomes which included Vital signs: (temperature, blood pressure, respiration, pulse), O2 saturation, lower peripheral perfusion and cardiac catheterization site assessment. 3) Visual Analogue Pain Scale to assess pain intensity. 4) Anxiety Scale to measure the level of anxiety. Results: there was a highly statistically significant relation between patients' age and vital signs reading at the fourth hour after ambulation p value is 0.05. Conclusion: Patients on supine position with restricted on bed rest increased the intensity of back pain level at a time (1h) and then decreased at the time third and fourth hour after cardiac catheterization. Recommendation: early ambulation after cardiac catheterization is safe and its' suggested to improve patients' outcomes.

Radiological risk and professional constraints in female staff in interventional cardiology

Concerns about exposure to radiation are often seen as a constraint, especially among young women and pregnant women who are forced to leave their jobs exposing to radiation. The objective of our study was to evaluate in a group of female doctors and nurses working in cardiac catheterization units their knowledge on radiation exposure and the perception of the radiological risk on pregnancy and the impact of pregnancy on the professional career. This was a descriptive, cross-sectional study carried out at the cardiology departments in Tunisia which involved the female workers exposed to X-ray the cardiac catheterization unit (CCU). We used a questionnaire referring to data from the literature. The study population consisted of 30 female workers working in the cardiac catheterization unit in Tunisia. The mean age was 34 ± 5 years. The average of the overall knowledge scores was 10.74 ± 2.9. We found a significant difference in the level of knowledge according to the grade and the duration of the experience of work in the (CCU). The main fear reported by workers was the risk of infertility in 76% of cases, cancer in 61.5% of cases, thyroid involvement in 53.8% of cases. A total of 92.5% of female respondents consider that a pregnant woman should stop working in the CCU. All workers who had been pregnant while working in the CCU stopped working during pregnancy. Risks of radiation to the fetus reported were malformations in 100% of cases and the risk of abortion in 76%. 23% of women workers reported that pregnancy or pregnancy projects have affected their professional career. In summary, female workers in CCU are not adequately trained in radioprotection. This lack of knowledge about radiological risk can affect the evolution of professional careers. Radioprotection training and awareness deserves to be reinforced by focusing on these shortcomings and involving more participants to collaborate in radioprotection.

Effect of Self Care Management on Nursing-Sensitive Patients’ Outcomes after Permanent Pacemaker Implantation

Background: Patients undergoing permanent implantable pacemaker, challenge with multiple physical, psychological and social complications. The patients may perceive the pacemaker device as an electronic security or as a source of physical, psychosocial and emotional discomfort. So self-care management for those patients and measuring nursing sensitive patient's outcomes will lead to improve their life and overcome physical, social and psychological problems. Aim of the study: This study was aiming to evaluate the effect of self-care management on nursing sensitive patients' outcomes after permanent pacemaker implantation. Study design: A quasi experimental design was utilized to meet the aim of the study. Subject: A Purposive sample included 50 patients after permanent pacemaker implantation which divided into two equal matched groups' (study and control groups).Setting: The study was conducted at the cardiac Catheterization unit at Ain Shams University Hospital. Data collection tools:1) Patient's socio-demographic characteristics sheet, 2) Patient's clinical data sheet, 3) Self-care management level assessment sheet, 4) Patients’ self-care practice observational checklists, and 5) Nursing Sensitive patient Outcomes Measuring Scales. Results: The present study revealed that satisfactory level of self-care knowledge, practice and the different levels of Nursing Sensitive patient Outcomes of patients in the study group were improved post implementation of self-care guidelines compared to control group and to pre implementation of self-care guidelines. Conclusion: Implementation of self-care management guidelines has positive effect on improving patient's self-care management level and enhancing all dimensions of nursing sensitive patients' outcomes (physiological health outcomes, functional health outcomes, psychosocial outcomes, health knowledge and behaviors and family health outcomes. Recommendations Generalize using nursing sensitive patient's outcomes based on (NOC) to provide more comprehensive standardized information on patient, family, and community outcomes that result from nursing interventions. Self-care management guidelines for patients after permanent pacemaker implantation should be applied in all cardiac catheterization units and should be updated periodically to enhance self-care management for those patients based on NOC.

Immune-modulatory Effect of Ionizing Radiation on Type 1 and Type 2 Immune Responses among Workers in Cardiac Catheterization Units

Immune-modulatory Effect of Ionizing Radiation on Type 1 and Type 2 Immune Responses among Workers in Cardiac Catheterization Units

AUTOIMMUNE THYROIDITIS AMONG IONIZING RADIATION EXPOSED WORKERS IN CARDIAC CATHETERIZATION UNITS.

Introduction: It is well known that ionizing radiation (IR) exposure increases the risk of thyroid cancer; however less is known about its role in development of autoimmune thyroiditis. Aim of work: to investigate the thyroid gland functions,level of anti TPO among interventional cardiology team members searching for an association between the level of their occupational exposure to ionizing radiation and the thyroid gland integrity. Materials and methods: This work was carried out in Cardiac Catheterization Unit in National Heart Institute Center. The study comprised two groups, an exposed group of 47 cardiac catheterization workers (19 physicians, 15 nurses and 13 technicians) and a control group of 47 workers matched with the exposed group as regards age and sex. The studied groups were subjected to a detailed questionnaire, full clinical examinations. laboratory investigations in the form of serum thyroid stimulating hormone (TSH), Triiodothyronine (T3), Thyroxine (T4) and antithyroxiperoxidase antibodies (anti-TPO). Radiation exposure was monitored by digital dosimeter. Results: Dosimeter readings were higher among physicians followed by nurses and technicians. Statistically significant higher level of serum TSH, anti-TPO along with statistically significant lower levels of T3, were found among the exposed compared to control groups (P<0.05). Significant positive correlation was detectedbetween the level of anti-TPO and TSH (r= 0.876 P<0.001). Moreover, a significant negative correlation was found between anti-TPO and each of T3 (r= -0.814 P<0.001) and T4 (r= -0.324 P<0.05). ANOVA and Post Hoc tests showed significantly higher level of anti-TPO with significantly lower levels of T3 among the physicians compared to control group. Conclusion: Autoimmune thyroiditis may be considered as one of the adverse health hazards of occupational exposure to ionizing radiation in cardiac catheterization units. Recommendations: We recommend the regular measurement of thyroid hormone especially TSH and anti-TPO to detect early affection of thyroid glandamong radiation exposed workers.

Strahlenexposition des Personals im Herzkatheterlabor

Radiation exposure in personnel of cardiac catheterization units is based on local dosimetry during patient investigations. In the present study, dose rates were measured at various heights in representative locations, with and without fixed radiation protection shields in place. To determine the effective dose values, TLD measurements were performed using an Alderson phantom to generate radiation scatter and a second phantom in the position of the cardiologist performing the catheterization. Various types of personal radiation protection garment and fixed shields were considered in the calculations. Our results indicate on one hand that good protective standards can be achieved with effective doses below 1 mSv/year under optimized conditions. On the other hand, inappropriate radiation protection equipment can cause substantial increase of radiation doses. Alone the lack of a thyroid shield increases the effective dose of the cardiologist by a factor of 3. For the personnel, effective doses were generally higher than personal doses by a factor between 1.5 and 4.8 depending on the radiation protection situation.

CARDIAC CATHETERIZATION IN GERMANY

To describe the diffusion of cardiac catheterization technologies and time trends of their use according to setting and geographic region in Germany during a 13-year period. It is hypothesized that the cardiac catheterization technology has matured from an experimental state to a broadly accepted technology. Data come from the annual survey of the German Society for Cardiovascular Research. All German cardiac catheterization units are requested to provide data on volume and type of catheterization procedures. Data are available from 1984 to 1996. Number and type of procedure, type of unit, diagnoses, and complications are all recorded. The overall response rate is 90%, on average. The total number of catheterization units was 324 in 1996, or an average of 3.69 units per 1 million population. In 1996, all of the East German Länder and districts were below average. Utilization of cardiac catheterization procedures increased exponentially during the study period. The number of angiographies rose from about 45,000 in 1984 to more than 450,000 in 1996; the number of angioplasties increased almost by a factor of 50 to 125,000 procedures in 1996. Inverse correlations between the rates per million population of either coronary angiographies or PTCAs and mortality rates from ischemic heart disease were observed at the level of the German Länder. Further studies taking patient characteristics, long-term outcomes, and other factors in account are necessary to clarify the large geographic variations and the negative relationship between utilization rates and coronary heart disease mortality found in this study.

Pulmonary artery diastolic-occlusion pressure gradient is increased in acute pulmonary embolism

To assess the pulmonary artery (PA) diastolic-occlusion (wedge) pressure gradient in patients with acute pulmonary embolism and to evaluate this variable's diagnostic utility. Retrospective, clinical review. Intensive care and cardiac catheterization units of a university medical center. None. A series of 19 acute pulmonary embolism patients with concurrent right heart catheterization. Control groups consisted of 19 age-, sex-, and heart rate-matched critically ill controls who also underwent right heart catheterization, eight patients suspected of having pulmonary embolism who had negative pulmonary angiography and concurrent right heart catheterization, and 255 patients with a primary diagnosis of coronary artery disease who underwent right heart catheterization at the time of left heart catheterization. Initial hemodynamics (systolic, diastolic, and mean systemic and pulmonary arterial pressures, occlusion pressure, PA diastolic-occlusion pressure gradient, cardiac output, systemic and pulmonary vascular resistances) were compared between cohorts. Other than differences in the PA diastolic-occlusion pressure gradients, no significant differences were identified between cohorts. Pulmonary embolism patients were found to have increased PA diastolic-occlusion pressure gradients (10 +/- 5 vs. 3 +/- 2 mm Hg for the critically ill controls [p < .0002], and 4 +/- 4 mm Hg for the coronary artery disease cohort [p < .0005]). However, no significant difference in PA diastolic-occlusion pressure gradient values was identified when patients with proven pulmonary embolism were compared with patients in whom pulmonary embolism was clinically suspected yet not confirmed by angiograms (10 +/- 9 mm Hg; NS). For three of 19 pulmonary embolism patients, no occlusion pressure could be obtained due to an inability to wedge the balloon tip; 13 of 16 patients had PA diastolic-occlusion pressure gradients of > or = 8 mm Hg. In the pulmonary embolism cohort, PA diastolic-occlusion pressure gradient correlated well with pulmonary vascular resistance (r2 = .50; p < .05), but not with cardiac output or heart rate. In the large number of patients with right heart catheters in whom the question of pulmonary embolism is raised, an increased PA diastolic-occlusion pressure gradient (especially > or = 8 mm Hg) may provide a clue to the diagnosis of pulmonary embolism, but is not specific for this diagnosis.