Pediatric Cardiac Catheterization Research Articles

Abstract 4128201: Reducing Blood Product Waste in a Pediatric Cardiac Catheterization Laboratory – A Quality Improvement Initiative

Background/Aim: Transfusion can be a life-saving intervention, however routine pre-procedural blood products frequently go unused. Recent national blood product shortages highlight the importance of blood product stewardship. In our pediatric cardiac catheterization laboratory (PCCL), packed red blood cells (pRBCs) were ordered prior to all cases. These units are rarely transfused and sometimes cannot be reallocated, resulting in waste. As a quality improvement project, we set a primary aim to reduce the percentage of monthly pRBC waste from a baseline mean of 7.4% to <5% over 12 months. Methods: Baseline data on all cardiac catheterization cases, excluding electrophysiology, lymphatic, and hybrid cases, were collected from 1/1/2022 to 2/28/2023. Interventions (Table 1) were implemented and outcomes measured from 3/1/2023 to 3/31/2024. Primary outcome measures were monthly percentage of blood wasted, and percent of unused pRBC orders. Emergency blood product activation was measured as a balancing metric. Statistical process control charts were used to display and analyze data. Results: During the intervention period 1,318 cases were performed of which 32% met low-risk criteria for pRBC order de-implementation. The percent of blood that was subsequently wasted was reduced from 7.4% to 5.5% (Figure 1A), primarily driven by the reduction in the anecdotal practice of pRBC unit splitting in patients <1 year old (Figure 1B). The percent of unused pRBC orders was reduced from 97% to 79% with sustained improvement following two cycles of routine blood order de-implementation for low-risk cases. No emergency blood activation occurred (0%, 97.5% CI: 0-0.28%). Conclusion: De-implementation of default pRBC orders for low-risk catheterization procedures and reduction in unit splitting reduced the percent of blood wasted in our PCCL, saving time and cost without compromising patient safety. A data-driven approach to blood stewardship may be broadly applicable across procedural areas.

Comparison of dexmedetomidine, ketamine, and magnesium sulfate for the prevention of emergence agitation following sevoflurane-based anesthesia in pediatric cardiac catheterization.

Emergence agitation (EA) is non-purposeful agitation that occurs during the early stages of general anesthesia recovery. This randomized, double-blinded trial aimed to compare the effect of dexmedetomidine, ketamine, and magnesium sulfate on the severity of EA following sevoflurane-based anesthesia in pediatric cardiac catheterization. We examined the fixed doses and assessed the severity of agitation using the Pediatric Anesthesia Emergence Delirium Scale (PAED) score. One hundred children undergoing heart catheterization without local anesthetic in the skin were randomly divided into four groups. The Dexmedetomidine (D) Group (N.=25) received dexmedetomidine 1 μg/kg IV over 10 min, then 0.5 μg/kg/h. The Magnesium Sulfate (M) Group (N.=25) received 15 mg/k MgSo4 IV over 10 min and then 10 mg/kg/h. The Ketamine (K) Group (N.=25) received 1 mg/kg ketamine over 10 min, then 1 mg/kg/h. The Control (C) Group (N.=25) received 0.9% saline at the same rate as other groups. All medications were diluted in 50 mL 0.9% saline. The dexmedetomidine group exhibited a 0% incidence of EA, compared to 4% in the ketamine group, 12% in the MgSO4 group, and 40% in the control groups (P<0.001). Dexmedetomidine significantly reduced the PAED Scale and pain scores compared to the other groups. The effects of ketamine and MgSO4 on PAED and pain scores were comparable, with both treatments demonstrating significantly lower scores than the control group. Dexmedetomidine exhibited higher efficacy than ketamine and magnesium sulfate in reducing the severity of postoperative EA. However, ketamine and magnesium sulfate demonstrated comparable efficacy, exceeding that of the control group.

Development and effect of hybrid simulation program for nursing students: focusing on a case of pediatric cardiac catheterization in Korea: quasi-experimental study.

Hybrid simulation has emerged to increase the practicality of simulation training by combining simulators and standardized patient (SP) that implement realistic clinical environments at a high level. This study aimed to develop a hybrid simulation program focused on case of pediatric cardiac catheterization and to evaluate its effectiveness. The hybrid simulation program was developed according to the Analyze, Design, Develop, Implement, and Evaluate (ADDIE) model. And deep learning-based analysis program was used to analyze non-verbal communication with SP and applied it for debriefing sessions. To verify the effect of the program, a quasi-experimental study using a random assignment design was conducted. In total, 48 nursing students (n=24 in the experimental group; n=24 in the control group) participated in the study. Knowledge (F=3.53, p=.038), confidence in clinical performance (F=9.73, p<.001), and communication self-efficacy (F=5.20, p=.007) showed a significant difference in both groups and interaction between time points, and the communication ability of the experimental group increased significantly (t=3.32, p=.003). Hybrid simulation program developed in this study has been proven effective, it can be implemented in child nursing education. Future research should focus on developing and incorporating various hybrid simulation programs using SP into the nursing curriculum and evaluating their effectiveness.

Using Quality Improvement to Optimize Blood Product Utilization in a Pediatric Cardiac Catheterization Laboratory.

Packed red blood cells (PRBC) are frequently ordered for cardiac catheterization procedures, which increases resource utilization and patient charges. We applied the Plan-Do-Study-Act (PDSA) principle in order to optimize the ordering of PRBC for pediatric cardiac procedures and reducing charges. Our primary aim was to increase adherence to ordering guidelines to greater than 97%, with a global aim to reduce resource utilization. The existing PRBC ordering guidelines were revised and procedure reports were updated to include administration of PRBC. The rate of pre-procedure PRBC orders, adherence to the new protocol guidelines, presence of documentation and rate of blood transfusion within 24h post-procedure, frequency of emergency release blood during a procedure were monitored. During our study period, there was an increased adherence from 86 to 100% adherence following implementation of the updated guidelines. With improved adherence, we decreased PRBC ordering and hospital charges to the patient in low-risk cardiac catheterization procedures, without an increase in blood transfusions.

An animated education program to reduce anxiety, vascular complications, and flat time among children undergoing cardiac catheterization: A randomized control trial, study protocol

One of the most dangerous and prevalent birth disorders is congenital heart defects (CHD). Children diagnosed with CHD may need many operations or medical treatments throughout their lives, including cardiac catheterization (CC). Children undergoing CC experience elevated levels of anxiety. Elevated levels of anxiety among children undergoing CC can be harmful to children physiologically, psychologically, and behaviorally. Additionally, vascular complications such as bleeding and hematoma represented the majority of complications among children undergoing CC. To achieve positive management outcomes, nurses must use an effective method to prepare children for CC. This study present the protocol for developing and implementing an animated education program (AEP) about CC on anxiety, vascular complications, and flat time among children undergoing CC for the first time. A Parallel Randomized Control Trial (RCT) design will be utilized to test the study hypotheses. It is an experimental design where participants are assigned randomly to either receive an intervention or not, and the outcome of interest is then evaluated after the intervention to assess its impact. The trial had been registered as Clinical Trails.gov PRS (Protocol Registration and Result system) Identifier: Protocol ID 101271-6 and clinical trials.gov ID (NCT06483087) under the brief title: Effect of Animated Education on Anxiety and Vascular Complications (VAEda) ClinicalTrials.gov Protocol Registration and Results System (PRS). A random sample of 98 children scheduled for a CC, whose ages range from 6 to 12 years old, will be recruited from a military hospital for medical and surgical heart disease in Jordan, with 49 children in the intervention group and 45 children in the control group. Children in the control group will receive routine care. However, children in the experimental group will receive an AEP, an 8-minute carton animated video that illustrates pediatric CC. The animated cartoon video was developed in Arabic using age-appropriate information. The study’s intervention is intended to give adequate information to children to prepare them for the events occurring before, during, and after the CC procedure, it will be presented to the intervention group 24 hours before the procedure. Outcome measures include anxiety levels that will be assessed 2 hours before children undergo CC. Bleeding and hematoma at the CC site will be assessed 2 hours postsheath removal, and flat time will be assessed by recording the hours that the child stays in a flat position postsheath removal. This exploratory experiment is a necessary first step in investigating important components of a full-scale clinical study. This study presents a novel technique designed for children undergoing CC to lower their anxiety, vascular complications, and flat time. The results of the current study provide evidence-based data that can improve nursing practice and research in pediatric cardiac nursing. Create a policy that emphasizes the critical role that nurses play in delivering high-quality health education through the use of AEP.

Effects of Digital Picture Books on Young Children Undergoing Cardiac Catheterisation and Their Family Caregivers: A Randomised Controlled Trial.

To assess the impact of digital picture books on preoperative anxiety, pain and sleep quality in young children undergoing cardiac catheterisation and the anxiety of their family caregivers. A randomised, single-blinded, two-arm, parallel-group controlled trial. Participants are young children aged 2-7 years with congenital heart disease scheduled for cardiac catheterisation and their family caregivers. They were enrolled at Fujian Medical University Union Hospital between September 2022 and July 2023. They were randomised to either a control group receiving usual care or an intervention group receiving digital picture book sessions. Anxiety and pain levels were assessed using standardised scales, and sleep quality was measured using actigraphy. The study included 64 pairs of young children and family caregivers. Digital picture books significantly reduced preoperative anxiety and bandage removal pain in children and anxiety in family caregivers. However, there was no statistical difference in sleep quality between the intervention group and the control group. Digital picture books prove to be an effective intervention for reducing anxiety and pain in paediatric cardiac catheterisation patients and anxiety of their family caregivers. The intervention did not affect sleep quality, suggesting the need for additional strategies to address this aspect of the hospital experience. This study demonstrated the effectiveness of digitally illustrated books in reducing preoperative anxiety and pain in young children and anxiety in family caregivers. Digital picture books offer a creative and engaging way to help children and their families cope with the stress and anxiety associated with medical procedures. Further research in this area may lead to the development of more innovative and effective interventions for paediatric patients and their family caregivers. The study's impact lies in its innovative approach to addressing the psychological and emotional challenges faced by young children and their family caregivers during the stressful experience of cardiac catheterisation. By demonstrating the efficacy of digital picture books in significantly reducing preoperative anxiety and postoperative pain, the research presents a non-pharmacological, accessible and engaging intervention that can be seamlessly integrated into existing healthcare practices. The findings have the potential to transform paediatric care by offering a safe, developmentally appropriate and cost-effective method to support the emotional well-being of children and their families, thereby enhancing the overall patient experience and clinical outcomes. Moreover, the study's emphasis on family caregiver involvement underscores the importance of a holistic approach to care that considers the needs of both the patient and their support system. Children and their family caregivers were invited to provide valuable input which has been critical to the development of the intervention. The participant information sheet and consent form, as well as the consent/recruitment process, were reviewed by a consumer advisor advocate from the pilot study. CONSORT. Chinese clinical trial registry: ChiCTR2200063973. Registered on 22 September 2022, https://www.chictr.org.cn/showproj.html?proj=132833.

A Retrospective Comparative Study of the Frequency of Hypotension in Pediatric Cardiac Catheterization under General Anesthesia: Remimazolam versus Sevoflurane

ObjectiveTo compare the incidence of hypotension between remimazolam and sevoflurane under general anesthesia for cardiac catheterization of congenital heart disease. DesignRetrospective observational study. SettingA single university hospital with 300 pediatric cardiac catheterizations by general anesthesia performed annually. ParticipantsPatients younger than 15 years who underwent cardiac catheterization under general anesthesia between March 1, 2021, and December 31, 2022. Exclusion criteria: general anesthesia maintained with other than remimazolam or sevoflurane, the administration of remifentanil, ASA score of 4–5, emergency procedures, and no direct arterial pressure measurement. InterventionsGeneral anesthesia was maintained with remimazolam or sevoflurane. Measurements and Main Results309 patients were analyzed, 28 in the remimazolam group and 281 in the sevoflurane group. Propensity score matching adjusted for confounding factors resulted in 28 patients in each arm, with no apparent differences in background factors. Hypotension was defined as a time-averaged area of systolic arterial pressure falling below 80% of the baseline from the start of anesthesia to the end of procedure that was > 1. Significance level: p < 0.05. The incidence of hypotension was 39.3% in the Remimazolam and 46.4% in the Sevoflurane with no significant difference (p=0.79), although the ratio of median systolic arterial pressure to the baseline was significantly higher in the Remimazolam: 91.4 (SD: 15.2)% vs 83.2 (SD: 11.4)% in the Sevoflurane (p=0.03). ConclusionsRemimazolam did not result in lower hypotension incidence than sevoflurane during pediatric cardiac catheterization for congenital heart disease, while maintaining significantly higher blood pressure overall.

Implementing Patient Protection Radiation Dose Alerts for Pediatric Cardiac Catheterization Examinations

Advancements in cardiac catheterization have improved survival for pediatric congenital heart disease patients, but the associated ionizing radiation risks necessitate ethical consideration. This study presents an empirical model to establish reference air kinetic energy released per unit mass (KERMA) and air KERMA area product, also referred to as dose area product, alert levels based on pediatric patient size during diagnostic or interventional cardiac catheterization. Recognizing the significant size variations among pediatric patients, the model provides a universal application for institutions to set quality assurance programs to prevent overexposure. Developed from 3131 unique procedures, the model uses linear regression of logarithmic reference air KERMA and dose area product against the patient's lateral thickness of the thorax for various procedural categories, setting alert levels at the top 95% and 99% of patient data. This allows institutions to tailor dose alert levels to their specific pediatric populations.

How We Would Treat Our Own Congenital Cardiac Catheterization Laboratory Patient

The field of congenital cardiac catheterization (CCC) has changed dramatically since it began eight decades ago. New techniques and devices have expanded the indications for interventional catheterization. Heart teams who care for patients in the pediatric and congenital cardiac catheterization laboratory are confronted with a growing number of patients presenting for a wide range of increasingly technically-challenging cases. Multiple societies have published expert guidelines for CCC management to provide recommendations for best practice. We reviewed risk stratification strategies for CCC and describe our institution's comprehensive, multidisciplinary approach to the periprocedural management of patients with congenital heart disease undergoing cardiac catheterization, using the index case of a 6-year-old patient with multiple heart defects. We concluded that risk stratification and a comprehensive, multidisciplinary team approach that begins when a procedure is booked is essential to inform management and optimize outcomes. Clinical decision-making should be informed by expert guidelines and evolving risk stratification research.

Device Closure of Ventricular Septal Defect: A Retrospective Study at Pediatric Cardiac Unit, Pediatrics Hospital, Ain Shams University

Abstract Background The ventricular septal defect (VSD) accounts for 20% of all isolated congenital heart conditions. Nowadays, transcatheter closure is considered a feasible method of therapy for different types of VSDs. Objective To do a statistical analysis of VSD patients' data who underwent interventional cardiac catheterization to evaluate safety and outcome of transcatheter closure of VSDs. Methods This retrospective cohort study included review of files of 35 patients with VSDs who underwent interventional cardiac catheterization at the Pediatric Cardiac Catheterization Unit, Children’s Hospital, Ain Shams University during the period from first of January 2018 to the end of January 2021.Data were extracted from patients’ medical records, either through medical history, physical examination, pre- and post-intervention investigations, or procedural data. Results In our study, 35 VSD cases had attempts for device closure. Perimembranous VSD was present in 19 cases (54.3%), muscular VSD was present in 12 cases (34.3%), and basal muscular VSD was present in 4 cases (11.4%). Amplatzer Duct Occlude II (ADOII) was used in 17 patients (48.6%), a Muscular Amplatzer VSD device was used in 8 patients (22.9%), a PDA device was used in 8 patients (22.9%), and Amplatzer Duct Occlude I (ADOI) was attempted in 2 patients (5.7%). The most common complications in our study group were minor ones, such as mild tricuspid regurgitation, which occurred in 5 patients (14.3%), hemolysis, and blood transfusion in 1 patient (2.9%). There were no major complications such as aortic regurgitation, heart block, residual VSD, arrhythmia, device embolization, thrombus or clot at the device site, or hemolysis requiring surgical removal of the device. There was also no mortality in the study group. There was a statistically significant increase in the percentage of ADOI devices in complicated patients compared with non-complicated patients (p-value = 0.001), while no statistically significant difference was found between the two groups regarding the percentages of PDA, ADOII, and Muscular Amplatzer devices. The VSDs of all 35 patients were effectively closed, achieving a success rate 100%. Conclusion transcatheter closure is a safe and practical technique for VSDs with different morphologies. The outcomes of transatheter closure of VSDs done in our relatively new center were satisfactory and approximated to results of other international pediatric cardiac catheterization centers as regards complications, mortality, and success rate.

Reducing Adverse Events Associated with Pediatric Cardiac Catheterization: A Quality Improvement Project Focusing on Decreasing Catheterization-Associated Blood Transfusions.

The objective of this study is to describe interventions and outcomes of a quality improvement (QI) project to reduce red blood cell transfusion (RBCT) within 72h of pediatric cardiac catheterization. Using Plan-Do-Study-Act (PDSA) methodology, we applied interventions including (1). Intraprocedural-to reduce hemodilution, blood loss, and excessive anticoagulation, (2). Standardization of institutional transfusion criteria, and (3). "Hard stop" requiring QI team consultation prior to elective post-catheterization RBCT. Primary outcome measures were frequency of RBCT from IMPACT quarterly reports and cases between transfusions (CBT). Length of stay (LOS) was the primary countermeasure. Characteristics of patients who did and did not receive RBCT were compared. 698 pediatric cardiac catheterizations occurred between 4/2017 and 8/2023. Intraprocedural interventions did not alter frequency of RBCT or CBT. Standardized transfusion guidelines followed by the "hard stop" decreased RBCT frequency from 10 to 1.9% and increased CBT without increasing LOS. Patients requiring RBCT were younger (medians 0.31 vs 2.4years), smaller (5.2 vs 11.8kg), and had longer procedures (2.24 vs 1.57h) all p < 0.001. Single ventricle patients were more likely to have RBCT than simple biventricular patients (14.1% vs 3.1%; RR = 4.57, 95% CI 2.29-10.4; p < 0.001). Procedure type (diagnostic vs. intervention) and starting hemoglobin concentration were comparable between groups. Programmatic adherence to standardized peri-procedural transfusion guidelines successfully decreased RBCT without compromising patient care or increasing LOS. Younger age, lower weight, procedure length, and single ventricle physiology were all associated with RBCT risk.

Radiation Reduction in Paediatric Cardiac Catheterization: We Can Go Even Lower

BackgroundRadiation reduction is an integral component in the management of a paediatric cardiac catheterization laboratory. Simple and easily implementable protocol changes and technical upgrades have been shown to significantly reduce radiation exposure. MethodsRadiation exposures (2020-2022) at Safra Children’s Hospital, Sheba Medical Center, Israel (unit A: n = 672) were retrospectively reviewed, including dose area product (DAP) (μGy m2), DAP/kg, Air Kerma (mGy), and fluoroscopy time (minutes) for 16 procedural types. Median doses were compared with those measured (2011-2014) at the Hospital for Sick Children, Toronto, Canada (unit B: n = 2033). Radiation reduction techniques included fluoroscopy acquisition at 7.5 frames/s, removal of antiscatter grids for children <30 kg, limiting field of view, use of Philips ClarityIQ technology, and an institutional culture of radiation mindedness. ResultsExposure was significantly lower in unit A in 14 of 16 procedure types. Total median doses were lower in unit A (DAP: 91.4 [44.7-205.4] vs 387 [138.2-1339] μGy m2 [P < 0.001], DAP/kg: 9.33 [4.3-16.4] vs 29.22 [12.8-65.9] μGy m2/kg [P < 0.001], and Air Kerma: 14.9 [7.8-29] vs 61 [23-176.4] mGy [P < 0.001]) despite higher fluoroscopy time (14.1 [4.2-24.6] vs 12.3 [6.8-23.3] minutes [P = 0.03]). DAP was lower for specific procedures including pulmonary valvuloplasty (46.3 [14.3-219.3] vs 127 [60-323] μGy m2 [P < 0.001]) and patent ductus arteriosus closure (51.9 [18.8-111.8] vs 178 [96-410] μGy m2 [P < 0.001]). ConclusionsEnhanced radiation reduction techniques can lead to lower than previously published exposure levels across a wide range of procedure types when employing dose-limiting protocols and radiation reduction technology.

Novel Uses of the SwiftNinja Steerable Microcatheter for Pediatric Cardiovascular Interventions.

In the present era, the intricacy of procedures undertaken by a pediatric interventional cardiologist has increased, primarily attributed to dealing with smaller, younger patients with more complex anatomies. To adapt to these smaller and more complex patients, we must adapt our interventions and our equipment to perform these procedures. This article outlines various innovative applications of the SwiftNinja steerable microcatheter within the pediatric cardiac catheterization laboratory.

Medical staff dose estimation during pediatric cardiac interventional procedures.

The purpose of this study is to evaluate the occupational doses (eye lens, extremities and whole body) in paediatric cardiac interventional and diagnostic catheterization procedures performed in a paediatric reference hospital located in Recife, Pernambuco. For eye lens dosimetry, the results show that the left eye receives a higher dose than the right eye, and there is a small difference between the doses received during diagnostic (D) and therapeutic (T) procedures. The extrapolated annual values for the most exposed eye are close to the annual limit. For doses to the hands, it was observed that in a significant number of procedures (37 out of 45 therapeutic procedures, or 82%) at least one hand of the physician was exposed to the primary beam. During diagnostic procedures, the physician's hand was in the radiation field in 11 of the 17 catheterization procedures (65%). This resulted in a 10-fold increase in dose to the hands. The results underscore the need for optimization of radiation safety and continued efforts to engage staff in a radiation safety culture.

OR12-7 | Reducing Red Blood Cell Transfusions Following Pediatric Cardiac Catheterization

OR12-7 | Reducing Red Blood Cell Transfusions Following Pediatric Cardiac Catheterization

Evaluation of Practices about Pediatrics Cardiac Catheterization among Nurses at District Head Quarter Hospital

Pediatric cardiac catheterization is a critical procedure that plays a vital role in diagnosing and treating congenital heart defects and other cardiac conditions in children. This procedure involves inserting a catheter into the heart chambers or vessels through a vein or artery. Nurses play multifaceted roles throughout the continuum of cardiac catheterization. Objective: To evaluate the practices of nurses about pediatrics cardiac catheterization. Methods: This study employed cross-sectional descriptive design at pediatric department of a District Head Quarter (DHQ) Hospital. Target population was registered nurses of age above 20 years and who had at least 6 months of practical experience with cardiac pediatric patients. Data were collected conveniently through observational checklist and analysis was done through SPSS Version 24.0. Results: Majority nurses were not encouraging bed rest to the pediatric patients nor keep affected extremity bend for 2-4 hours (80%) after catheterization. Moreover, they did not regularly check the vitals of the children and unable to monitor in every 15 minutes /hour or 30 minutes for next hour (81%). Nurses were unable to educate the pediatric parents for the removal of pressure dressing and nor assess the dressing site appropriately (92%). Conclusions: The present study findings suggested that majority nurses have poor practices before and after cardiac catheterization procedure while some have an average level of practices during the procedure. So, training programs should be arranged to enhance the practices of nurses about cardiac catheterization in pediatric population.

Catheterization for Congenital Heart Disease Adjustment for Risk Method II.

Current metrics used to adjust for case mix complexity in congenital cardiac catheterization are becoming outdated due to the introduction of novel procedures, innovative technologies, and expanding patient subgroups. This study aims to develop a risk adjustment methodology introducing a novel, clinically meaningful adverse event outcome and incorporating a modern understanding of risk. Data from diagnostic only and interventional cases with defined case types were collected for patients ≤18 years of age and ≥2.5 kg at all Congenital Cardiac Catheterization Project on Outcomes participating centers. The derivation data set consisted of cases performed from 2014 to 2017, and the validation data set consisted of cases performed from 2019 to 2020. Severity level 3 adverse events were stratified into 3 tiers by clinical impact (3a/b/c); the study outcome was clinically meaningful adverse events, severity level ≥3b (3bc/4/5). The derivation data set contained 15 224 cases, and the validation data set included 9462 cases. Clinically meaningful adverse event rates were 4.5% and 4.2% in the derivation and validation cohorts, respectively. The final risk adjustment model included age <30 days, Procedural Risk in Congenital Cardiac Catheterization risk category, and hemodynamic vulnerability score (C statistic, 0.70; Hosmer-Lemeshow P value, 0.83; Brier score, 0.042). CHARM II (Congenital Heart Disease Adjustment for Risk Method II) risk adjustment methodology allows for equitable comparison of clinically meaningful adverse events among institutions and operators with varying patient populations and case mix complexity performing pediatric cardiac catheterization.

Usefulness of deep sedation with intravenous dexmedetomidine and midazolam in cardiac catheterization procedures for pediatric patients.

Dexmedetomidine (DEX) is a highly selective alpha 2 receptor agonist that has the advantage of causing less respiratory depression than other sedative agents. We evaluated the add-on effects of DEX on sedation among pediatric patients who received midazolam and pentazocine during cardiac catheterization. 120 cardiac catheterization procedures in 110 patients under deep sedation at Department of Pediatrics, Kanazawa University Hospital from January 2013 to August 2018: 63 procedures without DEX (i.e., non-DEX group) and 57 procedures with DEX (i.e., DEX group). Intravenous midazolam and pentazocine were used in both groups, and DEX without an initial loading dose (0.6 μg/kg/h) was used in the DEX group. We retrospectively investigated complications during catheterization, doses of sedative agents, and changes in vital signs. Hypoxemia requiring oxygen administration during catheterization tended to be higher in the non-DEX group than in the DEX group (4.8% vs. 0%). Additional dose of midazolam was significantly lower in the DEX group (median [IQR]: 0.05 mg/kg [0-0.11]) than in the non-DEX group [0.09 mg/kg (0-0.23), p = 0.0288]. The additional dose of midazolam in the non-DEX group with hypoxemia was significantly higher than the dose used in the non-DEX group without hypoxemia. No case of bradycardia below the criteria for bradycardia occurred and no serious complications occurred in the DEX group. The use of intravenous DEX in combination with midazolam and pentazocine in pediatric cardiac catheterization may reduce the need for an additional dose of midazolam and may contribute to the prevention of airway complications associated with respiratory depression caused by sedative agents.

Doğumsal Kalp Hastalıklı Çocuklarda Kalp Kateterizasyonu Sırasında Aktive Edilmiş Pıhtılaşma Zamanı Testi ile 100 IU/Kg Fraksiyone Olmayan Heparin Yükleme Dozunun Yeterliliğinin Araştırılması

Purpose: This study investigated whether an activated clotting time (ACT) between 200 and 300 sec could be achieved with a100 IU/kg unfractionated heparin (UHF) loading dose in patients with congenital heart disease (CHD) during pediatric cardiac catheterization. Materials and Methods: We included 264 patients aged 0-18 years with CHD undergoing cardiac catheterization between January 2022-March 2023. Data on patient characteristics, UHF doses, and ACT values were retrospectively obtained. The patients were intravenously administered 100 IU/kg UFH after sheath placement. We aimed to obtain a value between 200 and 300 sec according to the ACT measured at the 5th minute. If the measured ACT value at the 5th min was &amp;lt; 200 sec, additional heparin doses between 20 and 50 IU/kg were administered such that the total heparin loading dose did not exceed 150 IU/kg. Patients were divided into two groups based on whether the ACT value was below or above 200 sec. Results: Median age, weight, and ACT value at procedure were 6.41(IQR:2.01–32.21) months, 6.13(IQR:3.79-11.9) kg, and 212(IQR:190-240) sec, respectively. The ACT value of 170(64.4%) of the 264 patients was between 200-300 sec, which was considered the target value. The ACT value of 86(32.6%) of the 264 patients was below the target value and that of eight (3%) patients was above the target value. Hematoma occurred at the access site in four patients (1.5%). We did not detect retroperitoneal hematoma, other bleedings at location, or thromboembolism in any of the patients. No significant differences were observed in comparisons between age subgroups and ACT distribution, or between age subgroups and ACT subgroups (p&amp;gt;0.05) Conclusion: This study revealed that a 100 IU/kg UFH loading dose produced the target ACT value in 64.4% of the patients and that the UFH loading dose should be individualized according to the ACT value in the remaining patients.

Evaluation of Radiation Exposure and Image Quality in Congenital Catheterization Laboratory; A Single Centre Comparative Study Using Different Acquisition Modes

Abstract Background The exposure to ionizing radiation delivered during the catheterization procedures has various negative biological effects to the patient, so concern has risen sharply about radiation hazards over the past decade.While angiography imaging system vendors have all made great strides with new technologies that reduce the amount of x-rays needed while maintaining excellent image quality, the procedures have become more complex, lasting longer and require more imaging than standard procedures. Aim of the Work To study the effect of lowering radiation dose by using a fluoro angiography on image quality in pediatric cardiac catheterization. Patients and Methods We studied 90 patients who underwent cardiac cath. for CHD at Ain Shams University hospital. Patients were randomized into three groups according to mode of acquisition used in procedure (fluro angiography only–cine angiography only–mixed). Radiation indices were measured, also image quality questionnaire was filled by operators after each procedure. Results statistically significant difference between three modalities of acquisition as regard the radiation indices (DAP, total air kemra, fluoroscopy time) with p value &amp;lt;0.005. While operators satisfaction with image was nearly the same in the three groups with median score 68.5 (p value 0.681). Conclusion Based on the results of the current study it can be concluded that: Mixed imaging acquisition had highest radiation exposure indices in comparison with other two acquisition modalities (fluro angiography only – cine angiography only), with statistically significant difference with fluro only mode (p value &amp;lt;0.005), and no statistically significant deference with cine only mode. Complexity of the procedures &amp; increased the cath. lab machine imaging protocol to 30 fps and repeat the same injection in the cine mode after fluro mode were the most important factors that made mixed acquisition had the highest radiation indices and exposure. Image quality and operators satisfaction were nearly the same in three acquisition modes (fluro-cine-mixed) with median image score 68.5 (p value 0.681), in expense of more radiation exposure in mixed mode. Increase operators awareness to radiation and continuous monitoring of radiation exposure with application of ALARA principles is important to reduce radiation exposure.