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Cardiac Catheterisation

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Organisation

  • All patients undergoing a cardiac catheter will need a "PCCS Cardiology booking form" completed (see PCCS team support / administration for form).
  • Booking form to indicate tests required and whether FICK or TOE is required 
  • If patient is considered to be a "high anaesthetic risk" this is clearly documented on the PCCS Cardiology booking form. It is the responsibility of the catheter consultant to discuss this with the anaesthetist and ensure the PICU consultant is aware

Pre Catheterisation

A Cardiology Fellow is allocated to each cardiac catheterisation case and will review the patient prior to the cardiac catheter.

  1. Admission (done by ward staff)
    Medical admission - follow cardiac catheter pathway (resource available on the cardiology ward)
  2. Tests
    The 'PCCS Cardiology booking form' should indicate which tests are required. Most patients will require the following done unless in the last week:
    - Chest x-ray
    - ECG
    - Blood tests: all patients should have a full blood count, electrolytes and group and hold.
    - ECHO: if not done within the last 3 - 6 months at Starship Hospital. If no ECHO in the last 6 months, this needs to be arranged via the on duty cardiologist. In general, children between 6 months and 2-3 years usually require sedation for the echo. Ask catheter consultant if unclear.
    - Ages and Stages Questionnaire to be completed on all children > 6 weeks of age to 6 years of age.
  3. Ongoing medication (when nil by mouth prior to catheter)
    a) Regular diuretics are withheld on the morning of the catheter
    b) Beta blockers are not stopped, especially in patients with Tetralogy or rhythm issues
    c) Captopril or other ACE inhibitor to be withheld on the morning of the catheter.
    d) Aspirin - does NOT need to be withheld
    e) Warfarin should be stopped 2-3 days prior to the catheter
         - ideally the INR should be >2
         - Heparinisation is required for prosthetic valves
         - Heparinisation is usually not needed in Fontans. Discuss with consultant.
    f) Sildenafil is evaluated on a case by case basis. Discuss with consultant.
  4. Cyanosis
    Cyanotic patients are at risk of thrombosis when dehydrated (ie nil by mouth over 4 hours). To prevent this cyanosed children should be first on the catheter list when possible. If this is not possible an IV infusion should be in place for anyone waiting longer than 4 hours.
    - This is especially important in infants or young children with an arterial shunt.
    - Severely cyanotic infants with polycythemia should have an IV infusion from the night before.
  5. "High Anaesthetic Risk"
    If patient has been identified as 'high anaesthetic risk" on the PCCS Cardiology booking form
    - ensure anaesthetist has been informed and PICU are aware
    - non surgical booking administrator to ensure this is recorded on PIMS
    - It is the responsibility of the catheter consultant to discuss this with the anaesthetist and ensure the PICU consultant is aware.
    - Link to the Management of high risk patients for investigation under general anaesthesia guideline.
  6. Aspirin
    Aspirin to start day before procedure for ASD closure.  

Post Catheterisation

  1. Pulse
    RMO is to check child's pulses within one hour of returning to the ward after cardiac catheter.
  2. Investigations
    Catheter consultant will specify post procedure monitoring/tests in cardiac catheter pathway
    a) Pulmonary artery dilatation or stent - CXR at 4 hours post.
    b) ASD closure - CXR,Echo and ECG prior to discharge.
    c) PDA - Echo prior to discharge.
    d) Aortic or pulmonary valve dilatation - Echo and ECG prior to discharge.
    e) Aortic valve dilatation - Continuous ECG monitoring overnight (Risk of ventricular arrhythmia).
    f) Stents - PA and lateral CXR, either 4 hours post or next day as directed by consultant. PA at 4 hours and lateral the next day when can stand is often practical.
  3. Heparin
    a) Heparin may be required if pedal puses absent post catheter. Discuss with consultant.
    b) Heparin may be given post stenting if a small stent is implanted and depending on the position of the stent. The consultant will specify how much to give and monitoring. See Starship Clinical Guideline Anticoagulation
  4. Antibiotics
    Two doses of antibiotic (usually cephazolin 25mcg/kg) given for coil, device or stent implantation cases.
    - One dose given in cateter lab
    - Second dose given: 4 hours
    Antibiotics are not needed for other non-interventional catheterisation, where no implantation took place during the catheter.
  5. Endocarditis prophylaxis:
    Antibiotic prophylaxis is recommended for 6 months following insertion of ASD device closures
  6. Aspirin
    ASD closure - for 6 months post procedure. Dose: 3-5 mg/kg/day for 6 months.
    * Aspirin might be advised by consultant after stent insertion and in some cases of angioplasty  

Information for Families

Download the Paediatric Cardiac Catheterisation: Pre-procedure Information sheet developed by the PCCS team at Starship Children's Health.

View of a copy of the Skin Preparation for Cardiac Catheterisation Information Sheet

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Document Control

  • Date last published: 24 April 2016
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Cardiology
  • Author(s): John Stirling, E Tilton
  • Editor: Marion Hamer
  • Review frequency: 2 years