When Your Child Needs Diagnostic Cardiac Catheterization
What is a diagnostic cardiac catheterization?
Diagnostic cardiac catheterization is a procedure that can be used to evaluate heart problems. During the procedure, a thin, flexible tube (catheter) is inserted through the skin into a blood vessel. It’s then guided into the heart with the help of live X-rays. Cardiac catheterization is done by a pediatric cardiologist. This is a doctor who diagnoses and treats heart problems in children. He or she has special training in cardiac catheterization.
Why does my child need a diagnostic cardiac catheterization?
Your child may need this procedure if a heart problem is suspected or to follow a known heart problem. It may also be needed if your child is being prepared for heart surgery and information on the heart is required before treatment.
The procedure allows the cardiologist to:
Check the structure of the heart and health of the coronary blood vessels
Check the function of the heart's ability to pump
Check the electrical activity of the heart
Check that the valves are working properly
Measure oxygen levels and blood pressure in the heart and blood vessels
How do we get ready for a diagnostic cardiac catheterization?
Don’t give your child anything to eat or drink for 4 to 6 hours before the procedure.
Follow all other instructions given by the doctor.
How to help your child prepare
You can help your child by preparing him or her in advance. How you do this depends on your child’s needs:
Explain what will happen during the procedure in brief and simple terms. Younger children have shorter attention spans, so do this shortly before the procedure. Older children can be given more time to understand the procedure in advance.
Make sure your child understands which body part(s) will be involved in the procedure.
As best you can, describe how the procedure will feel. An IV may be inserted into the arm to give medicine. This may cause a brief sting. Your child won’t feel any discomfort once the medicine takes effect.
Allow your child to ask questions. Answer these questions truthfully. Your child may feel nervous or afraid. He or she may even cry. Let your child know that you’ll be nearby during the procedure.
Use your hospital's services. Many hospitals have a child life specialist. This person is specially trained to help children understand what to expect during their time in the hospital. Books, videos, dolls, and toys may be used to help explain the procedure to your child. Be sure to ask your child’s healthcare provider about the resources available at your hospital.
What to tell your child's healthcare provider
Tell your healthcare provider if your child:
Recently had a cough, fever, runny nose, groin infection, or diaper rash
Has any allergies, such as contrast dye
Is taking any medicines
What happens during a diagnostic cardiac catheterization?
The procedure takes place in a catheterization lab. It usually lasts about 2 to 4 hours. You’ll stay in the waiting room during the procedure:
Your child lies on an X-ray table.
Your child is given a pain reliever and a medicine that makes your child relax or sleep (sedative). This is done by mouth or an intravenous (IV) line. He or she may also be given medicine that makes your child sleep and not feel pain (anesthesia). This is done through a facemask or IV. A trained nurse or doctor (anesthesiologist) is in charge of this process.
A breathing tube may be placed in your child’s windpipe (trachea). Special equipment monitors your child’s heart rate, oxygen levels, and blood pressure.
A local medicine so your child won’t feel pain (anesthetic) is injected at the catheter insertion site. This can be in the groin, shoulder, or neck.
Then a catheter is passed through a blood vessel and is guided into the heart. The movement of the catheter can be seen with live X-rays.
Contrast dye is injected through the catheter. The dye tracks the movement of blood through the heart and allows the structures and blood vessels in the heart to be seen more clearly. Pictures are taken of the heart and blood vessels using X-rays. Any abnormalities will be seen during X-rays.
Blood samples are drawn from the chambers and blood vessels in the heart. Oxygen levels and blood pressure are measured.
The catheter is removed once the procedure is complete.
What are the risks and complications of cardiac catheterization?
Possible complications include:
Reaction to sedative or anesthesia
Reaction to contrast dye
Abnormal heart rhythm
Injury to the heart or a blood vessel (rare)
What happens after the cardiac catheterization?
If no immediate treatment for a heart problem is needed, your child will be taken to a recovery room. You can stay with your child during this time.
It may take 1 to 2 hours for the medicines to wear off.
Pressure and a dressing may be applied to the catheter insertion site to limit bleeding. The doctor or nurse will tell you how long your child needs to lie down and keep the insertion site still.
Your child may be given only clear liquids for a few hours. This to prevent reaction to any anesthesia if it was given.
Any contrast dye your child is given should pass through the body in about 24 hours.
An overnight hospital stay may be required. You’ll be given instructions for your child’s home care before he or she leaves the hospital.
When should I call my child's healthcare provider?
Call the healthcare provider right away if your child has any of the following:
Pain, swelling, redness, bleeding, or drainage at the catheter insertion site
Severe pain, coldness, or a bluish color in the area that held the catheter
Shortness of breath
A seizure caused by fever
Unless advised otherwise by your child’s healthcare provider, call the provider right away if:
Your child is of any age and has repeated fevers above 104°F (40°C).
Your child is younger than 2 years of age and a fever of 100.4°F (38°C) continues for more than 1 day.
Your child is 2 years old or older and a fever of 100.4°F (38°C) continues for more than 3 days.
March 31, 2018
Felts, T., Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease, Circulation (2011); 123, pp. 2607-2652
Bass, Pat F. III, MD, MPH,Gandelman, Glenn, MD, MPH