When Your Child Needs an Interventional Cardiac Catheterization Procedure

Interventional cardiac catheterization can be used to treat certain 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. An interventional cardiac catheterization procedure is done by a pediatric cardiologist. This is a doctor who diagnoses and treats heart problems in children. They have special training in cardiac catheterization.

Why might my child need this procedure?

Some catheterization procedures are preferred over open heart surgery to treat certain heart defects. This is because they’re less invasive, may have fewer risks and complications, and have a shorter recovery period. An interventional cardiac catheterization procedure can be used to:

• Open heart valves or blood vessels. A balloon at the end of a catheter is inflated and deflated 1 or more times to open a valve or widen a blood vessel. A catheter may also be used to place a wire mesh tube (stent) in a blood vessel. This is a tiny device used to widen and keep open a blood vessel.

• Close holes or blood vessels. A catheter is used to guide a device, such as a coil or plug into the heart. This is usually done to close a hole in the heart or a blood vessel in or around the heart.

• Measure blood pressure in specific parts of the heart

• Treat abnormal heart rhythms with electricity, heat, cold, or sound waves

• Take a sample of heart tissue (biopsy)

How do we get ready for an interventional cardiac catheterization?

• Have your child follow any directions on not eating or drinking before the procedure.

• Follow all other directions given by the healthcare provider.

How to help your child prepare

You can help your child by preparing them 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 intravenous (IV) line may be inserted into the arm to give medicine. This may cause a brief sting. Your child likely won’t feel any discomfort once the medicine takes effect.

• Let your child ask questions and answer these questions truthfully. Your child may feel nervous or afraid. They 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 medicine

What happens during an interventional 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. They may also be given medicine that makes your child sleep and not feel pain (anesthesia). This is done by face mask or IV. A trained nurse or anesthesiologist, the healthcare provider who gives the anesthesia, is in charge of this process.

• A breathing tube may be placed in your child’s windpipe (trachea). Special equipment keeps track of your child’s heart rate, oxygen levels, and blood pressure.

• A local medicine given so your child won’t feel pain is injected at the catheter insertion site. This can be in the groin, neck, or shoulder.

• 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.

• Blood samples are drawn from the chambers and blood vessels in the heart. Oxygen levels and blood pressure are measured.

• Specific interventions to open or close a valve, hole, or blood vessel in the heart are done at this time.

• The catheter is removed once the procedure is complete.

What are the risks and possible complications of cardiac catheterization?

Complications can include:

• Reaction to sedative or anesthesia

• Reaction to contrast dye

• Abnormal heart rhythm

• Infection

• Bleeding

• Injury to the heart or a blood vessel

• Death (rare)

What happens after the cardiac catheterization?

• Your child is taken to a recovery room or the inpatient floor or ICU. 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 healthcare provider 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 to drink 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 is often needed. You’ll be given directions for your child’s home care before they leave the hospital.

When should I call my child's healthcare provider?

After an interventional cardiac catheterization procedure, call your healthcare provider right away if your child has any of the following:

• Pain, swelling, warmth, redness, bleeding, or drainage at the catheter insertion site

• Pain, coldness, or a bluish color in the extremity that held the catheter

• Fever, temperature of 100.4°F (38°C) or higher, or as directed by your healthcare provider (see Fever and children, below)

Call 911

Call 911 if any of these occur:

• Chest pain

• Shortness of breath or trouble breathing

• Irregular, rapid heartbeats (palpitations)

• The catheter insertion site swells up very fast

• Bleeding from the catheter insertion site does not slow down when you firmly press on it

• Passing out or unresponsiveness

• Sudden numbness or weakness in arms, legs, or face, or difficulty speaking

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

• Rectal. For children younger than 3 years, a rectal temperature is the most accurate.

• Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.

• Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.

• Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.

• Mouth (oral). Don’t use a thermometer in your child’s mouth until they are at least 4 years old.

Use a rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell them which type you used.

Below is when to call the healthcare provider if your child has a fever. Your child’s healthcare provider may give you different numbers. Follow their instructions.

When to call a healthcare provider about your child’s fever

For a baby under 3 months old:

• First, ask your child’s healthcare provider how you should take the temperature.

• Rectal or forehead: 100.4°F (38°C) or higher

• Armpit: 99°F (37.2°C) or higher

• A fever of ___________as advised by the provider

For a child age 3 months to 36 months (3 years):

• Rectal or forehead: 102°F (38.9°C) or higher

• Ear (only for use over age 6 months): 102°F (38.9°C) or higher

• A fever of ___________ as advised by the provider

In these cases:

• Armpit temperature of 103°F (39.4°C) or higher in a child of any age

• Temperature of 104°F (40°C) or higher in a child of any age

• A fever of ___________ as advised by the provider