Heart Catheterization

A cardiac or “heart cath" is minimally invasive.

Your child's doctor uses thin, flexible tubes called “catheters" to look at and get information about the heart from the inside.

To get inside the heart, the doctor:

• Inserts the tube into the big blood vessels in the groin, much like how they place an IV line. Sometimes the doctor will use other blood vessels, such as those in the neck or arm.
• Gently pushes the tube through the blood vessels and into the heart using an x-ray called fluoroscopy (floor-OS-co-pee) for guidance.

Once the catheter is inside the heart, the doctor uses it to gather different types of data.

There are many types of tubes or catheters doctors may use during a heart cath. Each tube serves a different purpose.

Some let the doctor take blood samples from different parts of the heart and lungs. This allows the doctor to look at oxygen saturation (how much oxygen is in the blood). It can also help measure the blood pressure in the heart and lungs.

Others allow the doctor to look at the electrical system of the heart. The doctor may insert a special dye called “contrast" through the tubes and look at it under an x-ray. This helps the doctor see the heart and the arteries and veins in the heart and lungs.

The doctor can see how well the heart is pumping and take pictures that they can look at later.

At the UPMC Children's Hospital Heart Institute, the doctors and nurses work as a team with many other experts.

This includes a:

• Pediatric anesthesiologist, who will give your child the drugs to make them sleep. They will also watch your child's vital signs during the heart cath.
• Pediatric heart doctor who specializes in the procedure. A cardiology fellow — that is, a pediatric doctor training to be a heart specialist — may help in the surgery.

The cath lab staff also helps prep your child for the procedure and gets the equipment the doctor needs.

If your child needs sedation or general anesthesia, they must follow important rules for eating and drinking. These rules apply for both the night before and the day of the procedure.

One business day before your child's heart cath, you will get a phone call from a scheduling nurse. (Nurses makes these calls between 1 and 9 p.m. and do not call on weekends or holidays.) Please have paper and a pen ready to write down these instructions.

During the call, the nurse will:

• Ask about your child's medical history, current medications, and readiness for the heart cath. If you have any questions, you may ask the nurse at this time.
• Tell you what time you should get to the hospital. Allow enough time for travel and parking. Arriving late may delay or postpone your child's heart cath.
• Give you detailed instructions for eating and drinking. For kids older than 12 months, they usually are:
  • No solid food or non-clear liquids after midnight the night before the test. That includes milk, formula, juices with pulp, and chewing gum or candy.
  • Only clear liquids up to two hours before the scheduled arrival time. Clear liquids include water, Pedialyte™, Kool-Aid®, and juices you can see through, such as apple juice.
  • No tooth brushing on the morning of the test.
  • Nothing to eat or drink in the two hours before the scheduled arrival time.

• Children younger than 12 months may have different eating and drinking instructions. No matter what age your child is, it's vital that you follow the instructions the nurse gives you.
• For the safety of your child, it's important to follow these specific times for eating and drinking. Remember, if your child eats or drinks after the scheduled times, it will delay the test. Or we may need to schedule it for another day.
• Dress your child in comfy, two-piece clothing or pajamas.
• You should not use any cream, lotion, powder, or baby oil on your child's chest on the day of the heart cath.
• If your child is sick with a mild cold or cough before the procedure, they can often still have the heart cath. If your child has a severe cold, fever, or flu in the days before the heart cath, we may need to reschedule. Please call our office to discuss your concerns.

The most important role of a parent or guardian is to keep your child calm. The best way to keep your child calm is to be calm yourself.

You should also know what to expect and explain it to your child beforehand.

Here are some guidelines to use when talking to your child about their heart cath and what to bring along.

At any age

Your child may bring along a “comfort" item — such as a favorite stuffed animal or blankie — to hold during the procedure. There are TVs in the same-day surgery rooms.

You're also welcome to bring a portable DVD player, laptop, or hand-held video game.

2 to 7 years

The day before your child's heart cath, explain the procedure using simple words. You might say that the doctor “will take pictures of your heart while you are taking a nap."

A medical play kit can be helpful so your child learns items they may see. For example, you can show your child how to use a stethoscope on a teddy bear. Books about going to the hospital also might help.

7 to 11 years

For older kids, it might help to discuss their heart cath about a week or so before the scheduled date.

At this point, kids know more about the body, the organs, and how they work. For that reason, they may be more afraid of pain.

You might tell your child that they'll receive medicine before the heart cath that will:

• Make them very tired throughout the heart cath.
• Keep them from feeling any pain during the procedure.
• Make it hard to remember much about the procedure afterward.

You might add that the heart is like a pump. The heart cath will help the doctor see how well their heart is pumping. Books about going to the hospital also might help.

12 years and up

Preteens and teens can understand the way the heart works, what their heart problem is, and why they need a heart cath.

They might ask very insightful questions. Use their questions to help guide your discussion.

• You will register for your child's heart cath at the Same-Day Surgery Center on the 4th floor of UPMC Children's Hospital.
• You and your child will go to an exam room where a nurse will check your child's vital signs.
• Your child will need to take off all clothes down to their underpants and put on a hospital gown.
• Someone from the hospital's anesthesia team will confirm with you and your child that they have not had any food or liquids. They will also ask you any other important questions about your child's health. After speaking with the anesthesiologist, you will need to sign a consent form to allow the anesthesia.
• The cardiologist doing your child's heart cath will come to meet you before the test starts. At that time, you may ask any questions you have about the test.
• A nurse will come to get your child when it's time to move into the cath lab. Parents can go to the waiting room. One parent may walk into the cath lab with the child.
• Once your child is in the cath lab and asleep, they will receive an IV in an arm vein. During the test, your child will get medicine through this IV to keep them asleep or drowsy. Your child will also receive fluids through the IV to prevent dehydration.
• Next, the doctor will do an EKG. They'll place small plastic stickers with wires on your child's chest. Then they will connect those wires to a machine.
• Your child will have a blood pressure cuff wrapped around their arm to measure blood pressure often throughout the procedure.
• Your child will have a light sensor taped to their finger to measure the oxygen in their blood.
• When your child is ready, your child's heart doctor will start the test.
• Your child will receive a shot of local anesthetic under the skin where the doctor will insert the catheter.
• The doctor will speak to you when they're done with test. That way, you will know the results before meeting up with your child in the recovery room.

• No matter what kind of heart cath your child has, they may need to stay in the hospital for a night.
• The doctor will decide whether your child may go home after that day or needs to stay overnight. So, you and your child should come to the hospital prepared for an overnight stay.
• After the heart cath, your child goes to a recovery room until the effects of anesthesia start to wear off. You can go to the room so that you can be there as your child wakes up. You can help by talking softly and touching your child so they know you're there.
• Your child will stay in the recovery room until they're alert and their vital signs are stable. The amount of time your child will need to spend in there will vary. That's because some children take longer than others to wake up after anesthesia.
• Your child will have pressure bandages on the sites where the doctor inserted the catheters. This tape needs to stay in place overnight to lessen bleeding. Even with pressure bandages, your child may have bruising in the areas of the insertion sites.
• Your child will need to lie flat on their back for at least four to six hours after the heart cath.
• If the doctor inserted the catheter through the leg, your child needs to keep the leg straight for four to six hours. This will help reduce bleeding.
• When your child is fully awake, they will either move to an inpatient room for an overnight stay. Or the doctor may let them go home after the "flat time" is over.

• If your child goes home after the heart cath, they may still be groggy. They should take it easy for the rest of the day.
• Your child can usually go back to school within a few days, but may have to limit their activity. Talk to your child's doctor about returning to school and activities, and allow your child to resume activities at their own pace.
• Your child may eat and drink a little at a time and then resume normal eating and drinking if they're feeling well.
• Your child may have bruising in the areas where the catheters were. You can give your child Tylenol® or Motrin® if the bruises are sore.
• Your child should avoid tub baths, hot tubs, and swimming for three to four days after their heart cath. This helps prevent infection of the catheter sites.
• You should follow up with your child's heart doctor if you have any further questions.

If your child has any special needs or health issues, it's vital that you let the care team know in advance.

Call the Heart Institute at 412-692-5540 before your child's heart cath and ask to speak with a nurse.