Catheterization
Catheterization is a medical procedure that involves inserting a tube, known as a catheter, into a body cavity to draw or inject fluids. This technique serves various purposes, primarily in airway management, urinary drainage, and cardiac interventions. Common uses include assisting with breathing by opening airways when a patient is unable to do so independently, such as during surgery under general anesthesia or in emergency situations. Urinary catheters help empty the bladder when there are obstructions or when patients cannot control urination.
Cardiac catheterization is a critical application where a catheter is maneuvered into a blood vessel to diagnose heart conditions, such as blockages in coronary arteries. It can also facilitate minimally invasive procedures like balloon angioplasty, which helps open narrowed arteries. Although catheterization is generally safe, it carries risks, including infections or complications during procedures. Recent challenges, such as disruptions caused by the Covid-19 pandemic, have impacted the availability of necessary materials and postponed elective surgeries, highlighting the importance and complexity of catheterization in modern medical care.
Catheterization
Anatomy or system affected: Bladder, blood vessels, circulatory system, genitals, heart, reproductive system, throat, urinary system
Definition: The insertion of a tube into a cavity of the body to withdraw fluids from or to introduce fluids into that cavity.
Indications and Procedures
Many different types of catheters exist and can be used for many different purposes. What they all have in common is the placement of a tube (catheter) into a body cavity. The tube draws or injects a gas or liquid into the cavity. The most common uses of catheterization are opening an airway for breathing, withdrawing urine from the bladder, and injecting dye or other substances, such as an intravenous (IV) drip into blood vessels.
Catheterization can be used to assist in the breathing process. This procedure may be necessary when the patient’s airway is blocked, the patient is unconscious and unable to breathe, or needs assistance breathing. The tube or catheter is placed into the mouth, nose, throat, or lungs. Oxygen passes through the tube and into the lungs, where the blood can absorb it. Catheters can also remove secretions from these areas to open the airway and improve breathing. They are also necessary in many emergency situations to open and maintain breathing. At times, a catheter must be introduced directly into the lungs through an incision in the neck; this procedure is known as a tracheostomy. A catheter may also be introduced into the patient’s nose to transport oxygen into the lungs. Catheterization is important for maintaining breathing during surgery under general anesthesia when the body’s breathing mechanisms are slowed or shut down.
Another common catheterization procedure involves the introduction of a urethral catheter. This type of catheter is inserted into the urethra to urine from the bladder. Such a procedure may be necessary to empty the bladder when the urethra is blocked, or it may be used to collect urine when the person cannot control their bladder.
An area where catheters are being used more frequently is heart diagnosis and surgery. In cardiac catheterization, a catheter is inserted into a large blood vessel in the upper arm or groin area. The physician then maneuvers the catheter into the heart and uses it to inject a dye directly into the organ. An X-ray can show the distribution of the dye within the heart, allowing the physician to see if and where any coronary arteries are blocked. In addition, cardiac catheters can be used to determine blood pressures within the heart, the amount of oxygen in the blood in the heart, and how the valves are functioning. More recently, cardiac catheters have been developed to perform some types of surgery. A good example is balloon angioplasty. Using similar procedures to insert the catheter, the cardiologist guides a specialized catheter into the coronary artery to the area of the blockage. A small balloon on the end of the catheter is inflated, pushing the fatty material blocking the artery against the blood vessel wall and opening the artery to allow for the normal flow of blood.
Uses and Complications
Catheterization has been used safely and successfully for many years. When people are unable to breath well on their own, airway catheters have been instrumental in saving lives and making such patients more comfortable. Such procedures have been widely used on a daily basis, with few complications.
Likewise, urethral catheters are routinely employed to control the flow of urine from the bladder. This type of catheterization can be seen in many clinical settings. Although caution must be used to prevent the introduction of bacteria and subsequent catheter-associated urinary tract infection (CAUTI), this procedure is considered to be safe and effective.
The overall success rate of cardiac catheterization has been good. It is a valuable tool for the diagnosis of heart diseases and disorders because a major incision in the chest is avoided. This procedure is performed many times each day in all cardiac care units. Angioplasty has also been successful, but it is useful for only some types of blockages. A major risk of angioplasty is rupture of the artery if the balloon is inflated too much. When this happens, open heart surgery is necessary to prevent death. Another problem with balloon angioplasty is that blockages can reform within six months in some patients. Nevertheless, this procedure offers a good alternative to coronary artery bypass surgery.
In addition to the adverse effects to human life stemming from the Covid-19 pandemic, other types of impacts to medical care, including those requiring cardiac catheterization. This situation resulted from the disruption of global supply chains to suppliers of equipment and products necessary to conduct medical procedures. One of these was a type of iodine commonly used in cardiac catheterization procedures to create color contrasts in areas of the heart to be operated. In May 2022, as the global medical community saw its stocks of existing medical supplies such as the contrast iodine 270 mg/mL Visipaque/Iodixanol exhausted, alternative solutions had to be employed. Many patients had near-fatal experiences with the replacement products utilized. A second impact concerned the postponement of non-life-threatening, elective cardiac surgeries as the volume of Covid cases rapidly increased. The measures were needed during the height of the pandemic as hospital bed space capacity began to fill, and medical staff were diverted to deal with soaring pandemic numbers. When Covid-19 began to abate, and elective surgeries were again authorized, medical staff found bottlenecks of patients needing attention for conditions that had negatively progressed during the unavailability of services.
Perspective and Prospects
The use of catheterization for airway management was first demonstrated in 1871 by Friedrich Trendelenburg. Since then, such procedures have been improved. Catheters will continue to be instrumental for airway management.
The cardiac catheterization of a living human being was done by Werner Forssmann in the 1920s: He performed the procedure on himself. His techniques were further developed by André Frédéric Cournand in the 1940s, leading to his Nobel Prize in Physiology or Medicine in 1956. Continued advances in the procedure and improved technology have increased the applications of cardiac catheterization. New and better procedures, which will continue to replace some types of open-heart surgery, are expected in the future.
In addition to the adverse health effects inflicted on individuals during the Covid-19 pandemic, other types of impacts to medical care resulted, including those involving cardiac catheterization. For example, a disruption of global supply chains affected suppliers of equipment and products necessary to conduct medical procedures. One of these was a type of iodine, Visipaque/Iodixanol, commonly used in cardiac catheterization procedures to create color contrasts in areas of the heart to be operated. In May 2022, as the global medical community saw its stocks of Visipaque/Iodixanol exhausted, alternative solutions had to be employed. Many patients had near-fatal experiences with the replacement products utilized. A second impact concerned the postponement of non-life-threatening, elective cardiac surgeries as the volume of Covid cases rapidly increased. The measures were needed during the height of the pandemic as hospital bed space capacity began to fill, and medical staff were diverted to deal with soaring pandemic numbers. When Covid-19 began to abate, and elective surgeries were again authorized, medical staff found bottlenecks of patients needing attention for conditions that had negatively progressed during the unavailability of services.
Bibliography
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