Cardiac catheterisation

Cardiac catheterisation is an investigative procedure that provides detailed information about the heart and its blood vessels, including:

• structure of the heart and vessels
• pressures in the chambers and blood vessels
• the amount of oxygen in the chambers and blood vessels
• the amount of blood pumped in the body
• the rhythm of the heart.

It involves a thin, flexible tube (the catheter) being inserted into a blood vessel, usually in the groin and fed up into the heart.

Why does my child need a cardiac catheter?

Cardiac catheterisation is used to help diagnose heart conditions, help plan future treatments and carry out certain procedures.

Some cardiac conditions can be corrected by cardiac catheterisation.

For example:

• Atrial septal defect (ASD) can be closed with a device.
• Patent ductus arteriosus (PDAs) can be closed with a device.
• ‘Balloon dilatation, whereby narrow valves and blood vessels can be stretched to improve blood flow.

Preparing for the procedure

When a cardiac catheter has been medically recommended, we will arrange an appointment with an interventional cardiologist at the Catheter Review Clinic and an appointment with Nursing Pre-admission.

Your child’s catheter procedure date will depend on a few different considerations including:

• how urgently they need a cardiac catheter
• the type of catheter they need
• the specialist skills needed by their doctor to perform the procedure.

Admission planning

The catheter coordinator will be in touch to help you plan your child’s hospital admission. They will talk you through arranging appointments, suggest services that may help you family prepare for your child’s procedure, and discuss your child’s condition and medical requirements. Your child’s care team will then complete a care plan and begin coordinating other health teams in the lead up to the procedure where necessary.

If there’s anything you’re still unsure about regarding the admission process, don’t worry. We will send you information about the hospital admission process either by post or by email. This will give you a better understanding of the catheter admission process and help you prepare.

Oral health clearance

Your child may require oral health clearance before their procedure. Children with congenital heart disease are prone to dental disease (such as tooth decay and gum disease), which puts them at risk of bacteria in the mouth entering the bloodstream, travelling to the heart and causing an infection (Infective Endocarditis). It’s best to book a dentist appointment for your child as soon as possible. This will allow enough time for any dental work without having to push the procedure date back.

Your dentist can supply a letter clearly stating that your child is orally fit for their procedure if they’ve seen them in the past 6 months. Please follow your cardiologist’s medical advice about giving your child prophylactic antibiotics before their dental treatment. If you are NOT sure of your child’s needs, please call your GP or the Cardiology Outpatient Department.

Rescheduling and short notice availability

Having a booked procedure cancelled is inconvenient and stressful. We do our best to keep scheduled appointments set to their original date, but cancellations can happen for several reasons including:

• emergency cases
• bed shortages
• technical problems
• more required tests
• illness.

Queensland Children’s Hospital is a tertiary paediatric cardiac centre. This means that we service the entirety of Queensland and northern New South Wales. Urgency plays a big role in scheduling catheter procedures and sometimes this means emergency cases are seen first, resulting in other scheduled procedures being pushed back.

If your booking is affected, we will let you know as soon as possible and reschedule it in a timely manner.

If you live within the greater Brisbane area, we can place you on the ‘short notice availability list’, whereby your child’s procedure process could be a 24-48 hour turnaround. If you feel as though this could work for your family, please let us know.

If your child becomes unwell with cold or flu symptoms, an infection, febrile illness, or a rash in the month before their catheter or pre-admission appointment, please notify the catheter coordinator on 07 3068 1765 or the cardiac bookings office on 07 3068 4306 (during business hours).

Catheter Review Clinic

Most children will have an appointment with a catheter cardiologist at the Catheter Review Clinic prior to their procedure. This appointment will include:

• a medical assessment
• a procedure consent
• an opportunity to ask questions before the procedure.

Your child may also need a cardiac echo and an ECG.

Pre-admission clinic with catheter coordinator

After the catheter review, you will need a pre-admission appointment with the catheter coordinator who will explain various aspects of the catheter process including:

• preparation and fasting before the procedure
• hygiene preparation before admission
• admission times and process
• post procedure management
• discharge care.

This appointment can be organised for the day of, or just prior to your child’s procedure.

If you and your child have travelled to attend your pre-admission appointment you will need to have organised accommodation or stay with friends or family.

Important: Cardiac procedures can only be carried out when your child is at their healthiest. It’s not safe for them to have anaesthesia or surgery if they are sick. If your child has a cold or other infection in the weeks before their procedure, please tell their cardiac coordinator. The procedure may have to be rescheduled until your child is well.

What to bring to Review/Pre-admission clinic

Essentials include:

• your child’s current medication and dosage information
• any recent test results not performed at the Queensland Children’s Hospital
• recent letters from medical professionals your child sees outside of the Queensland Children’s Hospital
• letter of oral health clearance from your child’s dentist (if required)
• relevant X-ray films (if specifically requested).

We recommend 2 adults attend the catheter review and the pre-admission appointment with your child. This helps to share the load of information provided and can make it easier to supervise all children present (i.e. patient and siblings).

Hygiene is very important in the catheter process. Remember:

• Have a shower or bath the night before and the day of the procedure.
• Use soap generously and pay attention to the neck folds, groin, umbilicus, groin, perianal and anal region.
• Wipe dry with a clean towel once freshly washed.
• After the second shower or bath in the morning, put on fresh clothes. Loose-fitting, comfortable or sleepwear is the best. Underwear like boxer shorts is permitted.
• Do not wear clothing with metal clips, zippers, studs or buttons.
• Do not wear bras, sports bras, or singlets.
• Do not apply creams, oils, deodorant, perfumes, talc or makeup after bathing.
• Remove all jewellery and piercings.
• Remove nail polish from fingers and toenails.

Important: Cardiac procedures can only be carried out when your child is at their healthiest. It’s not safe for them to have anaesthesia or surgery if they are sick. Similarly, do not bring your child to the cardiac specialty clinic if they are unwell. If your child has a cold or other infection in the weeks before their procedure, or if you have any concerns or questions, please contact your catheter coordinator on 07 3068 1765 or the Cardiac Specialist Clinic reception on 07 3068 2790.

Before the procedure

If your child becomes unwell the night before their appointment date (after hours) please notify us by calling the hospital switchboard on 07 3068 1111 (24/7). Ask for the patient flow manager and explain your situation, including your admission booking for a cardiac catheter in the morning.

Transferring from another health facility

If your child is in a regional facility with a heart condition, they may need to be transferred to the Queensland Children’s Hospital to have a cardiac catheter procedure and other necessary tests. Depending on the level of care they need before their procedure, they will either be admitted to the Cardiac ward (10b) or Paediatric Intensive Care Unit (PICU). A catheter coordinator will answer any questions you may have to the best of their knowledge.

Travel and accommodation

Families from rural and remote areas who live more than 50km from the referring hospital are eligible for travel and accommodation assistance under the Patient Travel Subsidy Scheme (PTSS). When you have been notified of your dates for appointments and procedure you can start arranging your travel and accommodation through the travel department of your local hospital. Your local travel department will require an appointment letter from the Queensland Children’s Hospital Cardiac Service to begin the travel process. Your child’s cardiac care coordinator can you help with this.

Please contact the QCH Welfare Workers on 3068 2940 if you require further assistance.

What to bring

Here’s what to bring to hospital when undergoing a catheter procedure.

Babies

• Clothes that zip or button in the front so that the wound can be easily accessed after the procedure.
• ‘Onesie’ suits/rompers with fold back feet and clips. This makes placing monitoring equipment and checking wounds more convenient.
• Socks.
• Dummies.
• Bottles and teats if your baby has a preference.
• Clean comforters. Comforters from home must be washed.

Nappies and wipes will be provided, so there’s no need to bring your own.

Teenagers

• Comfortable tops and bottoms. Short sleeved, button up tops are often preferred as they are the most comfortable when negotiating peripheral IV cannulas, monitoring equipment and wound site checks.
• Dressing gown or loose long sleeve jacket as it can be cool on the ward.
• Underwear and socks.
• Toiletries – toothbrush, toothpaste, shampoo, soap, hairbrush.
• Slippers/slip on shoes.
• Comfort toys, pillows, blankets may be brought in but must be washed prior to coming in.
• Entertainment activities.

Parents

We recommend you bring something warm to wear on the ward as it can get cold. You may also wish to bring your own pillow.

You can buy meal vouchers for $7.50/meal from the food court on level 2.

Breastfeeding mothers

It can be confusing and stressful to pack and prepare for a breastfeeding baby who is coming for a procedure. For information about what to expect, speak with your attending nurse. They can advise you and also direct you to an appropriate health professional (e.g., lactation consultants, dieticians etc.)

The procedure

Cardiac catheterisation is performed under a general anaesthetic. A doctor will insert the catheter (a long, thin, flexible tube) into a blood vessel, usually in your child’s groin (top of the leg) or sometimes the neck. Using X-ray imagery as a guide, the tip of the catheter is passed up to and into the heart and adjoining blood vessels.

During the procedure, doctors can measure internal pressures, take blood samples taken, and inject X-ray dye to show the pattern of blood flow.

At the end of the procedure the catheter is removed. Thin adhesive strips called steristrips and a clear dressing are then applied to close and support the wound.

What to expect

On the day of your child’s procedure, you will go through the following steps.

• Go to the surgical admissions lounge (4b) on level 4 (blue level) of the hospital. Bring your appointment letters/emails with you to assist in the admission process.
• Go to the glass windows and let the surgical admissions staff know you have arrived.
• Complete your child’s admission forms if you haven’t already completed them at the pre-admission.
• Complete an assessment with a surgical admissions staff member. They will ask a range of questions related to your child’s habits, behaviour, and lifestyle, as well as specific questions about their current health status and illness journey. You are welcome to stay by your child’s side while they check heart rate, blood pressure, temperature etc.
• Your anaesthetist will come and speak to you about their role, the induction process and may also prescribe your child some medication before their procedure.
• It’s a good idea to bring a few things to keep yourself and your child occupied as there may be a wait before the procedure. Our Children’s Hospital Foundation volunteers and other charity partners also drop in regularly to keep children entertained while they are waiting.
• When it’s time for your procedure, your child will be escorted into the catheter lab. You’ll be given with a gown and hat to wear if you choose to accompany them into the lab.
• Once your child is asleep you’ll be escorted back to the admission lounge. The catheter procedure can take a couple of hours to complete, so you’re welcome to wait in one of the parent lounges. However, it’s best not to leave the hospital because your child’s doctor may need to speak with during the procedure. Please keep your mobile phone on so that you don’t miss the doctor’s call at the end of the procedure.

After the procedure

After your child’s catheter, they will be cared for by different teams of specialist doctors and nurses. The Paediatric Acute Care Unit (PACU) team will monitor and manage things like breathing, pain, alertness and the condition of the wound straight after their procedure. One your child is fully awake, they will be transferred to either the Cardiac Ward (10B) or the Day Unit (4C).

When your child is transferred onto the ward or into the Day Unit, nursing staff will check the catheter site regularly during the first few hours to perform and record their observations. Your child will need to remain lying flat (at best) in bed and be as settled as possible for 4-6 hours. This helps manage major bruising, swelling and bleeding at the catheter insertion site.

Your child will also have intravenous access inserted in their hand or arm for fluid and medication. This will be removed before they are discharged from hospital. They’ll typically be discharged the same day as their procedure or the day after, but not until it’s medically safe. Before you can take your child home they must:

• be awake, alert and mobile
• have passed urine
• tolerate food and fluids
• have stable observations.

The catheter insertion site must also be intact and not bleeding.

Some children may need to have their medication dosages adjusted or start taking new medication after a cardiac catheter. If your child needs to start taking a new medication, a pharmacist will speak to you before you’re discharged.

You may need to complete some tests (e.g., chest x-ray, echocardiogram, ECG) and complete the recommended medication plan. Once the cardiac doctor is satisfied with the medical review, you will be discharged from hospital.

Care at home

It’s important to feel comfortable caring for your child at home. We will provide you with information to help you feel ready, including:

• Care after discharge resources, CPR information, contact phone numbers and any relevant medication information sheets
• follow up appointment timeframes.

The catheter coordinator will contact you within a week of your child’s catheter procedure to check on:

• the wound, its dressing and state of the site (e.g., bruising)
• your child’s general wellness and activity levels
• cardiology follow-up review appointment dates
• post-op orders.

Families from regional areas

You may need to return to the Queensland Children’s Hospital in Brisbane for your follow-up appointment, however we will always try to time your follow-up appointments so that they match up with your cardiologist’s scheduled visit to your local area.

Key points

• Cardiac catheterisation is used to help diagnose heart conditions, help plan future treatments and carry out certain procedures.
• Cardiac catheterisation is performed under a general anaesthetic.
• Cardiac procedures can only be carried out when your child is at their healthiest. It’s not safe for them to have anaesthesia or surgery if they are sick.
• A catheter coordinator will answer any questions you may have to the best of their knowledge.

For more information

• Aboriginal and Torres Strait Islander support
• Interpreter services
• Congenital heart disease (CHD) and dental health

Developed by Queensland Paediatric Cardiac Service, Queensland Children's Hospital. We acknowledge the input of consumers and carers.

Resource ID: FS077. Reviewed: June 2024.

Disclaimer: This information has been produced by healthcare professionals as a guideline only and is intended to support, not replace, discussion with your child’s doctor or healthcare professionals. Information is updated regularly, so please check you are referring to the most recent version. Seek medical advice, as appropriate, for concerns regarding your child’s health.