Complications Experienced During Right Heart Catheterisation in a Non-Fasted Anti-Coagulated Population

Wednesday, 24 July 2013

Roslyn A. Prichard, RN, BA, Grad Dip CCU/ICU
Heart Lung Clinic, St Vincent's Hospital Sydney, Darlinghurst, Australia
Justin Anh-Kiet Phan, MBBS
University of New South Wales, Kensington, Australia
Jacqueline L. Harris, MBBS, FRACP
St Vincent's Hospital, Darlinghurst, Australia
Anne Margaret Keogh, FRACP, MD, MBBS, FRCSANZ
Department of Cardiac Failure and Transplantation, St Vincent's Hospital, Darlinghurst, Australia
Patricia Mary Davidson, RN, BA, MEd, PhD, FRCNA
Centre for Cardiovascular and Chronic Care, University of Technology Sydney, Broadway, NSW, Australia
Christopher S. Hayward, BMedSc, MBBS, MD, FRACP, FCANZ, MD
Heart Failure and Transpant Unit, St Vincent's Hospital, Sydney, Darlinghurst, Australia

Learning Objective 1: Understand the commonly experienced complications of Right Heart Catheterisation and their implications.

Learning Objective 2: Understand the importance of clinical database interrogation to monitor complication rates and ensure benchmarking of program performance.

Purpose: Describe incidence of complications during Right Heart Catheterisation in a non fasted and anti coagulated population. Examine how we report complications and the implications for program management and benchmarking our practice.

Methods: Review of 1429 RHCs between January 2008 and June 2012.  Patients were not fasted, anti coagulation therapy was not ceased and patients were not routinely admitted.

581 patients records were reviewed by medical staff, the last 848 involved interrogation of a clinical database.

Adverse events were defined as either events caused by the RHC, which required intervention to treat or prevent an adverse outcome, were medically significant, resulted in an unexpected admission, or were life threatening. (Definition A) 

Or  in addition prolonged a procedure, required abandonment of the procedure or otherwise  impacted on program resources. (Definition B) 

Chi square analysis determined the significance of  anti coagulation on bleeding complications in the first 581 patients.

Results: Between 2008 and 2009 581 procedures were performed. Adverse event rate (Def A)was 4.3%.

Chi square analysis of bleeding complications and warfarinisation on bleeds gave  p=0.11

Between 2010 and 2012 a further 848 RHCs were assessed through interrogation a clinical database and revealed an event rate of between 4.8% (Def A) and 7.2% (Def B).

We describe acute musculoskeletal, respiratory, haemodynamic and anaphylactic  events. 

Conclusion:  Being un fasted had no effect on adverse events and allowed real life haemodynamic data to be collected. Bleeding complications were minor and being anti-coagulated made no difference to the event rate in the first 581 patients. (p=0.24). Difficulty obtaining access and a knotted catheter support the need for flouroscopy and ultrasound guidance in high volume services.

Overall our adverse event rate is comparable to rates described in the literature, and supports our current practice as safe. However rigorous attention should be paid to how and why events are described as complications.