What is Cardiac Catheterization?
The Cardiac Diagnostic and Interventional Unit (CDIU) unit consists of highly specialized doctors, nurses and other health professionals who diagnose and treat a variety of heart conditions. Using a specialized catheter, which is a long thin tube, and other small flexible tools, doctors can seal holes or open holes of the heart, widen narrowed passages, repair valves and obtain a sample or biopsy of the heart. Doctors can also gather information about the structure of your child’s heart and its valves; the pressure in the chambers of the heart and its blood vessels; the amount of oxygen in the chambers of the heart and its blood vessels; the amount of blood your child’s heart pumps to the body and the rhythm of the heart. The health-care team will use this as important information to create a clinical plan for your child.
Additionally, the unit has an interventional Magnetic Resonance Imaging (MRI) suite, which helps doctors view what they are doing in real time without using radiation.
Where are we located?
Who performs the procedure?
What is Interventional Cardiologist?
What is Cardiac Anesthesiologist?
What is Pre-Cath Day?
What to look for during the week before your procedure?
The evening before the procedure
The day of your child’s procedure
During the procedure
After your child’s procedure
If bleeding occurs
Other symptoms to look out for
We are located on the 4th floor (Burton Wing) at the Hospital for Sick Children, 555 University Ave. To get to the CDIU, take the Atrium Elevators to the 4th floor. Walk down the long hallway that separates 4D and 4A. At the end of the hallway you will see stars and planets painted on the wall. Turn left here. Be sure to register at the front desk. Procedures are performed in a catheterization procedure room. The procedure rooms are equipped with the latest technology, high quality imaging equipment, and all the necessary monitoring and emergency equipment.
An interventional cardiologist performs all catheterization procedures along with an interventional fellow. Together they work with a specialized team of nurses, a medical radiation technologist and technicians.
An interventional cardiologist is a doctor who is trained in paediatric interventional cardiac procedures. Interventional cardiology involves the use of X-ray imaging to perform minimally invasive procedures to treat heart conditions. The interventional fellow will meet with you in Pre-Cath Clinic before the date of your child’s procedure to explain how the procedure will be performed. The doctor will also explain the objectives of the procedure, the expected benefits and any potential risks. The staff interventional cardiologist will meet with you on the day of the procedure to answer any other questions or concerns.
Anaesthesiologists are doctors who give anaesthesia to patients. A general anaesthetic is a mix of medicines that will put your child into a deep sleep. While in this deep sleep, your child will not feel any pain. You may also hear general anaesthetic called "sleep medicine." Anaesthesiologists also provide pain relief after catheterization procedures.
Before the procedure, the anaesthesiologist will ask you to fill out a questionnaire about your child's current health, medical history, any allergies, as well as any prior experiences your child may have had with anaesthetic. The anaesthesiologist may discuss which method of sedation you prefer, as well as blood transfusions and your wishes with regard to the blood your child will receive. You may have the option of donating your own blood, or having your child set aside some of her own blood ahead of time. The anaesthesiologist will discuss the risks and benefits of these approaches.
Before the procedure, you and your child will be seen in Pre-Catheterization Clinic (Pre-Cath Clinic). Pre-Cath Clinic is often referred to as Pre-Cath Day. On Pre-Cath Day, please check in at the CDIU at 8:00 a.m. Here you will spend at least 3 to 4 hours meeting with doctors and getting tests completed.
Pre-Cath Day may also include:
- Assessments: weight, height, allergies, medications, physical assessment and vital signs.
- Pre-cath tests: chest X-ray, ECG, echocardiogram and blood tests, if needed.
- Discussing pre-cath preparations. This includes fasting instructions and arrival time.
- Discussing the procedure and answering your questions.
- Meeting with the interventional fellow to discuss the procedure.
- Providing your written consent for the procedure.
- Consultation with cardiac anesthesiologist, if necessary.
- Meeting with child life specialist.
- Consultation with interpretation services, if necessary.
If your child has a cold, cough, fever, or has been exposed to any contagious disease, please call CDIU Clinical Support Nurse between 8 a.m. and 4 p.m. at 416-813-6785.
If your child is taking any medications such as Coumadin, Heparin or Enoxaparin, please call CDIU Clinical Support Nurse between 8 a.m. and 4 p.m. at 416-813-6785. These medications may need to be stopped or changed before your child’s procedure.
On Pre-Catheterization Day, please bring a list of your child’s medications and dosages with you.
Please contact us if your child has been hospitalized outside of Canada during the past 12 months.
Attention Parents: Please bring all of your child’s medications or a printed medication and dosage list from your pharmacy to your Pre-Cath Clinic visit. If your child is taking any medications for heart rate, please call CDIU Clinical Support Nurse between 8 a.m. and 4 p.m. at 416-813-6785.
If you have any concerns or booking related questions, please call CDIU main desk 416-813-5609 between 8 a.m. and 4 p.m.
Your child should eat a good dinner and, if needed, a healthy bedtime snack. Give your child a bath before bedtime, and follow any other pre-cath instructions you received from the nurse.
Infant (under 1 year)
- No formula, milk, food for 6 hours before the procedure.
- No breast milk 4 hours before the procedure.
- Clear fluids until 4 hours before the procedure. These include: water, glucose water, and clear apple juice (no sediment).
Children (over 1 year)
- No food or milk after midnight.
- Clear fluids until 4 hours before the procedure. These include: water, apple juice, and ginger ale. Nothing by mouth after this time.
The following items are strictly prohibited:
- Chewing Gum
It is very important to follow these instructions so medicine can be given safely and effectively. Your child’s stomach must be empty for the sedation or anesthesia to work properly. The procedure will be canceled or delayed if fasting instructions are not followed.
Arrive on 4D or CDIU for registration. The nurse will take your child’s vital signs, temperature, heart rate, and blood pressure. The nurse will also help your child change into a hospital gown. Once the lab room is ready, you and your child will be taken to one of the preparation rooms. There you will meet with the CDIU nurse, interventional cardiologist and anesthetist performing your child’s procedure.
You will be asked to wait in the CDIU waiting room or return to your child’s room on 4D. Please provide CDIU or 4D main desk with contact information (i.e. cell phone). Waiting can be difficult, but we suggest that parents remain in the hospital while their child is undergoing the procedure.
During the procedure, sedation medicine and general anesthesia is administered to keep your child calm, comfortable, and properly positioned during the procedure. The anesthesia team closely monitors patients receiving general anesthesia.
The procedure takes between 2 to 4 hours. If the procedure takes longer than 4 hours, a CDIU nurse will update you.
The interventionist doctor will talk to you once the procedure is finished. He/she will discuss with you the results of the catheterization as well as any interventions performed during the procedure.
Your child will be transferred to the Post Anesthetic Care Unit (PACU). The PACU nurses will notify 4D or CDIU main desk once your child is settled. At this time, two visitors will be permitted. PACU nurses will provide all discharge instructions for activities, diet, bathing, and patient dressing.
If your child had an Atrial Septal Defect (ASD) closed in the CDIU, they will be discharged the same day from CDIU. You and your child will need to return to the hospital the next day for a follow-up Echocardiogram (ECHO) to ensure your child is recovering from the ASD being closed. The appointment time will be given to you prior to discharge.
Once your child is stable, they will be discharged home or transferred to 4D.
If you notice bleeding at the puncture site, apply pressure on the site using two fingers for at least 10 minutes. If there is a lot blood, or the bleeding persists, call 911 or go to the nearest Emergency Department.
Call 911 or go to the nearest Emergency Department if you notice any of the following symptoms in your child:
- Difficult to wake up or loss of consciousness
- Pale complexion
- Overly tired and weak
- Persistent vomiting (throwing up)
- Bleeding or redness at the puncture site