Coil Occlusion For Patent Ductus Arteriosus Closure In Children

WHAT YOU SHOULD KNOW:

• Patent Ductus Arteriosus (r-teer-e-O-sus) coil occlusion (o-CLUE-shun) is also called "PDA coil occlusion" or "PDA closure". It is done to close your child's PDA. PDA is a channel or path that connects 2 large arteries that come out of the top of the heart. Unborn babies need this channel. After a baby is born, the PDA should naturally close. After birth, your child does not need a PDA. A PDA causes your baby's heart and lungs to work harder than they should. This is because blood that should be pumped out to the body leaks back into the lungs and heart. In time, this "circling" of blood may cause congestive (kun-JES-tiv) heart failure (heart wears out) and lung damage.
  
  
• PDA coil closure is done during a heart catheterization (kath-uh-ter-ih-ZA-shun) or "heart cath". A heart cath is a procedure in which catheters (long, thin, bendable tubes) are gently threaded (guided) into your child's heart. Your child's caregivers push 1 or more tiny metal coils through a catheter and plug them into the PDA. If the PDA coil closes your child's PDA, he may not need surgery. Your child may go home the same day or may stay in the hospital after the PDA is closed.

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

RISKS:

• There are risks in putting catheters in the blood vessels. This could cause bleeding, a bruise, and soreness around the place where a catheter went in. Your child could bleed and need a blood transfusion (trans-FEW-shun) or surgery to repair the hole. Your child could get air bubbles or a blood clot from the heart cath or device. Air bubbles could give your child a stroke. Blood clots may go to your child's lungs or brain and cause a stroke. The clots may go to your child's arm or leg and stop the blood flow. Fluid could build up in your child's lungs and cause trouble breathing.
  
  
• Your child could get a collapsed lung or an infection. Your child could have an allergic (uh-LER-jik) reaction or kidney problems from the dye used during the procedure. A blood clot may form on the coil that was used to close the PDA. The coil could move out of place. Then your child may need surgery to remove the coil and repair the PDA. Caregivers will watch your child closely for these problems.
  
  
• If your child does not have his PDA closed, your child's health condition could get worse. Your child's heart could fail (wear out), his lungs could be damaged, and your child could die. Call your child's caregiver if you are worried or have questions about your child's PDA, medicine, or care.

WHILE YOU ARE HERE:

• Informed Consent:
  
  
  • You have the right to understand your child's health problem. You should understand what tests, treatments, or procedures may be done to treat your child's problem. Your child's caregiver should also tell you about the risks and benefits of each treatment.
    
    
  • You may be asked to sign a consent form. If you are unable to give your consent, someone who has permission can sign this form for your child. A consent form is a legal paper that gives a caregiver permission to do certain tests, treatments, or procedures. This form should tell you exactly what will be done to your child. Your child's caregiver should explain what the risks and benefits of each treatment are before you sign the form. Before giving your consent, make sure all your questions have been answered. This way you will understand what may happen to your child.
  
  
• Blood Tests: Your child may need blood taken for tests. The blood may be taken from your child's arm, hand, finger, foot, heel, or IV. It is tested to see how your child's body is doing before the PDA closure. Your child may need to have blood drawn more than once.
  
  
• Call Button: A call button may be in your child's hospital room. You or your child should use the call button if your child is having problems and a caregiver is needed. You can also use the call button if you or your child have questions for a caregiver. Be sure to keep the call button near you or your child at all times.
  
  
• Chest X-ray: This is a picture of your child's lungs and heart. Caregivers use it to see how your child's lungs and heart are handling his heart problem.
  
  
• Gown: A hospital gown is needed so caregivers can easily check and treat your child. Your child's gown should be put on so it opens in the back. Your child may be able to wear regular pajamas or clothes after the PDA closure.
  
  
• Heart Monitor: This is a machine used to see how your child's heart is doing before, during, and after the PDA closure. 3 or 5 sticky pads are placed on your child's chest. Each pad has a wire that is hooked to a TV-type screen or to a small portable box. This screen or box shows a picture of your child's heartbeat. Caregivers watch this picture to make sure your child's heart is doing well.
  
  
• IV: An IV is a tiny tube placed in your child's vein (blood vessel). Your child's IV may be hooked to a machine that will give your child liquids and medicine. The IV may be put in your child's hand, arm, ankle, or foot. Before putting in the IV, caregivers may put a special numbing cream on your child's skin. This is so your child will feel little or no pain when the IV is put in.
  
  
• Pulse Check: Caregivers will check your child's pulses (heartbeat) in his feet and ankles. The pulse is the feeling under the skin when the heart pushes blood through the arteries (blood vessels). Your child's caregiver may put an "X" over the spots on your child's feet where the pulse is strongest.
  
  
• Pulse Oximeter (oks-IH-mih-ter): This is a machine that tells caregivers how much oxygen is in your child's blood. It will tell caregivers how well your child is doing during the PDA closure. A cord with a clip or sticky strip is placed on your child's foot, toe, hand, finger, or earlobe.
  
  
• Vital Signs: This may include taking your child's temperature, pulse (heartbeats), respirations (breaths), and blood pressure. Your child's temperature may be taken in the mouth, ear, armpit, or rectum (rear-end). Caregivers may also listen to your child's heart and lungs by using a stethoscope (STETH-o-skop).
  
  
• Transport to the Heart Cath Lab: Your child will be taken on a stretcher or crib to the room where the PDA closure will be done. Your child's caregivers will help your child get comfortable on the bed. A belt may be put over your child's legs for safety. Your child's arms may be tucked at his sides to give caregivers more room to work during the PDA closure.
  
  
• PreOp Care: This is care your child gets right before surgery. Your child will lie on a hard, movable x-ray bed. There will be large x-ray machines and other equipment in the room. Caregivers will clean the groin or other skin areas with soap. This soap may make your child's skin yellow, but it will be cleaned off later. Sterile (no germs) sheets will be put over your child to keep the area clean. Your child will have tubes put in him and equipment attached him.
  
  
• Medicines: Your child may get one or more of these medicines before, during, or after the PDA closure.
  
  
  • Antibiotics (an-ti-bi-AH-tiks): This may be given to help your child fight an infection caused by a germ called bacteria (bak-TEER-e-uh).
    
    
  • Antihistamines (anti-HISS-ti-means): This medicine may be given to help decrease itching. This medicine may protect your child from a reaction to the dye.
    
    
  • Anti-Nausea Medicine: This medicine may be given to calm your child's stomach and control vomiting (throwing up). Your child may have an upset stomach after the PDA closure.
    
    
  • Blood Thinner Medicine: This medicine may be given to prevent clots from forming during the heart cath and PDA closure.
  
  
• Anesthesia (an-iss-THEE-zuh): This is medicine that makes your child comfortable during surgery. Caregivers may work with you to decide which anesthesia is best for your child. After taking this medicine, your child may feel drowsy, dizzy, or have unclear thinking. Your child may sleep for a few hours after the PDA closure because of the anesthesia. Your child may get one or more types of anesthesia:
  
  
  • General Anesthesia: This is medicine that puts your child to sleep and makes him comfortable during surgery. It may be given as a liquid or in an IV. It may be given as a gas through a facemask. This medicine may also go through a tube placed in your child's mouth and throat. This tube is called an endotracheal (end-o-TRA-kee-ull) tube or "ET tube".
    
    
  • Local Anesthesia: Caregivers may put a special numbing cream on the places where the catheters will go in. They may give a shot of numbing medicine into the skin where your child will have catheters put in.
    
    
  • Monitored Anesthesia: Your child will be given medicine through an IV. This medicine keeps your child comfortable, relaxed, and lightly sleeping during the procedure.

During Your Child's PDA Closure:

• Your child will change into a hospital gown. Your child will get medicine to make him relaxed and drowsy. He will be taken on a stretcher to the room where the PDA closure will be done. Your child will get an IV and may get more medicine to make him go to sleep. Once your child is asleep, catheters will be put into the blood vessels in your child's groin, neck, or arm. The catheters are gently threaded (pushed) through the blood vessels and heart.
  
  
• Caregivers will repair your child's PDA. Your child's caregivers may use dye and x-rays during the procedure. Caregivers may use these before and after the PDA closure to look at your child's PDA. During the procedure, caregivers will use 1 or more tiny coils to plug your child's PDA closed. The catheters will be removed after the PDA is closed. Caregivers will put pressure on the area where the catheters came out. This is to stop the bleeding. A pressure bag or bandage may be put in place for 2 or more hours. Your child may have stitches to stop the bleeding. It is very important for your child to lie flat and to keep the leg or place that had the catheter very still. This is to prevent bleeding.

After Your Child's PDA Closure:

• Aftercare: Your child will be taken to a recovery area. Then, your child may be taken to a hospital unit or room, or he may go home.Caregivers will watch your child closely for any problems. Caregivers will check your child's vital signs (pulse, blood pressure, and breathing) every 15 minutes for 1 to 2 hours. The pulses in your child's feet or wrists will also be checked often. Your child's toes and fingers will be checked to see if they are warm. Tell your child's caregiver if your child has any of the following:
  
  
  • Chest pain or discomfort.
    
    
  • Change in color or temperature of your child's arm or leg.
    
    
  • Swelling or bleeding from the area where the catheter was.
    
    
  • Pain, numbness, or tingling in your child's arm or leg.
    
    
  • Pain in your child's back, thigh, or groin.
    
    
  • Nausea (your child feels sick to his stomach).
    
    
  • Sweating a lot.
  
  
• Activity:
  
  
  • Your child will need to lie flat and still in bed for 4 or more hours after the procedure. Lying flat and still is very important. This helps to prevent bleeding. Your child's caregiver will tell you when it is OK for your child to get out of bed. Help your child to play quietly in bed until the morning after the PDA closure.
    
    
  • Bring favorite books, electronic games, or videotapes that your child enjoys. If your child is very young, bring a favorite toy or blanket. These may help your child to lie still when he is fully awake after the PDA closure.
    
    
  • Do not raise the head or foot of your child's bed without asking a caregiver. Do not remove your child's pressure bag or bandage. Tell your child's caregiver if your child is uncomfortable or tired of lying on his back. Caregivers may have ways to make your child more comfortable.
    
    
  • Ask a caregiver to help the first time your child gets out of bed. Your child may feel weak, dizzy, or sleepy. Help your child each time he gets out of bed to prevent him from falling or hurting himself.
  
  
• Bathroom: Your child may use a bedpan or urinal during the time that he must lie flat. After your child's caregiver says it is OK to get out of bed, you may help your child walk to the bathroom.
  
  
• Eating and Drinking: Ask a caregiver before giving your child anything to eat or drink after the PDA closure. Your child may be on a clear liquid diet. Your child may have drinks like water, apple juice, soup broth, or clear soda pop. If he does not feel sick to his stomach, your child may be able to eat "finger foods". These are foods that can be eaten while your child is lying flat in bed. Help your child to drink as much water as he can after the PDA closure. This will help to flush out the dye from your child's body. It will also help keep your child hydrated (keep good body fluid levels).
  
  
• Tests: Your child's caregivers may order tests to see how your child is doing after the PDA closure. They may order blood tests. They may order a chest x-ray and echocardiogram (eh-ko-KAR-d-o-gram) before your child goes home. This is to make sure the PDA coil is still in the right place after the PDA closure.

Copyright © 2012. Thomson Reuters. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.