Antibiotics and Anticoagulation

Hand washing

The most important procedure to prevent infection. For a minimum of 2–3 min, thoroughly scrub the hands and distal arms using an antiseptic agent. In some units it is acceptable to use volatile antiseptic solution in subsequent cases after an initial thorough wash to prevent skin irritation and dermal abrasion

Body protection

Each laboratory should have a specific policy on caps, masks and gowns and gloves. As a minimum, sterile gowns and gloves should always be worn by operators in contact with the patient and the scrub trolley

Table 3.2

Environmental catheterization of the laboratory

Clothes prevention	Appropriate laboratory-specific clothes and shoes are necessary
Cleaning of the room	The laboratory must be cleaned in accordance with the institutional requirements. In particular policies should be in place for blood spillage; notifiable infections, e.g. MRSA; and other potentially infectious situations, e.g. a patient with an active viral illness such as HIV or hepatitis B where specific cleaning of the laboratory may be required
Air vents	Well-serviced and efficient ventilation is a mandatory requirement. Local regulations should be in place

Table 3.3

Recommendation for patient preparation

Hair removal	Remove hair at the access site using clipper or depilatory on the day of the procedure or the day before
Skin cleaning	A 2 % chlorhexidine with alcohol is the most effective antiseptic agent but can be substituted with povidone-iodine. Take care in neonates and premature infants because of increased risk of skin irritation or even skin burns and absorption (b)
Drapes	As in an operating theatre, nonporous drapes are necessary to cover the working area. Drapes should be large enough and should contain an appropriately sized adhesive part attached to the skin to be attached around the area involved in the intervention

3.2 Antibiotic Prophylaxis

Prophylactic intravenous antibiotic should be routinely administered to high-risk patients (Tables 3.4 and 3.5) undergoing cardiac catheterization. The practical issues related to prophylaxis are the following:

Table 3.4

Pathology with higher risk of IE

Prosthetic cardiac valve

Prosthetic material used for cardiac valve repair

Previous infective endocarditis

Congenital heart disease

Unrepaired cyanotic CHD including palliative shunt and conduits

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