- It is used to evaluate the presence and location of coronary artery disease.
- A catheter is introduced into the arterial system retrograde to the ascending aorta under fluoroscopy.
- The right or left main coronary artery is then selectively cannulated, and a radiopaque dye is injected directly into the artery through the catheter.
- As dye flows through the artery.
- The lumen of the artery can be visualized and the image recorded on film.
- Disease in the coronary artery or one of its branches delays or obstructs the flow of dye and may be visualized on the film as a site of lumen narrowing and slow filling of the artery with dye.
- In patients who have undergone previous coronary bypass surgery,selective injections of saphenous vein bypass grafts or internal mammary arteries can be performed in a similar manner.
Role of nurse before cardiac catheterization
- Explain procedure to patient and family.
- Inform the patients about the procedures that will be performed
- Verify that the patient has taken nothing by mouth for at least 6 hours before elective cardiac catheterization except prescribedmedications as advised by the physician.
- Ensure ordered preoperative laboratory studies have been completed and results are available.
- Verify patient allergy information; ***** physician if patient is allergic to radiographic dye, medications, or specific foods.
- Ensure that informed consent has been obtained.
- Start hydration with IV fluids before the procedure and continue
afterward. (Because the dye may be nephrotoxic).
- Establish intravenous access per institutional protocol or physician order.
- Place patient on cardiac monitoring system with blood pressure and pulse oximetry monitoring.
- Provide supplement oxygen as ordered / indicated.
- Pre-medicate patient per physician order.
- Administer a mild sedative for patients before the procedure as prescribed
- Obtain vital signs before transfer to catheterization laboratory.
Health teaching before cardiac catheterization:-
- Instruct the patient not to take anything by mouth for at least 6 hours before the procedure except pre******ion medications as advised by the physician to reduce the chance of nausea and vomiting during the procedure.
- Tell the patient that an intravenous line will be placed to allow fluid and medication administration before, during, and after the procedure.
- Tell the patient that preoperative medication will be given before transport.
- Inform the patient that only a patient gown will be worn during the procedure.
- Advise the patient that the catheterization laboratory is usually cool, and the procedure table is firm and may be uncomfortable after a prolonged time.
- Tell the patient that he may be asked to turn his head, hold his breath, or cough during the procedure.
- Advise the patient that he may experience some discomfort during the procedure but that local anesthesia will be administered to minimize pain.
- Inform the patient that he will be placed on a cardiac monitor for the duration of the procedure and for a few hours after the procedure.
- Tell the patient that he will have to lie flat for several hours after the procedure to minimize the chance of bleeding from the catheter site.
- Inform the patient that he will be encouraged to take oral fluids as tolerated after the procedure to assist in elimination of the radiographic dye.
- Encourage the patient and family to ask questions.
Role of nurse during cardiac catheterization
- Assess patient vital signs, oxygenation, level of consciousness, and cardiac rhythm continuously per institutional protocol.
- ***** attending physician to significant changes in vital signs, oxygenation, and presence of malignant cardiac arrhythmias (e.g., premature ventricular contractions, ventricular tachycardia, ventricular fibrillation).
- Be prepared to initiate cardiac resuscitation with emergency equipment and medications.
Health teaching during cardiac catheterization:-
- Instruct the patient to inform the physician and team if he is experiencing chest pain.
- Remind the patient to lie still.
- Reassure the patient and allay anxiety.
- Encourage and answer the patient’s questions.
Role of nurse after cardiac catheterization
- Ensure patient vital signs are stable before transfer.
- Check catheterization site dressing for bleeding and integrity.
- Check distal pulses below catheterization site; if femoral site was used, check distal pulse, extremity color, capillary refill, and neurosensory status.
- Keep extremity straight and instruct patient not to bend leg or arm.
- Maintain intravenous infusion per physician order or institutional
- Maintain supplemental oxygenation support as ordered or indicated.
- Encourage oral fluids as ordered.
- Monitor renal function closely after the procedure for patients with low cardiac output or renal impairment ( they are especially susceptible to dye nephrotoxicity
- Check patient’s coagulation status per institutional protocol before sheath
Role of nurse when catheter is removed:
- Apply direct pressure over invasive site for 20 to 30 minutes to prevent bleeding or apply commercial hemostatic compression device per institutional protocol.
- Apply pressure over the site when percutaneous access is used, until bleeding has ceased. A pressure dressing, and in some laboratories, a sandbag, is left in place for several hours after the procedure.
- Check distal extremity for pulse, color, capillary refill, and sensorium.
- Remind patient to lie flat for 4 to 6 hours per institutional protocol.
- Place patients on bed rest for 6 hours after the procedure
- Instruct the patient not to flex the affected extremity.
- Check site dressing every 4 to 6 hours for bleeding and integrity.
- Check the access site after the procedurefrequently for signs of :-
- Hematoma formation.
- Monitor peripheral pulses in the affected extremity if a femoral arterial access site was used.
- Monitor blood pressure and heart rate closely and an awareness that retroperitoneal bleeding frequently presents as low back pain are useful in preventing a significant bleed.
- They should be instructed that they will be placed on a table with rounded sides and that their body will be strapped down so that they will not move as the table rotates from side to side.
- If they are to undergo ventriculography, they should be instructed that they may experience a temporary hot flash or flushing when dye is injected into the left ventricle.
- Post- catheterization procedures also should be explained to the patient, including bed rest and monitoring of the access site and vital signs.
- If the patient is to be discharged after the procedure and a cut down was used for access, the patient should be instructed to make a follow-up appointment with the physician for suture removal
Health teaching after cardiac catheterization:-
- Remind the patient to lie still and keep the extremity straight.
- Instruct the patient to verbalize any chest pain or shortness of breath if present.
- Tell the patient when the catheter sheath is due for removal.
- Encourage the patient to take oral fluids as ordered.
- Advise the patient that the physician will review the catheterization findings with him