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 Cardiac Catheterization

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عدد المساهمات : 17
نقاط : 25
تاريخ التسجيل : 25/11/2011

Cardiac Catheterization Empty
مُساهمةموضوع: Cardiac Catheterization   Cardiac Catheterization Emptyالسبت ديسمبر 17, 2011 12:56 pm

Coronary Angiography

Purpose:-

- It is used to evaluate the presence and location of coronary artery disease.

Procedure:-

- 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.

Nursing Care

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
protocol.

- 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
removal.




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 :-

- Bleeding,
- Swelling,
- 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
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Cardiac Catheterization
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