CARDIAC CATHETERIZATION – Definition, Purpose, Equipment, Precatheterization Care, During Procedure and Post-catheterization Care (Nursing Procedure)
DEFINITION
Invasive diagnostic procedure in which one or more catheters are introduced into heart and selected blood vessels to measure pressures in various heart chambers and to determine oxygen saturation in the body
PURPOSE
- To determine appropriate treatment, e.g. PCA/CABG, if atherosclerosis is present
- To assess patency of coronary arteries
- To measure pressures in various chambers of heart
- To obtain blood samples for measurement of hemocrit and oxygen saturation
- To obtain clear picture of cardiac anatomy prior to heart surgery
- To confirm diagnosis of heart disease and determine extent to which disease has affected structure and function of heart
- To obtain clear picture of cardiac anatomy prior to heat surgery
- To allow infusion of fibrinolytic agent directly into occluded coronary artery to restore coronary blood flow
- To obtain endocardial biopsies
Right heart catheterization: passing radio-opaque catheter from antecubital or femoral vein into right atrium, right ventricle and pulmonary vasculature
Left heart catheterization: insertion of catheter into right brachial artery or femoral artery, ascending aorta and into left ventricle. It can also be performed transeptally from right atrium, left atrium, and into left ventricle
EQUIPMENT
Cardiac monitor, pressure monitoring device, fluoroscope, sterile radio-opaque cardiac catheters, radio-opaque dye, sterile liner for draping, cleaning solutions, sterile gloves, cardiac catheterization pack, cut down set scalpel blade and emergency equipment
PRECATHETERIZATION CARE
- Explain procedure, purpose and risks involved
- Get consent from patient and relative
- Explain that this procedure will be performed in cardiac catheterization laboratory
- Ask for history of allergies particularly to iodine containing substance or shellfish
- Shave following areas:
Wrists, arms and axillae
Bilateral groin
Pubic area
- Make sure blood is collected and sent for HBsAg, HIV, etc. as ordered
- Instruct patient to withhold food and fluids for 8-12 hours prior to procedure
- Start IV line with heparin lock
- Remove jewelry, dentures/contact lens if any
- Make sure of blood investigation results are ready, e.g. HIV, HBsAg
- Assess baseline observations such as vital signs and neurovascular observations to both feet
- Administer morning dose of routine medications with sips of water
- Ask patient to empty bladder
- Administer premedications
- Send patient to catheterization laboratory with 5% dextrose 1 bottle, IV set 1, disposable 3 way 4, disposable 10 cc syringes 4, injection heparin 1 vial
DURING PROCEDURE
- Monitor vital signs
- Monitor for ventricular arrhythmias
- Watch for signs for allergic reaction to contrast dye
- Instruct patient to inform physician, nurse if chest pain develops
- Keep emergency equipment ready
- Provide reassurance throughout procedure
POST-CATHETERIZATION CARE
- Transfer patient from stretcher to bed gently
- Assess vital signs every 30 minutes for 2 hours initially and then hurly till stable
- Instruct patient about strict bed rest for 12-24 hours
- Advise to keep affected extremity straight to prevent bleeding
- Check dressing over puncture site for bleeding or signs of hematoma
- Assess neurovascular observations which include peripheral pulse, color warming, and sensation in affected extremity and compare with unaffected extremity
- Monitor cardiac rhythm for arrhythmias
- Encourage fluid intake for adequate fluid replacement and renal elimination of contrast
- Provide urinal bedpan whenever needed
- Observe for nausea, vomiting and other signs of hypersensitivity to contrast
- Encourage normal diet after 3 to 4 hours, if no vomiting
- Remove pressure bandage after 24 hours and watch for hematoma formation and pseduoaneurysms
- Maintain strict intake and output chart
- Instruct to restrict activities for 2 days after discharge
