SELECTIVE CARDIOGRAPHY – Definition, Purpose, Client Preparation, Special Equipment Needed, Procedure and After Care (NURSING PROCEDURE)
DEFINITION
- Selective cardiography implies injection of contrast medium through a catheter directly into one of the heart chambers, coronary arteries or great vessels in order to obtain the contours of the heart chambers (angiocardiography), coronary arteries (coronary angiography) or aorta (aortography)
- An angiogram is recorded by means of rapid film changer (cineangiogram) or motion picture camera. Selective angiocardiography requires either right-sided or left-sided cardiac catheterization
PURPOSE
- To find out the occlusion in the coronary arteries
- To assess potency of coronary arteries
- To obtain clear picture of cardiac anatomy prior to heart surgery
CLIENT PREPARATION
- Prepare the client psychologically for cardiac catheterization
- Instruct the client that he will be conscious during the procedure and he will experience no pain but some sensation, when the catheter enters the heart
- Explain the entire procedure including its risks and get a written consent for the procedure
- Make sure the client has not suffered from any of allergy, the sensitivity test for iodine should be carried out before angiography is done
- Instruct the client fast 6-8 hours before the procedure
- Antibiotics are administered to the client just prior the procedure and for a few days after to prevent possibility of infection
- Administer premeditations as ordered in order to relax the client
- Keep the IV line patent
- Mark the site of peripheral pulse with skin pencil; this will help locate the pulse during the procedure
- Prepare the site (usually femoral site) as for a surgical procedure
- Follow strict aseptic technique throughout the procedure
- Keep ready all emergency equipment and drugs for the immediate resuscitation of the client
SPECIAL EQUIPMENT NEEDED
- Defibrillator
- Cardiac monitoring
- External pacemaker
- Mechanical ventilator
- Articles for endotracheal intubation
- Intravenous fluids and administration set
- Cardiac drugs, antiallergic drugs and anticoagulants
PROCEDURE
- Explain the procedure to the client
- Place the client in comfortable position in the treatment table
- A radiopaque catheter is passed into the arch of the aorta through the femoral artery and is directed to the base of the coronary arteries under fluoroscopic control
- Small amount of dye is injected repeatedly in each coronary artery till these are clearly outlined as seen on a closed circuit TV screen
- The whole study is recorded on a film and reveals complete picture of the coronary arteries
AFTER CARE
- On completion of the procedure, when the catheter is removed, a sterile sponge is placed on the site and firm pressure is applied for 10-15 minutes to prevent bleeding from the puncture site and formation of hematoma
- Continue cardiac monitoring till the vital signs have stabilized
- Instruct the client to take complete bed rest for 12-24 hours
- Watch for the skin color, temperature and peripheral pulses to detect early signs of complication
- Keep the effected extremity straight to prevent clot formation in the vessel. The extremity may be immobilized on an arm board
- The puncture site is checked for bleeding, swelling or hematoma formation
- Watch for allergic reactions to the dye injected. These may include flushing, nausea, vomiting, numbness, tingling, diaphoresis, urticaria, fall in blood pressure, etc
